HomeMy WebLinkAbout1993-005716 - install garg door PERMIT . .
CIT� ,C,;� ORONO PERMIT TYPE: �,���i �����,_�
2750 Kelley Parkway • P.O. Box 815 Permit Number: r•���?
Orono, Minnesota 55356-0815 �"''�- ' �'�'
(612) 473-7357 Datelssued: � �����;°��:=;
SITE ADDRESS:
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APPLICANT/PEFMITEE SIGNATURE ISSUED BY:SIGNATUFE
„:.
�i���r CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� - � � On the North Slzore of Lake Minnetonka
DATA PRNACY 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
qualification for the permit or Iicense 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 iocal, state or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Counci� action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review prica��
data on yourself.
6. Yaur full name is required to process this applicatian or
permit.
/l/��c,Ur� � � /� Sc i�i.9i-LiZ —
First Middle Last
.�� 5 � �>��/>>c��'(�ii L c�> %��/��
Address
rI �
L/.i�j' 7�l � /-� �/� /1, .� _S _ ,
City State Zip
�, ? , _ c� ; , 5
Phone
I understand my rights as stated above.
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Signature "
BUILDING&ZONING—473-7357 • ADMIN[STRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
�.04 RIGSTS OF 3IIBJEC'I'S OF DATA �
gubdivision L Type cf date- The rights of individuels on whom the data is
stored or to be stored shall be as set forth in this section.
- - , gubd, 2. Information requiced to be giv� ����' An.individuel asked to
1 rivate or confidentiel data concerning himself Shall be informed of: (a) the
. • �PP y p state a en
purpose and intended use of the requested data within the collecting g �
tem; (b) whether he ma� refiise or is legaIly
political subdivision, or statewide sys �oy� consequence arising from his
required to supply the requested dats; (c) �►y
supplying or refusing to supply private or te orlfederal le w c receive the data.1tThis.
other penons or entities suthorized by sta P �vesti ative data,
requirement shall not apply when an individual is asked to su ply g
pursuant to section 13.82, subdivision 5, to e law enforcement officer.
The commissioner of revenue ma lace the no�a�tructions�nsteadhos
subdivision in the individuel income tax or ro ert tax re
on those orms. - --- -
3 A�� � �� � ����. Upon request to e responsible "
Subd. .
authority, an individuel shall be inYormed whether h�VBteeor eonfidentisl.e IIpon his
individusls; and whether it is classified as publi�, P ublic data on
further request, an individuel who is the subject of stotr�e�mrl�ae if he desires, shell
individuels shall be shown the data witho Of�hat dat�a. After an individuel hes been
�e informed of the eontent and meaning t� �� need not be ciisclosed to
shown the private data end informed of its uL��Bac�on p��t to this section is
him for six months thereafter unless 8 �SP
, � pending or additional data on the individuh h�gteeor p blie datarupon request by
responsible authority shall provide copies of P �ible authority may require the
the individuel subject of the data. The respe
requesting person to pay the actual costs of making, certifying, and compiling the
copies. 1 immediately, it possible, with any request
The responsible authority shall comP Y
made pursuant to this subdivision, or wit��e �ysimmediatea compliance eisu not
excluding Saturdays, Sundays and legal Y5�
possible. If he cannot comply with the request within that time, he shall so in�orth the
individuel, and may heve an additional five daYs within which to comply
request, excluding Saturdays, Sundays and legal holidsys•
Subd. 4. Pracedia'e �►ben data is not aceurate or complete. An in�ms�. To
contest the accuracy or completeness�of public or p�VBte � the�responsible authority
exercise this right, an in�iv�duel she� notify in ��e 8uthoritq shall within 30
describing the nature of the disagreement. The respo
days either. (s) correct the data found to be inae�iae���ngPec pients namedtby
notify past recipients of inaccurate or incomp
the individuel; or (b) notify the individuel that he believes the data to �ement is
Data in dispute shall be d i s c lose d e n 1 Y i f t h e individual's statement of disagr
• ineluded with the disclosed data. � BPpe�ed purs�►t to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
CITY OF ORONO - BIIILDING PERMIT APPLICATION
$ Date Received:
Date Approved:
Entered By: � Permit�:
A7•T• INFORMATION MIIST BS SIIBMITT� IN FIILL BEFORE PI,AN REVIEW WII.L B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE A.PPZICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRSSS: n�,��' ��/��y wo�/� ��r� ZIP: �S� �j
(work) �'�5- ���
NAML OF OWNER: ,�1�1�c i-/,��� �� if��`��- PHONE: (home) �/7/-0 3/3
I�SAILING ADDRESS: �? S I -Sf�/I�i v/�'v n �Z�� CITY: ��I'z i9 Tr� ZIP: S s 3 �j �
CONTRACTOR: S cz �= PHONE:
MAII�ING ADDR.ESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: PHONE:
MAIZING ADDRSSS: CITY: ZIP:
g�Mg: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration ;�r Renovate Land Alteration
PROPOSF.D WORR (describe in detail) : /� S ��L /� 9 X 7 � C���r�C� �o���
�)v L lris;i.-.��' S �/c�c r�2c
STORIES: SQ. FEST OF EACH FI�OOR:
NO. OF B$DROOMS: GARAGB STAI.Z�S: ATT. DET.
- �( �
ESTI�SATED CONSTRIICTION VALIIATION (eacluding Iand) : $ � ,< �= �-'
I hereby apply for a building permit and I acknowledge that the information
3bove is complete and accurate; that the wor3c will be in conformance with the
ordinances and codes of the City and with the State Building Code; that Z
snderstand this is not a permit and work is not to start without a permit; and
that the work wil 1 be in accordance with the approved plan. ,
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APPLIC�NT'S SIGNATIIRE: � �> �z. � , � . ._ DATE: /! - 5= �.z
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