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Home My WebLink About2005-P08704 - windows PERMIT ' GI7�Y" OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Numb r: Pog�o4 Crystal Bay, Minnesota 55323 Permit T�pe: M�nor aiterarions (952) 249-4600 Date Issu'ed: s�io�2oos SITE ADDRESS: 4465 Bayside Rd Maple Plain,MN 55359 � P I D: 06-117-23-21-0006 � DESCRIPTION: Proposed Use: Residential Permit Class: Building I nsus Code O/S-Building Permit Type: Minor Alterations ermit Sub-type(s): Windows DETAILS: Approved per resolution#: I Separate pernrits required: NOTICES/REMARKS: i n__i___ '____�_____ o c._�__'_ '_ i.. o_ �ti _:�__ ' ..Y'.,...G ..................J......b ...1 .7., .. .....G., � FEE SUMMARY: Permit Fee: $ 209.25 Valuation: $ 12,000.00 State Surcharge Fee: $ 6.50 TOTAL FEE: $ 215.75 ' APPLICANT: Terry Built OWNE ; Robert Carlson 340 Leaf Street 4465 Bayside Rd Long Lake,MN 55356 Maple Plain,MN 55359 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�E L IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'WCT COMPLIANCE WITH ALiL CI OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �� _ , L ._ ..._ _� APPL[CANT PERN�fI'EE SIGNAT�3IZE SSUED BY SIGNATURE �_ _ - I Copies: 1-File(SiQnttures Repuired), 1-Applicant, 1-Monthlv Reports, 1-Assessine. 1-Finance Page 1 Total Fee: $ I Date Received: Entered By: Permit#: CITY OF O�ONO - BUILDING ERMIT APPLICATION All information must be submitted in f 11 b fore plan review will be started. (please pf�int all�inf rt�tation) -------------------------------------------------------------•---- ----------------------------------------------------- THE APPLICANT IS: (circle one) OW�iE OR C�NTRACTOR JOB SITE ADDRESS: �y� �� A i S��c �'�� ZIP: 5�S3�� Will this be a �arade of Homes, Remodelers Show ase Home or other Display Home? ❑ YeS � NO If yes, a special event per•rnit is��equire with Police Depa�•tme��t and Ciry Council approval � 60 days priar to the event. Shzrttle bzrs s rvice will be requi�•ed unless applicant cfemonstrates sz fficient on-site parking is available. on per�milted events will not be allowed. NAME OF OWNER: /�D �%''�''` � �� '�^� `''��' PHONE: (home) y5`� — y�,2 — y�i� � (work) �;�� '4 7� 'SiG o MAII�ING ADDRESS: �`�� S �� CITY: f��o�1 c7 ZIP: 5 S 3.59 CONTRACTOR: ~�,,c-.�,e � �� .�i PHONE: ��.2 -s�s D- D� 9� CONTACT PERSON: �'o•�� EQ� l��OBILE/PAGER: '� MAILING ADDRESS: 3 yv �� CITY: �� P ZIP: �535� STATE LICENSE: # ��iS XPIRATION DATE: ARCHIT�CT/ENGINEER: /l�!��-;--- PHONE: MAILING ADDRESS: ' �ITY: ZIP: NAME: REGISTR.ATION: # TYPE OF WORK: New Additio Accessory Structure Move Home emodeUAlteration � � PROPOSED WORK(desci•ibe in detai�: �� 4 °� GJ r `t c�o c.�S � 5�� t��/ �o � '�: � G�c�5 � 5�O�� v r� t�� i S �.�� /`fo�� STORIES: �� -� SQ.FEET OF EACH LOOR: • NO. OF BEDROOMS: GARAGE STAL S: ATTACHED DETACHED_ ESTIMATED CONSTRUCTION VALUATION( xcluding land): $ �� UU C-% I hereby apply for a building permit and I acknowledge th the information above is complete and accurate; that the work will be in conformance with the ordinances nd codes of the City and with the State Building Code;that I understand this is not a permit and work is not o start without a pennit;and that the work will be in accordance with the approved plar�,, . � APPLICANT'S SIGNATURE: �� DATE: �— /�C-.= - cu S� 31 Sec.13,04 RIGHTS OF SUBJECTS OF DATA 3ubd. 1. Type of data. The nghts of individual on whom the data is stored or to be stored shali be as set forth in this section. Subd.2. Information required to be given individual.An individual asked to supply private or confidential data conceming himselfshall be informed of: (a)the pucpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to suppty private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall not apply when an individual is asked to supply investigacive data,pursuant to section 13.32,subdivision 5,to a law enforcement officer. The commissioner of revenue mayplace the notice required under this subdivision in the individual income tas or propertv tax reftmd instructions instead of on those forms. Subd.3. Access to data by individuaL Upon request to a responsible authority,an individttal shall be informed whecher he is the su6ject of stored data on individuals,.and whether it is classified as public,peivate or confidential. Upon his further request,an individuat who is the subject o` stored private or public data on individuals shall be shown the data withou[any charge to him and,if he desires,shail be infonned of the content and meaning of that data. After an individua]has been shown the priva[e data and informed of its meaning,the data need no[be disdosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority sha11 provide copies of the private or public data upon requesc by the individual subject of the data. 'Ihe responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,onvithin five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if imtnediate compliance is not possible. If he cannot comply with the request within that time,he shall so infoi�n the individual,and may have an additional five days within which to compty wich the request,excluding Saeurdays, 5undays and legal holidays. Subd.4. Proccdure when data is not accurate or complete. An individual may contest the accuracy or completeness of pub(ic or private data concerning himsel£ To exercise tltis right,an individual shall no[ify in writing the responsible authoiity describing the natuce of the disagreement.Thc responsible authority shall within 30 days either: (a)con•ect the data found to be inaccurafe or incomplete and attempt to notify past recipients ot inaccurate or incomplete data,including recipients named by the individual;or(b)no[ify the individual that he believes the data to be�o��-c'_ ?7a.�z in dispute shall be disclosed only if the individual's s[atement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursttant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a pemlit or license from the City of Orono or any of its departments may require you to fumish certain p:ivate or confidential information. You are notified that: 1. The information you fumish will be used to determine your qualification for the perniit or license requested. , 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the perniit or license. 4. If your requested permit or license requires Council action to approve,some inforniation 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 name is rec�uired to process this application or permit. First Middie Last Address City State Zip Phone I understand my rights as stated above. . � �.._�, �- - Signature ,= 32