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Home My WebLink About2003-P07006 - land alterationPERMIT CI T' QF ORONO Permit Number:2750 Kelley Parkway - PO Box 66 Po oo6 Crystal Bay, Minnesota 55323 Permit Type: User Defined 952) 249-4600 Date Issued: 11 1 2003 SITE ADDRESS: 220 Big Island Excelsior,MN 55331 PID: 23-117-23-23-0028 DESCRIPTION: Proposed Use: Other Pernut Class: General Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc DETAILS: Approved per resolution#: Separate pernuts required: Other-(Permit for Right-of-Way between Lots 38&39,Island Park) NOTICES/REMARKS: Pernut per"conditions" of attached letter,written by Mike Gaffro FEE SUMMARY: Permit Fee: 50.00 Valuation: $ 0.00 TOTAL FEE: 50.00 APPLICANT: Owner/Self OWNER: David&Sandra Lovelace 3120 Westedge Blvd Mound 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. Yt.-t- APPLICANT PERM[TEE SIGNATURE 1 SUED BY SIGNATURG Copies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessin, 1-Finance Page 1 y4` t Total Fee: $ Date Received: Entered By: Permit#: O C l CITY OF ORONO - BUILDING PERMIT APPLIC TION All information must be submitted in full before plan review i-ill be started. g -,please print all informattson)---- M-------------------------- c_ THE APP ICANT circl one) OWNER R CONTRACTOR J'- V d.9 tlkl. r"Ic fc l , ;- e -I g V-F o f-w. JOB SITE ADDRES : ., D Qj wtc9 3 1m 2.5 ZIP: z l w tp A a..lc- Will this be a Parade of Homes, Remodelers Showcase Honie or other Display Home? Yes . No If yes, a special event permit is required tivith Police Department and City Council approva160 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: Y[( !f i(Q PHONE: (home) 45.•-l{`20 work) CQ.L( ( Z. Qj l0. l3 MAILING ADDRESS: SaJ' 3 -~)CC.2IS 0 2- CITY: , ur ZIP: SS3S 1, l t v PHONE: MOBILE/PAGER:15 S t.l`e CITY: _ 7iP: y s P v/-v-r- ciTY: c, REGIST S 1'I. a_, Accessory Structure Move j , iteration Land Alteration_ n PRO S detai: M.I.Q. 'iA t. -cu-e. V 0 R GP oJ[t Cees S m UJ C t b z`s l r t.s, P zo,.., '.c f n c--tow c Z c,Q (t`cf . G w,su ocd oc le y Pree -a g y eu.¢Yo t sc. b STOI r., 2-'s EET OF EACH FLOOR: ``` `OU tc u.cs NO. ( __..,. GARAGE STALLS: ATT. DET. 2 ESTIMATED CONSTRUCTION VALUATION (excluding land): S I hereby apply for a building permit and I acknowledge that the information abo e is cor_:plete and accurate;that the work will be in conformance with the ordinances and codes of the City and w7th the State Building Code; that I understand this is not a permit and work is not to start without a pernut; and that the wor will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: ` Z- Zd 03 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The rights of individual on whom the dau is stored or to be stored shali be as set forth in this section. Subd.2. In[ormation required to be given individual. An indi idoal asl:e d to supply private or confidential data rnncerning himself shall be informed of: (a)the purpose and intended use of the requested data withim the co0ecting state agency,political subdivision,or statewide system;(b) whether he may re[use or is legally required to supply the requested data;(ci any Icnaw-n consequence arising from his supplying or refusing to supply private or conCdential data;and(d)the identity of other persons or entities aathorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant tn secbon 13.82,subdivision 5,to a law enCorcement officer. The commissioner of revenue mav olace the notice reauired under this sabdivision in the individual income tac or oropertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a respon le autbority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or wufidenriai. Upon his further request,an indicidual who is the subject of stored private or public data on individuals shall be shown the data without any chirge to him and,if he desires,shall be informed o[the content and meaning of that data. After an individual has been shown the private data ind informed of its meaning,the data need not be disclosed to him for six months therea(ter unless a dispute or action pursuant to this seMion is pending or iddidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon reyuest b-t6e individual subject of the data. The responsibie authority may require the requesting person to pay the actual costs of making,certifying,ind compiling the copies. The responsible authority shall comply immediately,if possible,with any rrquest made pursuant to this subdi-ision,or within five days ofthe date of the request,excluding Saturdays,Sundays and legal holidays,if immr i3te compliance is not possible. If he cannot comply with the request within thatlime,he shall so infnrm the individusl,and nay hav:an additional f e s wilhin w::Ech to comply w iti the equesi,eacluding Sat rdays,S ndays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individua]may contest the accuracy or completeness of public or private data concerning himselL To exercise this right,an individual shall notify in writi the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data fouod to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual_or(b)norify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreemeut cs i cluded with the disclosed data. The determination of the responsibie authority may be appealed pursuant to the provisions of the administrati e procedure act relating to contested cases. DATA PRIVAC':D ISORY In accordance with M.S.13.04,Subd.2,"Rights of subjezts of data",we would like to inform•ou that your request for a permit or license from the City of Orono or any of its departrnents may require you to furnish certain private or confidential information. You are notified that: 1.The information you furnish will be used to determine our qualification for the permit or license requested. 2.You may refuse to supply data,but refusal ma require that the City deny the permit or license. 3.The information may be shared with other IocaL state or federal agencies to the extent necessary to process the permit or license. 4.If your requested permit or license 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 data on yourself. 6.Your full na ne is required to rocess tY,is appli:tion or erriut. 1u 1 l- V' ' F t iVtiddle Last S . Address ti'v;C V`C , r I ,.c'c.. C tY Sute Zip Phone I understand my rights as stated above. Sign