HomeMy WebLinkAbout1999-011941 - replace windows .�. PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number:
Crystal Bay, Minnesota 55323 `"?'" {'
Date Issued: 941 f) 1
(612) 249-4600 t t ?.``4
SITE ADDRESS:
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DESCRIPTION:
T T N t_�
REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER:
THE UNDERSIGNED ER ' 3 r� S .y''`am 1 � F
! _ -kEE ��A. r ` MAKE A � E,ENT,
SPECIFIED AND AGREES TO 'b WORK OMLNCCI , ���
i_lKtw)NO ORDINANCES AND STATE J3F M I NNES STA: Sof ILD I NG CODE
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
otal Fee: $ ' Date Received:
Wintered By: I 1 (oft Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION �
All information must be submitted in full before plan review will be started.
(please print all information) t
THE APPLICANT IS: (circle one) .' OWNER OR.CONTRACTOR ,
JOB SITE ADDRESS _ eg'2-.11 c� ZIP: SS S
NAME OF OtiRs - `D� �Y�'v PHONE: 4 _UC�Sd
(work)
MAILIq G ADDRESS: CITY:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILEIPAGER:
MAILING ADDRESS: CITY: '
STATE LICENSE: #
ARCIZITECTlENGTi`TEER: 1 r, ,• _ . PHONE:.
_CITY:
ZIP:
IitiTG ADDRESS: REGISTRATION#
NAME:
TYPE OF NVORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED NVORK(describe in detail):
STORIES: - SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: _. GARAGE STALLS: ATT. - DET._____
ESTIMATED CONSTRUCTION VALUATION (excluding lana:
I hereby apply for a building 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 City and with
the State Buildi*ig 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.
APPLICA•N"T'S SIGNATURE: DATE: r'7
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
See.13.04 RIGHTS OF SUBJECTS OF DATA -- -
Subd. 1. Type of data. The rights of individual oa wham the data is stored or to be scored shall be as sec forth in this section
Subd.2. Infos oration required to be given individual. An individual eked to supply private or coafidtndal data concerning himself shall
be informed of: (a)the purpose and intended use of the rcquevmd data within the collecting State agency,Nadal subdivision,or statewide systrz
(b)whether h:;.ay refuse at is le required to supply-the requested data:(c)any Ierowu consequence arising from his supplying orre fusiag to supply
private or cOmFdendal dam;azd(d)the identity of Otherpersoas or enrides aut4orized by state or fede_'!zw to receive the d33. This require.:enc sh.T!
not apply wi:hn an i.dividual is asked to supply investigative dam,pursuant to secdoa 13.82,subdivision 5,to a law eafarcementofficer.
The eerunisforer of revenue may lace the notice rauir_d under this subdivision in the individual income tax or orooery tax refund
Instructions L-tstead of on those forms.
Subd.3. Access to data by individual. Upon request to a respacsible authority,an individual shall be Informed whether he is the subject
of stared dam on individuals.and whether it is classified as public,private or confidential. Upoa his further r_quesr an individual who is the subject
of stated private or public dam on individuals shall be shown the dam without any charge to him and;if he desires,shall be informed of the content
and meaning of d=data. After an individual has beta shown the private dam and informed of its meaning,the dam need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is pending or additional dam on the individual has been collected or created.
The responsible authority shallprovide copies of the private or public data upon request by the individual subject of the dam. The responsible authority
may require the rtquesdag person to pay the acetal costs of making,certifying,and compiling the copies.
The responsibte authority shall comply immediately,if possible,with any request trade 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 tierce,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and Iegal holidays.
Subd.4. Procedure when data Is not accurate or complete. An individual may contest the accuracy or completeness ofpublic orprivam
dam concerning Himself. To 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)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the dam to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed dam.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
eontes..d 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 Ment 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.
Fust Middle Last
City Suite Zip Phone
I understand my ricy is as stated above.
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01• CITY OF ORONO
F � SITE PLAN - GRADING PLAN
5 s r K A PPROVED
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