HomeMy WebLinkAbout1998-010666 - land lateration � PERMIT
CITY OF ORONO PERMIT TYPE:
2?��Kelley Parkway- P.O. Box 66 t�f°���� s iL_�i�.i���.
� � Permit Number. �i i i_ti�,r�`,
Crystal Bay, Minnesota 55323 � _� ;;�::,
(612) 473-7357 Date Issued: t;�;i•�:._. _.�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - '��`�'' ��=`'�'T� �
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATU �.
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Total Fee: $ ��""--- Date Received: ,
Entered By: �� Permit#: /O�olo�
CITY OF ORONO - BUII.DING PERMIT A�PPLICATION
All information must be submitted in full before plan re�iew will be started.
(please print all information) .
T'HE APPLICAI�"T IS: (circte one) O�VNER OR CONTR.ACTOR� � � .
[, . I .
JOB SI'I'E ADDRESS: � ��D �S/10rQ I1 �L� ,pC. �c��IP: ��3�1 �
� NAME OF Oti�NER �z�� ��a ��7`�i P V'n� PHOiVE: (home) � �7� —� �j'�
(work) ��� — �� �a
1�IA.II�ING ADDRFSS: ,y�a w�.�P_.� CITY: ZIP:
. , �
CONTRA.CTOR: G. L. �m,n�ra,c-I-,'r,�. � � PHONE: 4-78-c15Z� � ;
COl�t'I'ACTPERSON: �,•f MOBILE/PAGER: 8�t-Zt�¢ �
I`�A�'�T�i 1G ADDRFSS: �o �l lo�.� D�. CI�Y: f✓�ed�'►.�q ZIP: 55�.�.0
STATE LICE�'SE: #
ARCHIT'ECT�E�'GINEER: (�,hes-F��. �- �ss��, PHONE: �3�- ��G �
;�•IAILIVG ADDRESS: 2335 v�l. l-�ws. 3� CITY: �f• �� ( ZIP:�_
I�'AME: G(enn �ti�ok T—REGISTRATION# `�S(
TYPE OF tiVORb': New Addition Accessory Structure
Move � �`'� Remodel/Alteration Land Alteration_�_
PROPOSED�SVORK(describe in detai�: �n f „ e�,� G,eh �� �o C.�.. 1
-�r'o✓��"aaP QAAd'c�x (CY� � �o �- ¢� ���4G� /es% �-1-�n �"�oc� c-
STORIES: SQ.k'EET OF EACH FLOOR: � -
NO. OF BEDROOMS: GARAGE STALIS: ATT. DET.
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E.STIl�i IA.T'ED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a buildinJ permit and I aclmowledoe that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Buildin� Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be i.n accordance with the approved plan.
A.PPLICA:�IT'S SIGNAT'URE:� � _DATE: �� �
NOTE! i'arade o Homes events require separate permit approval by Police Department and
� City Council 60 days prior to the event. Non permiited events will not be allowed.
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Sec.13.04 RIGFiTS OF SiTBJECIS OF D�TA
Subd. 1. ?ype o[data. The righcc of individual on whom che data is scoced or to ba s:or.d shalI be as sec foc�ia this secaon. -
Subd.2. Iaformation required to be pvea iadiddual. An individual asked to suppty private o�coaFdeadal dard eonceraing himttl[shall
be icformed o!: (a)eh�pnrpose aad inreaded use of che requesc�daa within che cotlecring Srate ageury.polidca!subdivision,or sac-wide rys.em;
(b)whecher he may r_fuse or is(e3alIy czquir_d m suppty ehe r:quest:d d3n;(e)any]mowa eoasequence arisiag fromhis supplyiag or reCusiag to suppty
privar_or eon.zdendal daa;u:d(d)the idendry of other persoat or enrides aachociz:d by sc;ce or fedecal law ta receive the dara. This requirement shall
-not apply when att individual is asked to supply iavesrigadve dan,punvant to secdon 13.83,subdivision S.to a law eaforcement offccer. — .
The eommissioner of revenue mav olace the rtocce reaui�:d under this subdivision in the individual incone ctx or oraoem az tsfued
inscrucciors inscezd of on chase forms.
Subd.3. Aeeess to data by iadiv-idual. Upon request w a responsible auchoriry,an individual shall be infocraed whed:er he is the subject �
of scor:d daca on individuals,and whaher ic is etusified u pubiic,private or confedenaal. Upon his turcher tequest,aa individual who is the subjeu
a!scor.d private or public daci on individuals shall be shown che data widsaut aay charge to him and;if he desires,shall be infocmed of the conttnt
and meaniag o[that dara. Aher an individua!has been showa�he private data and iaformed of ics meaning,the data nead not be d'udased to him for
six monchs t�ereat�er unIess a dispuu or acrion pucsuanc w chis secdon is pending or addidonal dara oa the individual has been colkec:d or ereared.
The r_sponsibl:att�horiry shall provide copies of the private or public data upon reqaesc by the iadividual subjecc of che dan. Tbe responsibte authoriry
may cequire che cequuang pe�son to pay the accual cosc�of making,cecdfying,aad compiling che copies.
'Ihe responsible auchoriry shall ce,aply immediacely,if possible,wich any nquest made pursuant to chis subdivision,or wichin five days of
che dac:of che request,exctuding Sacurdays,Sundays and legat holidays,if immediate compliance is aoc possible. If he canaoc comply with the requesc
wichin thac titne,he shail so intorm�he individuat.and may have an addidonal f ve days widun wluch to comply wich the requuc,e�eiuding Saturdays,
Sundays and legal hotidays. "
Subd.4: Proeedure r�hen data is not aeeunte or eomplete. An individual may contest the accuracy or compleceness of publie or privace
daca concerning h'ir•sselE. To ezercise this righi,an tridtvidual shall nodfy in wridng the responsible au�horiry describing the natuce of the disagceemeac
The responsible authoriry sh�ll wi�hin 30 days eichec: (a)eorrect the dan faund co be inaccance or incompiae and acumpc to nodfy puc ncipiencs of
inaccurate o�ineomptete daca,including recipiencc named by the individual;or(b)aoafy[he individual that he believes the data to be coaecc Data
in dispuce shalt be disclosed only if�he ind'e�idual's sa�emenc o[disagre:rr:en�is induded wirh eh:d'uclosed dzn.
The dececminadon of the responsible authoriry may be appealed pursuant co the provisions of che adininisQarive procedure act reladng to
eontested easts. �
DATA PRIVACY ADVISORY �
In accordance with M.S. 13.04,Subd.2, "Righ.ts of subjects of data",we would like to inform you that your request
for a pemut or license from the Ciry of Orono or any of its deparcments may require you to furnish cenain private or
confideatial information.
You ue notified that:•
1. The information you furnish wiil be used to deternliaeyour qualification for the permit or licease requested.
2. You may refuse to supply data, but refusal may require that the City, deny the permit or licease.
3. The information may be shared�with ocher local,state or federal agencies to the excent necessary to process
' the permit or license.
4. If your requested permit or license requ�res Council actibn to approve, some information maq become
public.
5. � You have cenain rights under M.S. 13.04 (available upoa request) to review private data on yoursalf.
6. Your full name is required to process this application or permi�. :
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