HomeMy WebLinkAbout2000-P02598 - minor alterations PERMIT
.-C I�Y O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Po2sag
Crystal Bay, Minnesota 55323 Pe�mit Type: Minor Alterations
(612) 249-4600 Date Issued: 6i2�i2oo
SITE ADDRESS: 2967 Casco Point Rd
WAYZATA,MN 55391
P I D: 20-117-23-31-0064
DESCRIPTION:
Proposed Use:
Buildin Census Code 434
Permit Class: g
Permit Type: Minor Alterations Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution #:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 153.25 Valuation: $ 7,789.00
State Surcharge Fee: $ 3.90
TOTAL FEE: $ 157.15
APPLICANT: SEARS HOME IMPROVEMENT OWNER: T& D ROZEBOOM
8823 ZEALAND Ave N 2967 CASCO POINT RD
BROOKLYN PARK,MN 55445 WAYZATA MN 55391
T[-�UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-IE 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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AP I' ERM ATURE ISS BY SIGNATURE
Copies: City,Applicant,Assessor, Finance Page 1
,Total Fee: $ �� �� � t' Date Received: ��� �7'" � `"
� Entered By: ���� �'' Perm.it#: �-� '�� ��l�
CITY OF ORONO - BUII�DItiTG PERII�IIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print a11 information)
THE APPLICANT IS: (circle one) OWivER OR CONTR.ACTOR
JOB SITE ADDRESS: �����- �� i :�vt 1�c�z�: 55���
rra�� oF owlvEx: Te �. �o�� PHo�: (home) C,,1�y`}L-�5��J
L (work)
1�IAIL�'G ADDRESS: CTTY: pc�c>��� ZIP: � ;<
C0�1TR�CTOR• �-� _ -�-, , PHO�IE: �-$�.� .qC>`3-�^l�`{(o
CON'TACTPERSON: �s� . �� OBILE/PAGER: -
NIAILL1tG ADDRESS:��2 2�.�c.�,� i�vc'_ dl;�CTI'Y: - - ' ZIP: ti� ��" .
� ��.�
STATE LICENSE: #.�2(`.��`1C�>��
ARCHITECT/ENGINEER: PA��'
1�LAIJ..Ti�'G ADDRESS: CITY: ZIP:
���,,�: REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � t,J ° ``" o
c_
STORIES: SQ.F'EET OF EACH FLOOR:
NO. OF BEDR001�IS: GARAGE STALLS: ATT. DET.
ESTII,i IATED CONSTRUCTION VALUATION (excluding lanc�: $���f`�"`—
I hereby apply for a buildin�permit and I acknowled�e that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
� the State Building Code; that I understand this is not a permit and work is not to start withou[ a
permit; and that the work will be in accordance with the approved plan.
� DATE: s
APPLICANT'S SIGNA . '
:_-.- -
1�'OTE! P�r�de o�'Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.0�i RIGHTS OF SLBJECTS OF DaT?.
Subd. 1. Tvpe of data. The righ�s oi i�dividual on whom the daci is s;o;ed or m be stor_d shalI be as sec forth in chis secdon.
Subd.2. Information reqirired to be�vea individual. An individual bsked to suppiy privarc or co�u:dendal da¢conceraing himseIf shalI
be iaformed of: (a)�e purpose and inrended use of che requesied dan wichia eh=collecdng 3�ace a�eary,poliriczl subdivision,oc sacewide rysum:
�b)whe�'�er he may r.fuse or is le3a[ly reGuirrd co sti:ppty�he requesud dsr3:(c)any Icown caas��u--ce arising froei his supplyi:.g or refusing m supply
privam or conr:dendal dara;and(d)[he idaedty of oc�er persons or enades auchoriz�by sc3m or fed��l law co rceive t�e dae. This requir.menc shall
no�apply when an individual is asked to sspply incurizadve daci,pursuanc ro sr_�oa 13.82, subdivision 5, [o a law enforzec.ea�officer.
The commissioner of r�:ence mav olsce the nocce r_auired under chis subdivision in �he individual ir.comc ax o; orooem taz refur.d
instrucdans inst��d of on chose farms.
Subd. 3. ?.ecess to data br•individuaI. lipon requesc[o a rtsponsible au��oriry,an individual shall be infor,ned whe�her he is che subjecc
of scDr_d dara on individuals,and whe:�er it is classifed as public, privace or con::�e-ca1. L:Fon his fur,her rertuest,an iadividual who is the subjecc
of smr_d pdvam or pub(ic daci on individuals shall be show-n rhe daea wi�houc aay ccar3e m hia and,�if he desires, shall be iaiorcied of[he coa[enc
ar.d meaning oi�hat dara. After an individual h�s�een shown che privam dari and ia:or.r.cd oi its me3niag, [he daca ard not be disclosed ro hun for
su moncfu cher_aiter unless a d'upute or acdon pucsuanc to chis secdon is pending o;addidoa3l daci on�he individual has beea coilecud or creaced.
Tne responsibia auchoriry shall provid:copies of�he pcivace or public da�a upon r.�u:s:by t�e i�dividual subjecc of�:e daca. T'ne responsible au�horiry
may r:quir che �equesring person ro pay the acnul cosc�of rzuking,c�rufyin,,ir.d.ompiling the copies.
'Ihe responsible auchoriry shall comply imrr:edia[ety, if possible,wi�`:a:y r-quest m3de persuant co chis subdivision, or wichin five days oi
the dace of cha requesc,ezciuding Sanirdays,Sunday;and legal holidays,if imcr.ed�a:e compliacce is no�possibla If he csnnot comply wi[h[he requa�
wi[hin�ac drae,he shail so inform che individual,ar.d may have an addidoaai fiv:days wichin which to:omply witz�he requesc,excluding Saturdays.
Sundays and legsl holidays.
Subd.4. Pracedure when data is not accurata or complete. An ir:dir.�uai may contest[he accuracy or comp(ateaess of public or pri�•ate '
daca cor.cerning himself. To exer.ise chis righc,an individual shall nodfy in wriang�.=resporsioIe aurhoriry describing�he naa::e oi th�disagreemeac. .,
The responsiblt auttsoriry shall within 30 days ei�`:_r: (a)cocrect the data found ro t:inaccu�c.or ir:comple�e az:d aaempc to noa�past recipien�s of
inaccura.e or incomplece dan, induding recipieaa named by che individual;or(b)codfy [I:� individual chac he believes rhe dara to be correcc. Daca
in dispuce shall be dise!osed only if the individu�l's sn�emenc of disagreemenc u ir.cluded wi�`�che d'uclosed dac3.
The dece:minadon of tha rasponsiot. auchoriry may be appealed pursu�^.c ro the provisions of the adminis�arive pro:edure act relaang to
contested cases.
DAT?. PRIVACY ?.D`'ISORY
In accordance wich 1�I.S. 13.04, Subd.2, "RiQhts of subjecu oi da�a", �•e would like to inform you that your reauest
for a permic or License from che City of Orono or any of its depz.�;:ents rr�ay require you to fumis� certain private or
confidential information.
You are notified that:
1. The information you fi:rnisa will be used to de�ermi�=your qualitication for che perm.it or license requested.
?. You may refuse to supply daca, buc refusal may ree��ire that the Cicy deay the permit or license.
;. The informacion may be shared wich ocher Iocal, sca::or federal agencies to the extenc necessary to process
the permit or license.
.�. If your requested perm.ic or license requires Council action to approve, some informacion may become
public.
5. You have certain riQhcs under �1.5. 13.04 (availabl: upon request) to review private data on yourself.
6. Your full name is required to process this applica�:on or pe:mic.
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I understand my righcs as staced above.
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