HomeMy WebLinkAbout1997-009807 - antenna �, PERMIT
* CITY OF ORONO PERMIT TYPE: :
2750 Kelley Parkway- P.O. Box 66 ��' � �� �
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Crystal Bay, Minnesota 55323 Permit Number: �`�_:`{°•-::-�_:;�
(612)473-7357 Date issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR. -- _._____..___ OWNER:�
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APPLICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE •
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Total Fee: $ Date Received:
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)
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THE APPLICANT IS: (circle ok�_NER R CONTRACTOR
JOB SITE ADDRESS: a"I D� �_�A�,��� ZIP:
NAME OF OWNER: ����Y.��7 PHONE: (home)
(work) �� - �te70
MAILING ADDRESS:a�pp t_p?•l� ap��CITY: �„�,�� ZIP: �lZ 1
CONTRACTOR: PH4NE:
CONTACT PERSON: 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 detain: �-�-r�.H M�t�? �'o c��� G�"�._
ut�"j}�.�oy,��r'(�-1_ �T�oMt+�ll N I G(clT lOt�e .�K't�{lU/L``a
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 conformanee with the ordinances and.codes of the City and with
the State Building Code; that I unders 's is not a permit and work is not to start without a
permit; and that the work will be in ccorda ce wi the approved plan. �
APPLICANT'S SIGNATURE: DATE: /�./F,— �7_
NOTE! Parade of Homes events require separate permit approval by Poliee Department and
City Couneil 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom[he data is stored or co be stored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given individual. r1n individual asked to supply priva[e or confidendal data concerning himse(f shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'sta[e agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(C)any Irnown coasequence arising from his supplying or refusing to supply
• private or confidendal data;and(d)the idennty of other persot�s oC enddes authorized by state or fedecal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieadve data, pursuanc to secaon 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund
instrucaons ins�zad of on chose forms.
Subd. 3. Access to data by individual. Upon request to a responsible aurhoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is classified as public, privace or confidenaal. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content
and meaning of that data. Afrer 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[o this section is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person ro pay the 3ctual 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 of[he request,exc(uding 3aturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additionai 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 individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this rieht,an individual shall norify in wridng the responsible authoriry describing the nature of the disagreement.
The responsible authority shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attemp[to nodfy past recipiencs of
inaccunte or incomplete data, including recipients named by the individual; or(b) nodfy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The de[ermination of the responsible authoriry may be appealed pursuant ro the provisions of the administnrive procedure act reladng to
contesred 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:
1. The information you fumish 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 informaYion may be shared with other local, state or federal age�ies to the extent necessary to process
the permit or license.
4. If your requested pernut or license requires Council action to approve, some information may become
pubiic.
j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
First �fiddle Lasc
A�9� ���.��`�a� � 14a —
Address
��-�aN �I�` �'�l2 I L�� ' ��70
Ciry Stata Zip Phone
I understand my ghts as tated abo .
Signa[ure
CITY OF ORONO � 6124730510 06/08/97 5:51 � :03/03 N0:173
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AN7ENNA SITE ApPLICATI�N '
City of Orono Water Tower � -•
Please provide tAs following informadon: `
1. Narr�of Appiicant: S rint PCS
Z. Addnas of Applicant ���e �on� eaic �ta��c�a� �. �4 8 �
� Ea an, Minnesota 55121 � '
3. ConteCtPersontorApplicant Ronald B. Gunderson
4. Telephone Number for�3: 612-6 8 6-2 6 7 0
6. proQosed Radlo 8and: CS -
8. Proposad Radio Frequency(s) (exact values,�ot range): � � � y ' 1�� ��'
�7. Technica(Advisor(if any): aG�J d
Telephone Number for# . 6 � �� � ��D
Provlde the foliowinfl technicai data: � .
8. VN�et rype of Senrke(SMR, ESMR, P S,Two-VYay Paging,etc. PCS
Propoeed Base 3tatlon8(s): Mfg. UV` e l� �
Mode�• ' - C�t� .o r — T�S
Power Output � �
8. Mfg. and Modei of Isolator. � T �a a � � � ��
10. �Mfg. end Model of Duplexer. o)"' 2- %
11. Mtg. and Modei of Fllte�s: � C0�'h � �
12. Dete proposed }or operation: C U
13. Oescribed spece and AC power �equlrements: 120 or 220 Volts AC�,Wattage?
; -�. hQ e- �
14. 81gn:turo: Date: � ' 9�
15. Applicadon feea:
. $325.00 psr frequency pair for�single user, RCC, Ce!!ular,-and/or Trunking
• 3625.00 tor PCS Syatem -
. .$1,025.00 per channel for ESMR ' � � �
18. Aiter ali avallable information has been included above, maii the applicatfon fo together with the
Appllceble fee(s)to: . .
Mr. Ror� Moorsa � .
Ctty Adminislrator �
CRy of Orono �
P.O. Box 68
Crystal Bay, MN 66323
QueaUona regardin9 this applicaoon cen be dlreeted to the City's Consutting Telecommu icatlons Enginee�,
John R. OuBois at(715)967-2321. A copy ot the Technical Minimum Site Standards la nciosed.
S,I ATE� J�ME
CITY OF ORONO CALLED IN 3'__�`��
INSPECTION NOTICE SCHEDULED /� •�
PERMIT N0. � O 7 COMPLETED
ADDRESS 7�-
OWNER CONTR. ;LP
TELEPHONE NO. d�3" �C� �.5�
� DESCRIPTION
W 1 FOOTI 11 MECHANICAL RI 18 EXCAV/GRADIN�/FILLINCi
� 02 FRAMINQ 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Z p5 FlNqL 14 SEWER NOOK-UP O6 PROGRESS
�` 07 DEMQ—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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�Q 07 DEM�FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBINCi RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBIN�FlNAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d ❑WORK SATISFACTORY:PROCEED C PROJECT COMPLETE
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� ❑CORRECT WOFIK 8 PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ` pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next in pection 24 hours in advance.473-7357
Owner/Contracto o it •
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Inspector. �
White Copyllnspector's File Canary Copy/Site Notice