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Home My WebLink About1997-009677 - replace windows PERMIT C�Y OF ORONO PERMIT TYPE: ?'50 Kelley Parkway- P.O. Box 66 - Crystal Bay, Minnesota 55323 Permit Number: . .. . (612)473-7357 Date Issued: SITE ADDRESS: - . ��: . . , . .. DESCRIPTION: _ � � : � .. `:. - ...,_ � _:: � _; . . �.: - . ;:. : � <. . ... . __ - .. , ? ._�., . . � � ; t � � : _ . : .:W,.. .: .. ,. .. _. . �� . , . _ _._ ._ _ � . _ . � �. � -.:-:_:_: . ;� � =, - - ;'.=i:� _ _ . . . _ _�.. _ . . . .._ _ __ . . . .._ REMARKS: FEE SUMMARY: CONTRACTOR. .; . ;.-.:. _ ;-; ! - . : , . OWNER: - : _., ,. - . _., . , ; . . ,:_ . . :-�. = _. . . , : , _ �� t: . _.,_., -_ _ {� �¢+it_ 6�, ��2+..t!y!�� G��i�,.��i� i b�i.1;-S,��«.,.n�4�' �t�.!x,'f k��'`8, ,�• 3�;V��q� �£ �:,�.�-r �€=.��t f��+f ��..��-'�r��== �'�'t ��f i ��.,. �1��1�: I i� �;�'�`;�`�:`t �"$��'�.I r��,�.� ��T� �a�� i�,-� ��: :",�_ ";"�; �:�� I�t��=��%: ��i�;_` �fi��i- �,��:��'�' F��'��?�.��:��''��.. _ :: � � . �u�: _. . � � � � � � :- .._ (.l!�i�uc�z LI A ERMITEE S NATURE ISSUED BY:SIGNAT E � � � Total Fee: $ �f„.�� Date Received: Entered By: ,� Pernut#: �� ?� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ' ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: 'j�.�7S/ es� W�.r2n� �I� ZIP: �S-�SO��-�NS NAME OF OWNER: � b(p �,�.�a PHONE: (home) (work) MAILING ADDRESS: �SzS��.��CITY: �r�,,,_,9 ZIP: CONTRACTOR: T,,,�„�� )"��n J� PHONE: c.{-7 g av� �- CONTACT PERSON: � �,o ,,_e__ MOBILE/PAGER: �i 4�C,Sf MAILING ADDRESS: �3 y�� ,,�.-Id.e�a�� CITY: �� ,J ZIP: SS.�4�c7 STATE LICENSE: # �'3�g' ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME; REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration <' Land Alteration PROPOSED WORK(d scribe in detai�: (� � � ��-c 4�-.__ lc�o �r �d�2ofl� kr��s��'rf�—�'��.s �L�-- < � STORIES: ��L-_ SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �,�a °� I hereby apply for a building pernut 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 City and with the State Building Code; that I understand this is not a pernut and work is not to start without a permit; and that the work will be in accordance with the approv plan. APPLICANT'S SIGNAT . DATE: � /O ��_ , NOTE! Parade o�Homes e ents require separate permit approval by Police Deparlment and City Council 60 days prior to the event. Non pernzitted events will not be allowed. (�• � � �s S c�- G,�� - . . � -+� Sec.13.04 RIGH'TS OF S[JBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom che dare is stored or[o be stored shall be as set forth in rhis secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendai data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting�tate agency,political subdivision,or statewide sysum; (b)whethet he may refuse o'r is legally required to supply the requested data;(c}any laiown coesequence arising from his supplying or refusing to supply priva[e or confidendal data;and(d)the idenriry of other persoas or enrides au[horized by state or federal law to roceive the data. This requirement shall not apply when an individual is asked to supply invesdgadve.data,punuant to section 13.82,subdivision 5, to a law enforcement o�cer., The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income tax or_prooem tax refund instrucrions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stomd data on individuais,and whecher it is classified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wichout any charge to him and,-if he des'ues, shall be informed of the content and meaning of[hat data. After an individuai has been shown the private data and informed of its meaning,the daCa need not be disclosed to him for six monttts thereafter unless a dispute or acdon pursuant to [his secaon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acrual cos[s of making,certifying,and compiling the copies. The responsible aurhoriry shall 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 compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal 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 of public or private data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccutate or incomplete and attempt to nodfy past recipienu of inaccutate or incomplete data,including recipients named by che individual;or(b)noafy the individual thac he believes the data to be cortect. Data in dispute shall be disclosed only if the individuai's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the adminisaative 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 fumish 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 eztent 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. 1 �,�I � ��-�� -� y-t'^ - First � D'tlddle Last ��5� � � ,� � )o v �� Addres \ ,, ` �/i/ ��1C�� O C-C�� `�`� � 'State Ztp �one City I understand my rights as sta d above. � _`_---_ Signamre , ' PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE Minnesota Statute Section 176.182 requires every state and local licensing agency to wit.�hold the issuance or renewal of a license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Section 176.181, Subd. 2. The information required is: The name of the insurance company, the policy number, and dates of coverage or the permit to self-insure. This information will be collected by the licensing agency and put in their company file. It will be furnished, upon request, to the Department of Labor and Industry to check for compliance with Minnesota Statute Sec. 176.181, Subd. 2. This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not pro�ided and/or is falsely reported. Furthermore, if this information is not provided and/or falsely reported, it may result in a $1,000 penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry payable to the Special Compensation Fund. Provide the information specified above in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. Insurance Company Name: (NOT the insurance agent) Policy Number or Self-Insurance Permit Number: Dates of Coverage: OR I am not required to have workers' compensation liability coverage because: ( � I have no employees covered by the law. i ( ) Other (Specify) I HAVE READ AND UNDERSTAND MY RIGHTS AND OBLIGATIONS WITH REGARDS TO BUSINESS LICENSES, PERMITS AND WORKERS' COMPENSATION COVERAGE, AND I CERTIFY THAT THE F RM ION PROVIDED IS TRUE AND CORRECT. (Signature) ate) �/�� P�y� (Bu— siness PhonT il�umberj