HomeMy WebLinkAbout2002-P05435 - windows �I1� F R N PERMIT
O � O O Permit Number:
2750 Kelley Parkway - PO Box 66 Pos43s
Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations
(952) 249-4600 Date Issued: ��22�2ooz
SITE ADDRESS: 730 Gander Rd
Wayzata,MN 55391
PID: 04-117-23-43-0021
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Pernut Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Windows
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 472.05 Valuation: $ 32,190.00
State Surcharge Fee: $ 16.60
TOTAL FEE: $ 488.65
APPLICANT: Pacesetter Prod.MN Inc. OWNER: Ed Anderson
4343 S. 96th Stree 730 Gander Rd
Omaha,NE 68127 Wayzata,MN 55391
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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APPLICANT PE MI7'EF,SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Sieriitzcres Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
� Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATIOl�
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ;',�� (�G.✓1 d��Y- �lo�1v ZIP:
NAME �F OWNER: /� . - 1=� �1 ���S�o� PHONE: (home) `� z-�yy- `�G� o
(work)
MAII.ING ADDRESS: ��G� G �.-, yJf� CITY: �`: �`���,� �, ZIP:
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CONTRACTOR: � se 1 e � C G r , PHONE: �`�� - G�G G - �5 O �
CON'TACT PERSO : T2��'� MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: t'��J ,s�� '
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTNi IATED CONSTRUCTION VALUATION (excluding land): $ ��� /��, (�L�
I hereby apply for a building pernut and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance with approved plan.
APPLICANT'S SIGNATURE: � DATE: ��7-Z - ��
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF D�Ta
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenual data concerning himself shall
be informed of: (a)the purpose and intended use of the requesrrd data within the collecting"state agency,poliacal subdivision,or sratewide system;
(b)whether he may refuse oY is lega(ty required to supply the requesced data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the ideadry of ocher penoas or enrides authorized by sta[e or federal law to receive the data. This requirement shall
not apply when an individual is asked co supply invesrigaave data, pursuanc to secrion 13.82, subdivision 5, to a law enforcement ofFicer.
The commissioner of revenue mav place the noace rewired under this subdivision in the individual income tax or propertv taz refund
inscructions instead of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is ciassified as public, priva[e or confidendal. Upon tus fucther request,an individual who is the subject
of stored pri�rate or public data on individuals shall be shown che dara wi[hout any charge to him and, if he des'ues, shall be informed of the contenc
and meaning of�hat data. Ahzr an individual has been shown che private dara and informed of ics meaning, the dara need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuant to [his secrion is pending or addidonal data on the individual has been coilected 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 authoriry
may require the requescing person to pay the actual coscs of making, cerafying, and compiling the copies.
The responsible au[horiry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp(y with the request
within[hat time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,exctuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or pri�•ate
data conceming himself. To exercise chis righc,an individual shall noafy in wricing the responsible authoriry describing che nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccunte or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shali be disclosed only if the individual's sratement of disagreement is included with the disclosed data.
The decerminarion of the responsible au�horiry may be appealed pursuanc to the provisions of the administrarive 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 pemut or license from the Ciry of Orono or any of its departments may require you to fumish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit 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 wich other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permi[ 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.
First �fiddle Last
Address ,
C��, State Zip Phone
I understand m rights as ated above.
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Signature