HomeMy WebLinkAbout2002-P05814 - windows � � . PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P05814
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: tii�i2oo2
SITE ADDRESS: 1709 North Farm Rd
L.ong Lake,MN 55356
PID: 27-118-23-44-0006
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Pernut Class: Building Census Code O/S-Building
Pemut Type: Minor Alterations Permit Sub-type(s): Windows
DE�AILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: PernutFee: $ 431.65 Valuation: $ 28,004.00
State Surcharge Fee: $ 14.55
TOTAL FEE: $ 446.20
APPLICANT: Harmony Homes Inc. OWNER: Mr. &Mrs. Randy Rosengren
3158 Viking Blvd. 1709 North Farm Rd
Wyoming,MN 55092 Long Lake MN 55356
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 PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Anvlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
1 - .
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATIOleT
All information must be submitted in full before plan review will be started.
" (please print all information)
THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR
JOB SITE ADDRESS: ��O l �IOr-�h -�/n� � ZIP:�S�S,3,S,�
NAME OF OWNER: � c PHONE: (home) o`�Z- �-�'(,p
� c��u ��-q�� -sy��
MAII.ING ADDRESS: l��'1 Ni�'�- ln-. CITY:Cyr� L�,C� ZIP:L�
CONTRACTOR: hQ' PHONE: �63� yt3���(:i)
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: ' CITY: w., ' ZIP:��
STATE LICENSE: #�(a,��,�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
�TAME: REGLSTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPO ED WORK(describe in detain: � - P,cti�l �l�v� ��� �v1�►�U✓S . ����
�Q�� �e� �'�� �'i Z��'
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ,�O� �U `1
I hereby apply for a building pemut 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 permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
/ �
APPLICANr'S SIGNATURE: �ii���� DATE: �I �'�
NOTE! Parade of Homes events require separate permit approval by Potice Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
. _ !
Sec.13.04 RIGHT'S OF SUBJECTS OF D�►TA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth ia this secdon.
Subd.2. Information req�rired to be given individual. An individual asked w supply private or confidendal data concerning himself shall
be informed of: (a)�he purpose and inteaded use of the nequested data wi[hin the collecdng 3tate agency,political subdivision,or statewide system;
(b)w6ether he may nfuse oY is legally required co supply the requesmd data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the idenriry of other persoas or endaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to suppiy invesagadve data,punvant to secdon 13.82,subdivision 5,to a law enforcement officer.
The commissioner of rovenue mav place che noace rewircd under this subdivision in the individual income tax or�ronertv taz refund
instcuctions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a respoasible authority,an individual shall be informed whethec he is the subject
of stond data on individuals,aad whether it is class�ed as public,private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown ehe data wi[hout any charge to him and;if he desires,shall be iaformed of the content
and meaniag of that da[a. Aher an individual has been shown the private dara and informed of irs meaning,the data need not be disclosed to him for
six months thenafter uqlCss a dispute or acdon pursuanc to this secrion is pending or addiaonal 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 che data. The respons�'ble authoriry
may require the roquesting person w pay the actua!cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,wieh any request made pursuant w this subdivision,or within five days of
the date of the request,excluding Sacucdays,Sundays and legal holidays,if immediate compliance is not possible. If he camot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays,
Sundays aad legal holidays.
Subd.4. Procedure when data is not accurate or complete. An mdividual may contest the accurdcy or completeness of public or private
dara conceming himself. To exercise chis right,an individual shall nodfy in wriring the responsible authoriry describing�he nature of the disagreement.
The responsible authoriry shall within 30 days eifher: (a)correct the data found to be inaccurate or incomplete and aaempt W nodfy past recipients of
inaccurate or incomplete data, iacluding recipieats n2med by the individual;or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
The determination of the responsible au[horiry may be appealed pursuaat to the provisions of the adminisaadve 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 Ciry of Orono or any of its departments may require you to furnish certain private or
confidential information.
You ue 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 Ciry deny the permit or license.
3. The information may be shazed 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.
First Middle Last
Addnss
Ci�y Sate Zip Phone
I understand my rights as stated above.
�Gtf�
Signaare