HomeMy WebLinkAbout2006-application-No permit required �J c� 'nti` r �`�e1 J 11l/e'Y� � l'�„-^
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Total Fee: $ � � ` Date Received:� U�%
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Entered By: � �=+ `� ' x _
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all�nforrnation)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �:� .' �' ` i��-rl/,�� � �✓'e- ZII'� �' =5 ��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes 0 No !f yes, a specinl event pej�mit is requi�-ed with Police Departrnent and City Cot�nci/approva!
60 days prior to the event. Shuttle bus service�vill be reqi�ired unless applicant denzonstrates
strffrcient on-site par•king is available. 1�'on-permitted events tivill not be alloived.
NAME OF OWNER: ��i �` r T�' /��.��.-;��^`� PHONE: (home)
(work)
MAILING ADDRESS: .2�'rC.` ,��_r '.�i� - �:��' CITY: ,��fl�fn ZIP: �''"� �' !
CONTRACTOR: :,�.�F .i � /�•.-�./� � :-.,, PHONE: �,�. ,� ,,� ... �;'i
CONTACTPERSON: ^/o;-.� �t/, ;,�•% � MOBILE/PAGER:
MAILING ADDRESS: ��/ �s �� � .��.1.,�� CITY: /����S r ,,�u ZIP:S S;;� 3
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
NIAI�,iNG A���SS: CI'7'Y: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home ,✓,� Addition �/�1 Accessory Structure v�.fi�
Move Home ,�-q Remodel/Alteration (ie: Siding, Windows) ,-✓2//�
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detcrin: ��;���✓s �-.,,�,;��; ,r y����s l�°�
�'r�,,�c ,�l�t:��c+,�o i'E'�e
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHEI)
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ s^.L:,���� "�
,
[hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate;
that the work will be in confonnance with the ordinances and codes of the Ciry 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���-��.�---�- �_ �r��"�.... DATE: ,��y���
3t
Sec.13.04 RIGHTS OF SUBJECTS 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 section.
Subd.2. Information required to be given individual. An individual asked to supply private orconfidential data concerning himselfshall be
infonned of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confdential data;and(d)Gie identiry of other 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 investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of revenue ma�place the notice required under this subdivision in the individual income tax or prope�tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible suthority,an individual shall be informed whether he is the subjectof
stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of
stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed ofthe 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 thereafte�unless a dispute or action pursuant to this section is pending or additional 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 authority
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compl iance 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 to 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 oFpublic or private data
conceming himsel£ 'fo 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)corcect the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete dat�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 disclosed data.
The determination of the responsible authoriry 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 qualification 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
..—�� >
Signature
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