HomeMy WebLinkAbout2002-P05888 - land alteration CITY OF ORONO PERMIT
2�50 Kelley Parkway - PO Box 66 Permit Number: Possss
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: izit9i2oo2
SITE ADDRESS: 100o Herita�e La
Wayzata,MN 55391
P I D: 10-117-23-14-0005
DESCRI PTION:
Proposed Use: Residential
Pernut Class: General
Permit Sub-type(s): Land Alteration(0-500 cu yc
Permit Type: User Defined
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: � 50.00 Valuation: � 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/Self OWNER: Dennis Libby
MN 1000 Heritage La
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 SI'ATE OF
�IINNESOTA BUILDING CODE REQUIREMENTS.
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APPL PER SIGI�7ITURE / 1SSUEDBYSIGNATURE '
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Cooies: 1-File(SiQnitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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Total Fee: $ ' ��,�. ' Date Received: �.-`{-0�
� Entered By: rjYl�'L- Permit#: � v5 8
CTe�at:�,t�
, �,� CITY OF ORONO - B G PERNIIT APPLICATIOleT
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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
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JOB SITE ADDRESS: � � " (,�� �� -e- �� ZIP: S� 3 � �
NAME OF OWNER: I Q:n�%� s L . �.;1 �°C
� PHONE: (home) cl S � . y�`l' - �'��/I�
(work) cj S�- L%7 5�� k c;< <� ``'�
9�i-�3 y'-�-rE�f
MAII..ING ADDRESS: S<-�- �"'`� CITY: G✓��•` �;C.E� ZIP: �� 3
CONTRACTOR: PHOiVE:
CONTACT PERSON: MOBILE/PAGER:
MAII.ING 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�_
��� l7"�✓� � -.c' � C'. ' �5� vv � � � , �� :
PROPOSED WORK(describe in detai�: � � G '� � � �l ' ���
,,�,� �,� �� C-� �-— �t � C�� -3�.�� �� we��C—������;
� ����� � - �� ���� c�-�.� ���� ���� � s�� ��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
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 ordinances and codes of the City and with
the State Building Code; that I understand this is not a pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: ';' �- ~:-��' ' DATE: �-� ���( ��-�
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NOTE! Parade of Homes events require seprtrate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGH'TS OF SLJB.TECTS OF D.aTA
Subd. 1. Type of data. "Ihe rights 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 confidenaal data concerning himself shall
be informed of: (a)-the purpose and intended use of the requested dara within the collecting'state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply[he reques[ed data;(c)any irnown coasequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)the idendry of other persoas or enories authorized by state or federal law to receive the data. This requ'uement shall
not apply when an individual is asked to supply invesrigadve dara,pursuant[o section 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re��enue mav place [he nodce reauired under this subdivision in the individual income tax or propertv taz refund
instructions inscead 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 whether it is class�ed as public, private or confidenaal. Upon his further request,an individua] who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and,'if he desires, shall be informed of the content
and meaning of[hat data. Aftzr an individual has been shown the private data and infoaned of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuanc to this secaon is pending or addidonal data on the individual has been collected or created.
The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual cosrs of makin¢, cemfying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Saturdays,Sundays and legal hotidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shail so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An mdividual may contest the accuracy or completeness of public or pm•ate
data concerning himsetf. To exercise this right,an individual shall nodfy in wridng the responsibie authoriry describing[he nature of the disagreement.
The responsible auchoriry shait within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)nocify the individual thac he believes the data to be correcc. Data
in dispute shall be disc(osed only if the individual's stacement of disagreement is included with the disc(osed data.
The decerminarion of the rzsponsible auchoriry may be appealed pursuant ro [he provisions of the adaunistrative procedure act relating to
contested cases.
DATA PRIVACY �DVISORY
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 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 pemut 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,�i�'application or permit.
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First` �-�`�� ddle Last
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City 5race Zip Phone
I understand my rights as stated above. .-�
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Mar-18-2002 �2:59pm From-CITY OF OR�NO ` �
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