HomeMy WebLinkAbout1996-09-17 App for Land Alteration PermitI
Total Fee: $_
Entered By: __
Date Received:_____
Permit#:
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 (|g'cONTRACTOR~
JOB SITE ADDRESS: _________ZIP: $5^5^
NAME OF OWNER: ___________ PHONE: (hoiiie)^^^-Q^S9
(work)
MAILING ADDRESS: Ifet CITY:
CONTRACTOR: j/kfC.__________PHONE:
CONTACT PERSON: AL MOBILE/PAGER: j .'O-
MAILINGADDRESSriM^S^jy^Lfly/Mfe. CITY: CPfiK^ ZIP:
STATE LICENSE: » /
I
IptVfffp'
ARCHITECTIPMrjHrBP'
MAILING ADDRESS: P&
NAME:
____PHONE: ^-^02.
CITY: ZIP:
REGISTRATION#
TYPE OF WORK: New
Move
Addition
Remodel/Alteration
Accessory Structure
Land Alteration ^
PROPOSED WORK (describe in detail): » pCOU
STORIES:________ SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS:GARAGE STALLS: ATT.DET.
ESTIMATED CONSTRUCTION VALUATION (exclu4|ing land): )
I hereby apply for a building permit and 1 acknowledge tjiaftlje, information above Is complete and
accurate; that the work will be in conformancfe with the ordinances and codes of the City and with
the State Building Code; that I understand* this'is* iibt a permit and work is not to start without a
permit; and that the work will be ima<^rdance jvith 1)19 approved plan. * . • V
DATE::APPLICANT'S SIGNATURE: .
NOTE! Pnrndp 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.
f
id
Sec. 13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the daa is stored or to be stored shall be as set forth in this section.
Subd “» Information required to be given individual. An individual asked to supply private or confidential data concerning himself shail
be informed of: fa) the purpose and intended use of the requested data within the collecting State agency, political subdivision, or statewide system:
... . ______t____I__________thm r..mi^«f..H data- tci anv known conseouence ansuie from his supplying or refusing to supply
be informed of: (a) the purpose and intended use of the requested data w.thm the collecting state agency, po.ioca. suooiv.a.un. ur >u»cwiu.
(b) whether he may refuse or is legallv required to supply the requested data; (c) any known consequence ansing from his supplying or refusing to supply
private or confidential data: and (d),thc idepaty of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individi|al is asked to supply investigative .data, pursuant to secnon 13.82. subdivision 5. to a law enforcement officer.
The, commissioner of revenue mav place the nonce required under this subdivision in the individual income tax or property tax refund
instructions instead o? on those forms. , ' ^
Subd. 3. Access to data by individual. Upon request to a responsible authority, an individual shall be informed whether he is the subject
of stored dau on mdividuals. and whether it is classified as public, private or confidential. Upon his further request, an mdividual who is the subject
• vi' • • ' *L.i* ■ - -u-ii u- •kA fA him Aficf. if hc dcsiTcs. sh^ be informed of the contentof stored pnv^te or publiccVS di uidividuals shad b. shoJb d.. dab. »id,Obi ahy him a«t. if h. das.«s. shaU ba ib/o™.d of d.= coo.a„.
and maaoio, of-d-l da». Aha. ^iod,.ido. baa b„„ ^
sS it, ........ da,.
the date of the request, excluding Saturdays. Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with
within that time.'te'shall so inform the individual, and may have an additional five days within which to cqmpjy with the request, excludmg Saturdays.
Sundays and legal hfilidays. *. ’ ‘ • .Sundays and legal hfilidays. _ ^
• • • Subd 4 Procedure when data U not accurate or complete. .\n individual may.contest thqaccuracy or completeness of public or pnvate
ditfdoi.con.lng him»lf. To oxercte d* righl. ao indivalual shall oonjy-in »noh, dtt (el|»as,W,u.ll»!iB' doKnlbbS
contested cases'. ' ' . , • • . V ^
DATA PRIVACY ADVI.SORY . .
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 depanments may require you to furnish cenain private or
confidential information.
You are. notified that:
’' ' I i '' 'the infAnhation.ybufurnish will b« used to determine your qualification for the permit or license requested.
•• i t,' < t 2, -a • i You* may. reftise to supply data, byt’r^s^ ihay require that the Qty deny jhe pe^.t.oj license
‘ ' / ‘ 3. .‘^.TTie information may be shared with other local, staie or federal agencies to,the extent n^es^aiy td process
^ ” * ■ • - • the oftrmit or ficense. ...
4.
the pftrmit or ficense. .
If your requested permit or license requires Council action to approve, some information may Decome
5. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself.
, • . ^ ' your full name is required to process this application or permit.
A/ai j I---------------------------
First
Address.
Usi
City
kklMlSislk
1 Sute Zip Phone
I understand my riahts ^ yated above. • . ,
0^1Signanire