HomeMy WebLinkAbout1993-005001 (Remodel) v � PERMIT
CITY OF ORONO ' � PERMIT TYPE:
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1335 Brown Rd. South • P.O. Box 66 Permit Number: - - -
Crystal Bay, Minnesota 55323 Date issued: �=l�-l��-�����
(612) 473-7357 `-'='`'�`=,f��=::
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PER ITEE SIGNATURE ISSUED BY:SIGNATURE ��yv)
CITY OF ORONO - ��UIL�ING PERM.IT APPLICATION
Total Fee: $ �� � �� �� Date Received:
Date Approved:
Entered By: ' ,� i�t,- � -
Permit�: ` �����
ALL INFORMATION MIIST B$ SIIBMITTBD IN FIILL BEFOR.E PI,AN REVIEW WIZ�L B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
� A.PPLICANT IS: (circle one) OWNER or CONTRACTOR
Jos si� �nx�ss: '�'�-�S� ��� ���,�. r�=`��� ��c�D zzP:�����/
(work)
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CONTRACTOR: �� t�O N/��0 6U l;-G�� 5 l PHON$: �i����� �'
MAII,ING ADDRSSS:yY� A ��-(.,_ j L ,� I � , �� ���"�CITY: ZIP:
Cy,
STAZB Z�ICENSE: ���% 7 oZ /
ARCHITECT/ENGINEER: PHONE:
MATLING ADDRESS: CITY: ZIP:
NAME: RBGISTRATION u
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration C/'- Renovate Land Alteration
PROPOSF.D WORK (describe in detail) : �Y�J�i�[.�� �� C 1�,� Z�G(.� S � �� �S ,��1�(u�
STORIES: � SQ. FEBT OF EACH FLOOR:
:70. OF BEDROOMS: G�GE STAI.LS: ATT. DET.
ESTIMATED CONSTRIICTIDN VALIIATION (eacluding Iand) : $ �v�Jl�'
I hereby apply for a building permit and I acknowl.edge that the information
above is compl.ete 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 per it and work is not to start without a permit; and
that the work wil 1 be in acc rdance with the approved plan. .
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APPLICANT�S SIGNATURE: DATE:� /
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� � CITY of ORONO
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`` ' � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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� - � Y o � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
Iicense 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 wi3.l be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other iocal , state or
federal agencies to the extent 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 to review priva��
data on yourself.
6. Yaur full name is required to process this applicatian or
permit.
�1�Fr����� ���� � c +�a C—
First Middle Last
/��'� ��'���u ,� ��-�K- �0
Address
��.' ��/��'�-l�- 1�1 ��'l�/ �=�^�-�-��
City � State Zip
����6 �c
Phone
I understand my rights as stated above.
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S gnature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
513.04 RIGHTS OF SIIBJECTS OF DATA -
Subdivision 1. Type of data- The rights of individuals on whom the data is
stored or to be stored shall be es set forth in this section.
Subd. 2. Information required t° be g��� u'���`L An.individuel esked to
� � supply private or confidentiel data concernin�g �BmWi hin the collecting state agency,
purpose and intended use of the requested
political subdivision, or statewide system;
(b) whether he may refuse or is legally
required to supply the requested date; (c) any known consequence arising from his
supplying or refusing to supply private or confidential data; and (d) the identity of
other persons or entities authorized by state or federal law to rice�est gat ve da a
requirement shall not apply when an individual is 8sked to supp y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav ro1e�� tgX re�und instructeonsunsteadhOs
subdivision in the individual income tax •r
on those orms. _ - --- - -
Subd. 3.
Access to �.ta bp in�vi�L UPon request to a responsible "
authority, an individusl 5hall be informed whether h r vateeor confident e.l.e Upon his
individuels, and whether it is classified as public, p ublic data on
further request, an individual who is the subject of Se to himrlendeif he desires, shall
individuels shall be shown the date withou�fan�y ��g. �,fter an individual hes been
�e informed of the content and meaning the data need not be �isclosed to
shown the private dats and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dfspute or action p
, � pending or additional data on the individual hes been c b�c�tgrupongrequest by
responsible authority shall provide copies of the private or p require the
the individual subject of the data. The responsibl cert f �nity and compiling the
requesting person to pay the actual costs of making,
Yi g�
copies. immediately, if possible, with any request
The responsible authority shall comply
made pursuant to this subdivision, or within five �f Simmediatea compliance eisu not
excluding Saturdays, Sundays and legal holidays,
possible. If he cannot comply with the request withi�i��nt W�ch toh omply w�h the
individual, and may have an additionel five days
request, excluding Saturdays, SundeYs and Iegal holidsys.
. Subd. 4. Procechu'e when data is not accura ivate dat1a lconcerning himself. To
contest the accuracy or completeness of publ�c or p the res nsible authority
exercise this right, an individuel shall notify in ���e authority shall within 30
describing the nature of the disagreement. The respo
days either: (a) correct the data found tcom lete dataeincludingpee�Pi�� namedtby
notify past recipients of inaccurate or in p
the individual; or (b) notify the individ�h in��iaual'Ps statementof disagreementcis
Data in dispute shall be disclosed only if
• included with the �isclosed data. e�ed �rsuant to the
" The determination of the responsible authority may be aPP P
provisions of the administrative procedure act relating to contested cases.