HomeMy WebLinkAbout1996-007933 - remove & reside , . �� P�RMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 '�'"�' `���'.'�
Permit Number: i j�_�7,:�_:�;'� '
Crystal Bay, Minnesota 55323
(612)473-7357 Date Issued: :�}��t_,�=�t��r�.
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — A���l. i c���t. — OWNER:
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AP CANTiPERMITEE SI URE ISSUED BY:SIGNATURE �-"( (
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Total Fee: $ � `� ��� DateReceived:
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Date Approved:
Entered By: -r�� , _ Permit#: '7�_�-�
CITY OF ORONO - BLT�.DING PERMIT APPLICATION
ALL INFOR1tiIATION�TIJST BE SLB1�iTTTED I�t FULL BEFORE PLAN REV�W WII-L
BE STARTED
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THE APPLIC��t'T IS: (circle one OWNER 0 CONTRACTOR/
JOB SITE ADDRESS: ��o (� -5�9�V�coC� � � _ ZIP:
NAl��E OF OW�IER: )4 n1 5 �� ; 1 c�_�i��' PHOiVE: (home) y'7/ -g�
(work)
iViAILING AD)RESS: -�, l� � <:S�i�c�v,� TY: � r�n� ZIP:
CONTRACTOR: ��f�e�G�9 � � PHONE: 7,�l-1 G � �
NIOBILE PHONE/PAGER:
M�ILI�i iGADDRESS: �� S/�/�i'.+�� ��CITY: � / ' ZIP: ' � �
STATE LICENSE: # ,�I 7 �j'
ARCHTTECT/ENGINEER: PHOi�tE:
MAILING ADDRESS: CITY: Z��
N��: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration Land Alteration
PROPOSED WORK(describe indetail): � ��-t�v� � ��S�cl-�- h�v S`i- �
T�( � • . ' ^ S > � �l
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROONIS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excludingland): $ �7 ��C�
I hereby apply for a buildin; permit and I acknowled�e 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.
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APPLICANT'S SIGNATLJRE: -�.�- DATE:- - ,� --9 —��
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NOTE! Parade of Homes events require separate ermit a�proval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sea 13.04 RIGI-TTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secaon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenual data concerning hunself shall
be informed of: (a)the purpose and intended use of[he requested data within the collecting'state agency, poliucal subdivision,or statewide system;
(b)whether he may refuse or is le¢aily required to supply the requested data;(c)any known consequence arising fmm his supplying or refusing to supply
private or confidendal data;and(d)the idenaty of other persons or enrides authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigaave data,pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be infocmed whether he is the subject
of stored data on individuals,and wheche�it is classified as public, private or confidenaal. Upon his fur[her request, an individual who is the subject
of stored private or public data on individuals shall be shown the data without any charge to hirn and, if he desires, shall 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 acrion pursuant to this section is pending or addidonal data on the individual 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 authoriry
may require the requesting person to pay the actual costs of making, certifying, and compiling the copies.
The responsible authority shall comply immediately, if possible, with any request made pursuant co this subdivision, or within five days of
the date of the request,excluding Saturdays,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 additional five days within which ro 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 right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.
The responsible authority shatl within 30 davs either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipients of
inaccurate or incomplete data, including recipients named 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 statement of disagreement is included with the disciosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act reladng 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 pernut 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 deternune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut 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 pernut.
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First Middle Last
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Address rn� ��, C'� �� , �� �
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City State Zip Phone
I understand my rights as stated above.
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Signamre