HomeMy WebLinkAbout2007-P10684 - re-side PERMIT �
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p10684
Crystai'Bay, Minnesota 55323 Permit Type: M;nor Alterarions
�J52)249-4600 Date Issued:
3/16/2007
SITE ADDRESS: 1310 Spruce Pl Unit#
Mound,MN 55364
PI D: 08-117-23-32-0017
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Pernvt Class: Building
Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Side
DETAILS: ,
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Reside,Replace Few Windows&Doors
FEE SUMMARY: Permit Fee: $ 139.25 va�uation: $ 7,000.00
State Surcharge Fee: $ 3.50
Misc.Fee: $ 139.25
TOTAL FEE: $ 282,00
APPLICANT: Owner/Self OWNER: Jeffrey&Ethel Gustafson
MN 6020 Loring Drive
Minnetrista,MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLI 'P RMI E SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
01108l2007 16:48 FA� C�001/002
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Total Fee: S oZ • � Date Received; �-/� -�,7
Entered By: Permit#; /p���
CITY OF ORONO � SYJ'YLDYNG PERMIT APPLYCATION
All information must be submitted in full before plan review will be started.
(Plea�e print all dnformatiun)
THE APPL�CA�iT�S: (circ[e one OWNER OR CONTRACTOR
JOB SITE ADDRESSc �� � � SP Q��� ZIP: S 3�
Wilt this be a Parade of Y�omes, Ytemodelers Showcase �ome or other Display Home?
❑ Yes �NO !f yes, a special evenl permit is required with Police Departmeni artd Cily Council approva!
60 days prior�o rhe evenr, Shurlle bus servlce wil!be required unless applicar,r demonsrrqtes
suffcien�o�-sire parkirtg is availr�ble, Non permitted events wrll not be allowed.
NAME OF OWNER:�GTT ��� �/�N�/� PHON�E; (home) 6�Z �O_!'��,�
work)
MAILINGADDRESS; �oD�-� �R�a��CITY: �M�(1 Y ZIP;
CONTRACTOR: PHONE:
CONTACT PERSON: MOBXLE/PAGER:
1V[A�LrNG ADDR„ESS: CITY: �YP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: pHOl�E:
MAILING ADDRE5S: CYT7C: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Additioz� Acccssory Structure
Move Home emo e lteration (ie: 5iding, 'Windows)
Any easth movement ire MCWD review �nd �ermits!
PROPOSED WORYC(descrtbe in detaan: �� I� ����@, �Q {�Q,w
wltihows �i�-�1��
STORIES: Z SQ,FEET OF EACH FLOOR: �dD ���
NO, OF BEDROOMS: 7... GARAGE STALr,S: ATTACHED�iDETACI-TED�
ESTYMATEb CONSTRUCT�ON VALUATION(excluding land): $ ��
T hereby apply for a building permit and 1 acknowlcdge that thc infoiTnation above is eomplete and accurate;
that the work will be in conformance with the ordinances and codes of the City and with the State Building
Code;that 1 understand this is not a permit an ork's not to siar�without a permit;and that the work will be
in �ccordanee vvith the appro�ed plan.
APPLICANT'S SIGNATURE: DATE: I � '' �
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01/08/2007 16:48 FAx f�0021002
. •
Sea13.04 RIGFTTS OR SUB,�CTS OF DwTA
Subd.1, Type of daw. The righ�s of individusl on whom�he dsw is swred or ro be acored shall be as set forth m thia sectian.
Subd.2. Infbrma�ion required to bo given individusl,An individual oaked W avpply p�vate arconfidendal data conceming himselfsha�l be
jnfomicd ofi (s)the pwpose and inDended uee of�he requee�ed ds�wi�hin the collxtins eta[e agency,policical eubdivieion,0�3[atewide Syslem;(b)
whe�hor he may rcfusc or ia lcgally rcquircd to supply�Nc requwtcd dau;(c)any knovm crnuequcnce ari�ing fFom hls supplying or isfuaing to supply
privace or cunfiden�ial dsra;and(d)�he�dcn�iry ofothcr persona or en�i�iea surhonzed by srare or fodero�law�o recdve�he da�a,This nquironunt ehal]
not apply when an individux)is axkeJ tu aupply investibuuvo ddtu,pursunnt�o sec[ion 13,62,eubdiviaion 5,W a Iaw enforc�me��office[,
Tlfe commissioner of ravenue msv nlace�he ne�ice rcnuired�nd�r thia nubdivision in�he indiv;dLal income enx or ero9emr tax retimd
inatrucdons in6�ead of on chose forme.
Subd.3. Acceaa ro daca by indiv�dual.Upon requesc[o a roeponsible authoriry,an individual ghall be infonf�edwhe[herhe is�he Subject of
swred ds�a on mdividuals,and whed�er ic is eleseiFied as public,privace or canfidenual. Upon hig fuN�er requegt,an Ind'Ivldual who is rhe�ubject of
swrcd pnvau or public dara on ind�vidual9 shell bc ehown�he da�a wi[hout any chargc[o hiro and,if he des�ros,shsll be infortned of�he conunt and
meaning of sha�data, After an individual ha�bcen ghown tl�c prjvate da�a and informed of iu meening,the dete need not be disclosed to him for 9ix
mon�s�hereaftcr unless s dispuu oe action pursuan�co�is secdoo is pending or additional daw ua the indi�idual has been collected or erea�ed, The
re8punaibla auchoriry shrll pruv�cle copies of the privute or public dstx upon roquest by she individusl aubjec�of�he data, 'I'he responsible authoriry
mey requiro the roquesting person co pay�he actusl co6ts af malong,cenifying,and compiling�he copiCs.
The reaponsible authariry 9hall comply immcdia�cly,ifpossible,virnh any reques�made putsuao[[o this subdivision,orwichin fivc days of
�ha deC�uf[hb requtst,excluding SnNrdays,Sundays end legnl holidrys,if irtunediate campJiance ia nocpassiblc, Ifhc csn�ot cornply wi�h�he request
within that time.he ahall ao inform the indiv�dual,and mey he�e an addiiional five days wid�ie whiah to comply wi�h�ho reqvesR excluding Soturdnys,
Sundeys snd legal holidays,
Subd,d, Prueedurc when Jalu is oot sccura�e or complrta An iculividurl mny wnteat�he accuracy or complaoness of public ar privnu dam
concerning himsel£ To exeroiu shis righ�,an individual shall notiYy in ariting the ro5pon9ible audlwity doBCnbing ehe nature of the disagrtement.Thc
responaible au�horiry shall wichin 30 days ei�er: (a)correc�rhe daw Yound so be inaccucek or incomple�e and aaemp�w noufy pa�s recipien�s of
maccurafe or incornpltte daw,including recipien�s ne�ned Fry�he individusl;or(b)oadfy the iodividual rhat he belicvcs thc daraw be correcc.D�tn in
dispute Bhall be disclosed only if the iodividual's sra�emeac ofdi9agreement ie included aith�ho disclosed daw,
The dec¢rmina�ion of�he responsible au�horiry may be appealed pursuan�co cha provisions of the administradve procedurc ac�rcle�ieg w
con�esced casea.
PATA PRIVACY ADVISORY
In accordance with M.S, 13,04,Subd.2,"Rights ofsubjects of data",we would like to infoTmyou[hai�ourrequcst
for a permic or licens�from the Ciry of Orono or an� of i�s deparcmens�may require you to fumish cenain priva�e or
confidential information.
You are no�ified chat;
1, The information you furnish will be used to determine your qualificavon fot the permit or license
rcqucstcd.
2. You may refuse to supply data,but refusal may reyuire that the Ciry deny the permit or license,
3. The informacion may be shared with ocher local, state or federal agencies w the extani neeessary to
process che pe�mic or lieense,
4, If yow requesced pemtit or lieense requires Council action to approve,some information may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to review private deta on yourself,
G. Your full name is�equired to process this applicaGon or poimit.
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