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Home My WebLink About2009-00035 - windows , , CITY OF ORONO PERMIT NO.: 2009-00035 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: O1/29/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 330 BIG ISLAND PIN : 23-117-23-32-0066 LEGAL DESC : MORSE ISLAND PARK : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOWS ACTIVITY : O/S BUILDING -UNDEFINED VALUATION : $ 800.00 NOTE: REPLACE(3)FRONT WINDOWS APPLICANT PERMIT FEE SCHEDULE 34.75 EDIEN, JOHN 330 BIG ISLAND STATE SURCHARGE(VALUATION) 0.50 P.O. BOX 24 TOTAL 35.25 EXCELSIOR,MN OX 24 PAID WITH CASH 35.25 OWNER EDIEN,JOHN 330 BIG ISLAND P.O. BOX 24 EXCELSIOR, MN OX 24 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission Yor additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compicd with whether or no[specitied herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.7'his permit may be revo};,�d�any time for due cause. ' �:;�:�.. _ _ ,/ �Z `%� � l 2`T� O-��' �l'plicant Permitee STgn re Date u d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . . Totat Fee: $ �� Date Received: / 0 Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------------------------------------------------------------ -- �-- THE APPLICANT IS: (circle on�) OWNER OR CONTRACTOR JOB SITE ADDRESS: �� i �? � -� � �c� �I ZIP: Will this be a arade of Homes, Remodelers Showcase Home or other Display Home? ❑ YeS If yes, a special event permit is reguirecl with Police Department and City Council approval � 60 days prior to the event. Shuttle bus service wil/be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed f� � NAME OF OWNER � �; h �-��, � � �1.-�� PHONE: (home) � � � � �� (work) MAILING ADDRESS: �Z CITY:- IP: �cz�3 �_��-�-�-�'Z / CONTRACTOR: -- -- - --- -- PHONE: CONTACT PERSON: �� ,e --.r'— MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory e Move Home Remodel/Alteration (ie: Sidin Window Any earth movement may require MCWD review ermits! PROPOSED WORK(describe in detai�: �c -�' � �: C� `� .-�.`�� .� i �, v� � � /c- �c. � �--� c�� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $��u d � I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ardinances and codes of the City and with the State Building Code;that I understand this is not a permit and ark is not to start without a permit;and that the work will be in accordance with the approved plan. � �-- APPLICANT'S SIGNATit�.�; _ �=,-�------- DATE: � � � 31 , , Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of. (a)the purpose 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 supply 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 investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or property tax refund instructions mstead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authorit��,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuRher request,an individua]who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed ofthe content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed 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 authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesfing 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,or within five days of the date ofthe request,excluding Saturdays,Sundays and legal holidays;if immediate compl iance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Sat�rdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the datato be correct. Datain dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination ofthe responsible authority may be appealed pursuant to the provisions ofthe 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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: ]. The information you furnish will be used to determine your qualification for the permit or ficense 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 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 name is required to process this application or permit. � ��`` �^ � ��S� 1� First Middle Last � � a � s Address �, � �� ,� � ,� ,� „ l � � � � 1 Z3 � � � City State Zip Phone I underst�rrti my righ�as stated above. ' / , _ , __-_-- _...__. _.___---4 S' nature�� M. Reset Form� ` r� 32 /