HomeMy WebLinkAbout1998-010566 - land alteration , : PERMIT
` CITY OF ORONO PERMIT TYPE: , �-�-� -�-�,:--;���
2750 Kelley Parkway- P.O. Box 66 ='3='"��'� ='�� ��"'=-='
Crystal Bay, Minnesota 55323 Permit Number: �_;�4_�L;�,�_
(612)473-7357 Date Issued: �;_;;s��j:�w;
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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APPLICANT� M EE ATURE ISSUED BY:SIGNATURE .
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R Total,Fee: $ �'1_�D� Date Received: � ;
Entered By: ,C.�. ' Permit#: �D �?o� a�/D Sb�
CITY OF ORONO - BUILDING PERtVIIT APPLICATION �
All information must be submitted in full before plan reYiew will be started.
. (please print all information) .
� THE�APPLICANT IS: . (circle.one) OWNER OR. ONTR.ACTOR� . . . � � �
aos sx� annxEss: �I3C�� l,v a-���,y,,N P-d z�:
�a� ss ��, A�• �.� � , .
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� NAME OF Oti'�NER: , �t�S �dhn.b�r/ PH0�1E: (home)
C(na� les Lavs�� � (work)
MAILING ADDRESS: � . CITY: ZIP: �
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. �
CO�I'I'RA.CTOR: c�S �-P C�c�+�l��[�v� PHOi�TE: ���3 -C�3 7� !
COy'TACT PERS ON: `�,r�-}-�Y t L MOBII.E/PAGER: o'L FSU-C�7�/L �
MA.ILT�i TG ADDRESS: /30�/ F�4(It I rt iavt-l-'rat I CITY:�II R�� ZIP: fo0/ �
STATE LICENSE: # .
AF.CHITECT/EI�'GINEER: �PH0�1E: �
MAII.l�i TG ADDRESS: . CITY: ZIP:
NAME: REGISTR.ATIO�I#
TYPE OF ZVORb: New Addition Accessory Structure
Move ' � Remodel/Alteration Land Alteration
PROPOSED tii�ORB(describe in detai�: i �+ti- �2 �Y
STORTFS: SQ.FEET OF EACH FLOOR: • - -
NO. OF BEDROOiVSS: GA.RAGE $TALLS: ATT. DET. � .
. � � . .,
FSTII�IATED CONSTRUCTION VALUATION(excluding land): $
I hereby apply for a buildin�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 Ciry and with
the State Buildin� Code; that I understand this is not a permit d work is not to start without a
permit; and that the work will be in acco 'th appr ved plan.
� .
APPLICANT'S SIGNATURE: ' DATE:
NOTE! P,�rade Q A'omes events require separate pe it approvat by Police Department and
' City Counci160 days prior to the event. Non permi ed events wilt not be allowed.
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Sec.13.04 RIGHTS OF SLlBJECIS OF D�TA �
Subd. 1. Type of data. The righcs of individual on whom the data is scored oc co be scor:d shall be as sec forsh in this secdac. -
Subd.2. IaPormaHon reqvired to be given iadiridual. An individusl uYed to supply private or confideaaal d.aea concemiag himsdf shatl
be iatocmed of: (a)the purpose aad inteaded use of the reques�data wichin the eallecang Stare agency,polidcal subdivision,or satewide rystem;
(b)whecha he may r:�use or is legal[y requimd to suppty the requesud daa;(c)any laiown coasequence arising!rom his supplyiag or refusing W supp(y
priva�e oreonndendaI dara;ar.d(d)�he ideariry of o�her persons or encdes auchoriz:d by smce ar fedecai Iaw to receive the data. Thu tequirement shaIl
�nnc apply when an individual is asked to suppiy invesdgacve daa,pursuaac ro seerioa 13.83,subdivision 5,to a taw enforcemen[ofFccer.
The eommissionec of�evenue mav vlaee che nodce r�uir-d und-r chis subdivision in �he individual incone tax or oraoectv taz reCuad
inscrucdocu�nsce�d oC on chose foans.
Subd.3. Access to data by indivfdual. Upon requesc w a responsible au�horiry,an individual shall be infocraed whechec he is[he subjecc '
of scor_d dati on individuals,and whetha ic is dusified u pubiic,privacr,o�conFdendal. Upon his fucther requesc,aa individual who is the subjec�
of scored private ac public daa on individuals shall be shown[he dam wichouc any charge to him and;if he desires,shall be infocmed of the eoateat
and meaning ot that dara. Aher an individual hac been shown the privace data and iaformed of ics meaaing,the da�aeed not be disdosed ro hica for
si�c moncfis thereacrcr unl:ss a dispute oc acdon pursuanc ta �his secdon is pending oc addidoaal daca on the individua!has been collec�d oc creared.
The r_sponsibie authoriry shall pcovide eopies of the private or publie dan upon request by the iadividual subjecc of the dara. The responsible authoriry
may require[he cequesang pecson to pay the accual cosc�of making,cerdfying,aad comp�ing the copiu.
The responsibte authociry shall compiy immediace(y,if possibte,wirh any requesc made pursuant to thi5 subdivision,or wirhin ftve days of
the dan_of the request.ezcluding Saturdays.Sundays and legal holidays,if immediate compliance is not possible. If he caanot comply with the requesc
within that time,he shatl so infocm the individual,and may have an addidonat five days wi�hin which w comply wich the request,ezctuding Satundays.
Sundays aad legat holidays.
Subd.4. Procedure Khen data is not acc.vrate or complete. An individnal may coatest the accuracy or compteteness of public ocpcivate
dan cancecning tivaselG To exercise this right,an individual shatl noefy in wridng the respoasbie suchoriry describing the nacure of the disagreemeec.
The responsible authoriry shall wichin 30 days eirhec: (a)correct the dsta faund to be inaecurace or incamplete and attempt W nodfy past reeipieats of
inaccurate or incomplete data, inctuding recipieacs named by the individ�ai;or(b)noafy the individual that he believes che data to be correcc Data
in dispute shalt be disclosed only if the indir•idual's satem�nt of disagreerr,ent is inctuded with th:diselosed dara.
The dececminadon of the responsible au�horiry may be appealed pursuant to the provisions oF the administrarive procedure act relaang to
contested ca.ses.
DATA PRIVACY ADYISORY �
In accordance wi�h M.S. 13.04.Subd.2, "Rights of subjects of data"�we would like co inform you that your request
for a pemut or license from the Ciry of Orono or any of its departments may require you to fumish cenain private or
confideatial information. - �
You aze nocified that:•
1. The information you furnish will be used to dttermine 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 licease.
3. The information may be shazed with other local�state or federal a�encies to the extent necessary to proctss
' the permit or license.
4. If your requated permit or license requires Council actlbn to approve, some information maq 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.
Firsc � Middie ��
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