HomeMy WebLinkAbout1998-010550 - land alterataion PERMIT
�C�'�"Y OF ORONO PERMIT TYPE: - -
275 Kelley Parkway- P.O. Box 66 t;�=;`�4�'�'4 4�:"�}-}
� Permit Number: i:i i i._=;�+
Crystal Bay, Minnesota 55323 . _ _ _
(612)473-7357 Date Issued: �;;_;;•�_�;/�-;;�;
SITE ADDRESS:
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FEE SUMMARY:
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��+ PLICAN /PER I SIGNAT RE ISSUED BY:SIGNATUR 'G"� •
�I'otal Fee: $ Date Received:
Entered By: C!, . Permit#: /G.��.��
CITY OF ORONO - B�.TII.,DING PERIVIIT APPLICATION
A.11 information must be submitted in full before plan review will be started.
(please print all information) .
----------------------------------------- -_--_-- - �--�-_=%�___�----- ---= --
THE APPLICAI�TT' IS: (circle one) O�VNER OR NTRACTOR � � .
JOB SITE ADDRESS: ��G�} tS ix� � ZIP:
� NAME OF OWNER: '�,�'b �� �,�►..an.- PHO�IE: (home)
(work)
MATLING ADDRESS: � CITY: ZIP:
CON'I`RACTOR: �.�.� Ccr.i r o� PHOivE: �7.��.� 73
CONTACT PERSOI : ;: :� MOBILE�PAGER: � �C}�-G ?
1��lI.I�i tG ADDRESS: /3 c�a / �e I�'�' ,::�~T%��L CITY: ' �.e� ,--:� ZIP: .s-(<, /
STATE LICENSE: #
ARCHITECT/Ei\TGINEER: PHO�IE:
NIAII,ING ADDRESS: CITY: ZIP:
I�,TAME; REGISTRATION#
TYPE OF tiVORb': New Addition Accessory Structure
Move � Remodel/Alteration Land Alteration
PROPOSED'�VORK(describe in detai�: � �� �G�� ��.� ��iv,�
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STORIES: SQ.FEET OF EACH F'LOOR: - -
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIi1�IATED CONSTRUCTION VALUATION (excluding land): �
I hereby apply for a buildin�pennit and I aclrnowledge 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 pe 't and work is not to start without a
permit; and that the work will be in acco ce with e a ' roved plan.
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APPLICANT'S SIGNAT'URE: �"; ,!� '� DAZ'E: ��''
, �
NOTE! t'arade of Homes events require se arate�rmit approval by Police Department and
� City Counci160 days prior to the event. Non permitted events will not be allowed.
_ . �.
Sec.13.0:RIGHZ'S OF SUB.TECTS OF D�Ta
Subd. I. Type of daca. The rizhcs of individual oa whom thc data is stored or to be scor:d shalt be as set foru`�in this secaon. -
Subd.2. Information reqtrired to be given indi�idual. An individual asked ro supply priva[e or confidenaal data concerning himseif sball
be informed of: (a)the purpose and in�nded use of the teques�dara wi[hia the collecdng 3tatt agency, polidcal subdivision,or statewide ryr�m;
(b)whe�her he may r_;vse or is legally requir.d to supply the r:quested dac�;(c)any Imown coasequeaca arising from his supplying or refusing to supply
privac_or connden3�1 data;az:d(d)the idenary of ocher persoas or enades auchorized by s�ate or federal law co receive[fia data. This requuemeat s�all
r.bt apply when an ir.dividual is asked to suppiy invesrigadve daca,pursuanc to secdon 13.82,subdivision 5, to a law enforcemenc ofricec. -
"[h� com;.issioner of revenue mav olace tha norice r_auir_d under chis subdivision in the individual income ax or orooem [ax REllCd
insm�caons insread of on�hose forms.
Subd. 3. Access to data by indiridual. tipon rcquesc to a responsible auchoriry,an individual shall be informed whecher he is the subjecc �
of scord dac�on ir.dividuals,and whzcher ic is classified as pubiic, private or confidenaal. Upon his further tequest,an individual who is the subjecc
of scor:d privace or public dara on individuals shall bo zhown che dat;wi�houc any charge to tiim and;if he desues, shall be informed of the eoncenc
and meaning of chat data. Ahar an individual has been shown cho privam data and informed of ics meaning,the data need not be disclosed to hira for
six monchs tt:ereafe.r unless a dispute or acdon pur�uane to chis secaon is pznding or addidoaai data on the individual has been collecc�d or creaced.
The responsibl�au�oriry shall provide copies of the privac�or public daca upon request by the individual subjecc of the data. Tnz responsible auchority
may requir the reques:ing pt�son to pay the actual costs of a�king,cerrifying,and compiling the copies.
The responsible auchoriry shall comply immediately,if possible, wich any request mada putsuant to this subdivision,or wi�hin five days of
the da�e of cha requast,excluding Sacurdays.Sundays and legal holidays,iF immediate compliance is not possible. If he cannot comply with the r:quesc
wichin tha[cime,he shail so inform che individual,and may have an addiaonal five days wichin which to comply with the request,excluding Saturdays,
Sundays ar.d legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest[he accurdcy or completenzss of public orpri�•ate
data concerning hir.:self. To exercise�his ri¢hc,an individual shall noa"ry in wridng the responsibla auchoriry dascribing the nature of che disagreemeac
The responsible aucl:oriry shall wichin 30 days either: (a)comct the data found to be inaccurate ar incomplece and attempt to nodfy past recipienu of
inaccurate or incomplece data, inciuding recipiena named by the individual; or(b)aoafy the individual that he believes ehe data to be correcc. Data
in dispute shall be disclosed only if the individual's sc3�emenc of disagreement is included with che disclosed da�a.
The decerminarion oF the responsible aurhoriry may be appealzd pursuant to the provisions of che adminiscrarive procedure act reta¢n� to
conta�ed cases.
DATA PRIVACY ADVISORY
In accordance wich 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 Ciry of Orono or any of its departments may require you to fumish cercain 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, buc refusal may require tha[ the Ciry deny the permit or license.
3. The information may be shared with other local, state or federal a�eacies to the excent necessary to process
' the permit or license.
4. If your requested pernut or liceuse requires Council acttbn to approve, some information maq become
public.
5. You have certain riQhts under M.S. I3.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permic.
Firsc �fiddle Lasc
Address
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City Srate �`iQ Phone
I understand my ri�hcs as st �
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Signature �---