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Home My WebLink About2004-P08002 - minor alterations � ITY F R PERMIT �' � � �N� Permit Number: 2750 Kelley Patkway- PO Box 66 Posoo2 Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: 9/28/2004 SITE ADDRESS: 2690 Pheasant Rd EXCEISIOR,MN 55331 P I D: 21-117-2 3-2 3-0019 DESCRIPTION: Proposed Use: Residential Permit Class: Building Census Code O/S-Building Pernut Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: PermitFee: $ 167.25 Valuation• $ 9,000.00 State Surcharge Fee: $ 5.00 TOTAL FEE: $ 172.25 APPLICANT: WF. Smith Construcrion OWNER: M J&G R PUDIL 6585 So. Saunders Lake Dr. 2690 PHEASANT RD Minnetrista,MN 55364 EXCELSIOR MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENT'S SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. ��_�� - � APPLICANT RM EE S GNATURE ISS[JED BY SIGNATURE Conies: 1-File(SiQnitures Required), 1-Auplicant 1-Monthlv Reports, 1-Assessin¢, 1-Finance Page 1 • Total Fee: $ Date Received: 9-�'�`� Entered By: Permit#: /� gGt�2 CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------- --------------- - -------------------------------- THE APPLI�CANT IS: (circle o�ie) OWNER CONTRACTOR JOB SITE ADDRESS: 7i��1 4 {�(�-s�T 12.�. ZIP: �S�r-r � Will this be a P rade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: � ( �G.� I� � � PHONE: (home) (work) MAILING ADDRESS: �?6 �1 - CITY: ZIP: � CONTRACTOR: �) , �' �/'h,�'f Ca y�,� PHONE: �5�--�7�- ��-�-�� CONTACT PERSON: 3 v r� MOBILE/PAGER: G�a--8 6 �-3 i� � MAILING ADDRESS: 6S`�S So. S�wr-n��.s Lk �CITY:�'Ll��l�e�-r,� � ZIP: S�s � STATE LICENSE: # s'3 c�� ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration�� Land Alteration PROPOSED WORK(describe in detai�: �� U� �'�'�! ' -- STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. � ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �, O U6 I hereby apply for a building permit and I aclrnowledge 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. APPLICANT'S SIGNATURE: DATE: � ' � �- 6 � . � � ti Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. 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 prlvate or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collectlng state agency,political subdivision,or statewlde system;(b) �vhether he may refuse or is legally required to supply the requested data;(c)any known rnnsequence arising from his snpplying or retusing to suppiy private or conFdential data;and(d)the identity otother 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 investtgative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav nlace the notice reautred under th(s subdivision in the individual income tax or aronertv tax refund instructions instead of on those forms. Subd.3. Access to data by indivldual. Upon request to a responsible authority,an individual shall be informed whether he is the subject ot stored data on individuals,and whether it is classified as public,private or con6dential. Upon his further request,an individuai who is the subject of stored private or publtc data on individuals shall be shown the data without any charge to him and,if he desires,shail be informed of the 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 3ndividual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.The responsible authority may require the requesting person to pay the actual rnsts of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdlvision,or within tive days of the date of the request,excluding Saturdays,Sundays and legal holidsys,if immediate compliance is not possible.If he cannot comply with the requestwithin that time,he shall so inform the individual,and may have an additio�al live days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. 5ubd.4. Procedure when data is not accurate or complete. An indivlduel 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 either: (a)correct the data found to be lnaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the indivldual;or(b)notify the individual that he believes the data to be correct. Data in dlspute shall be disclosed only it the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the 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: 1. The information you furnish will be used to determine your quatification 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 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-�.�-'� First Middle Last � � � s- Sa S' �Y---r-�-��--� L� r� � Address V� , r�� s l�a ✓�'�r' sJ?� c-1 �'��-- �'��-65 .3� City State Zip Phone I understand my rights as ated ove. Signature