HomeMy WebLinkAbout1999-011501 - reside � PERMIT
t CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 m�°�_�T i i:T��v:�
Crystal Bay, Minnesota 55323 Permit Number: -^' �-::�
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Date Issued: -"
(612)473-7357 ����_.::"_'=::`__=:
SITE ADDRESS:
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REMARKS: I
FEE SUMMARY: ,
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PPLICANT-PER E SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ Date Received:
Entered By: Permit#: �//�b/ '
CITY OF ORONO - BLTII..DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started. .
(please print aIl information)
�____-____ --- . - ---- .
1'HE�APPLICAh"T IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��v o�O S�4��l �-���c��ZIP: �.5��-`� �
NAl�iE OF Oti'PI`�R: Jo� r� �'�';c�S o � PHONE: (home) y7/-9S�C�
'�' (work) �
NIAII..ING ADDRESS: / c� � ���rl�Y: �rc�n c� ZIP:________
CONTRACTOR: ��n I e C g"C � _PHONE: 7v7� - � 8
CONTACT PERSON: MOBILE/PAGER:
M�L�'G ADDRESS: � I'I'Y: ZIP:—y�:�o�
STATE LICENSE: # � 7
ARCHITECT/El\'GIl`TEER: PHO�TE:
iV1AILING ADDRESS: CITY: _ ZIP:
NAME: REGISTRATION#
T'YPE OF ti�ORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED ti�ORK(describe in detain: �
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STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOVSS: GARAGE STALLS: ATT. DET. �
FSTI�i IATED CONSTRUCTION VALUATION (excluding lan�: $ ���/� � � �
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 permit and work is not to start without a
permit; and th�t the work will be in accordance with the approved plan.
APPLICANT'S SIGNATLTRE: � . A'TE: f - - 9
NOTE! Parade qf Homes events require separat it approval by Police Department anci
� City Council 60 days prior to fhe event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SiJBJECTS OF DATA '
Subd. 1. Type o[data. The righcs of individuai on wham�he data is scoced or ro be swrcd shall be u sec for�h in this secaon.
Subd.2. Intormation nqirired to be givm indiridual. An individual uked to suppiy priva�e or confidendal dara conceraing himself shall
be info�med of: (a)[he purpose and intendcd use of the tequesced dan wichia the coUecdng State ageary.polidcal subdivision,or samwide rystem;
(b)whectec he taay reFuse ot is_legaily nquir:d co supply the r.quesmd data:(c)any laiowi�caasequeace uising from.his supplying oc tefusing w suppty
privace or confidenda.l da�;and(d)che ideadry a[ocher persons or enddes aucfiarized by sta�e or.fedecel law to receive che data. This requiremenc shaII
nat appiy when an individual is uked to supp(y iavesdgadve daa,pursuanc ro secaoa 13.82,subdivision 3,co a law enfoc�emeac officec. .
The cecnmissioner of revenue mav olae: che nodc� t-auird unda this subdivision in the individual incomc �c or orooertv raz cefund
instrucaons inscesd of on�hose focros. ;
Subd.3. Access to data bv iadiriduaI. Upon tequest to a responsible auchoriry,an iadividual shall be informed whether he it�he subjeu
o[sto�:d dse on individuats,aed whecher it is clau�ed u pubiic,privace or confdenaal. Upoa his furchec cequest,an iadividua!who is the subjecc
af stocai private or public daa on iadividuals shall be shown�he dan wi�hout any charge to him and;i!he desires,shall be infocmed of che cont�nc '
and meaning o!rhat dara. Aher an individual has been shown the priva�e dara and informed of ics meaning,the dard need not be discloud oo hica fo�
siz months thereatu�unless a dispute or acdan pursuanc to this secdon is pending or addidonal dan on the individual has ban eoilecttd oc creaced.
The�esponsible auehoriry shall�provide copies of che privace or public dara upon cequest by die individua!subject of rhe daa. The responsible auchoricy
may require rhe requesring person to pay ehe acnul coscs oi making,cecrifying,and compiling the eopies. I
The responsible aurhoriry shail compty immediately,if possible,wich aay requac made pursuant co fiis subdivision,or wiehin five days of '
the date o[rhe cequesc,ezduding Saairdays,Sundays and legal holidays,if immediate compliance u noc possible. If he eannot comply wid�the requesc !
wichin d�at dme,he shaii so inform the individual,and may have an nddidoaal five days withia wluch to comply wich the requesc,exctuding Saturdays, �
Sundays and legal holidays. '
Subd.4. Procedure when data ts not�ecurate or complete. M iadividual may contest d►e accuracy or eompleteness of pubiic or private
daa conceming tiunself. To exercise diis right,an individual shall noafy in wridng the respoasibte au�horiry describing the nacu�e of the disagreemenc '
The cespoasible authoriry shall within 30 days eitt:er: (a)correct�t►e data faund w be inaccucate or incomplete aad atumpt to nodfy past recipiena of
inaccucate or ineomplece dam,tncluding recipiencs named by rhe individual;or(b)nodfy rhe individual thac he betieves che dara to be correct Data
in dispuce shall be disclosed onty if the individual's statemenc of disagreemenc is induded wi�h the disclosed data.
: The decerminaaon of the responsibie auchoriry may be appealed pursuant to the provisions of tha adminisaarive procedure act relaang m
contesud cases. ' •
DATA PRIVACY ADYISORY
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 aze notified that:
1. The information you furnish will be used to determine your qualificadon 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 shared with other local�state or federal agencies to the ettent necessary to process i,
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 permic.
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First �Siddle Lasc �
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Addcess
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Ciry Sate Zip Phone �
I understand my ri;hts u stated above.
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Signaate