HomeMy WebLinkAbout1997-009018 (land alt.) �.,� PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 =.�;;; �:�w:� �,���-::�?
Crystal Bay, Minnesota 55323 Permit Number: ;;.:,,-;; :_:-
Date Issued: - -� z j`� -
(612) 473-7357 .-. .- .
SITE ADDRESS:
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DESCRIPTION: a
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REMARKS:
FEE SUMMARY:
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AP LICANT%PERMI EE SIGNATURE ISSUED BY:SIGNATURE
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� Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER�R CONTRACTOR
JOB SITE ADDRESS: �'7 � � C���C.r U /�Y���ZIP: ,.��'�� � C� ��J�
NAME OF OWNER: �j_.Pr � -r?���I/�r�/��✓�PHONE: (home) ' — C
(work � •� .` �
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MAILING ADDRESSi �7�� C ��t�'C� ��TY: " � T� �ZIP: � �i��3 J/
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� L l7 � �I�.... PHONE: ����-"��C t i�,� ✓
CONTRACTOR: r
CONTACT PERSON: l' � _ ', OBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: � I f= �t��( � `^ �J L.�--
,: Y�t�!f f�' ..�-1 -�. i�'��T � =I L L._ Z� � I � i Z� � �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
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 Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be i�accordanc with the approved plan.
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APPLICANT'S SIGNATURE: ��., �� � � ������ D�,TE: ,�����/
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NOTE! ParadeQf Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
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Sec.13.04 RIGH'I'S OF SUB.TECTS OF DAT�,
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shall
be informed of: (a)the purpose and in[ended use of the requesied dara within the collecting'state agency,poliacal subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply[he requested data;(c)any lrnown consequence arising fmm his supplying or refusing to supply
private or confidential data;and(d)the identiry of other persons or enades authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdearive data, pursuant to seccion 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the noace reouired under this subdivision in the individual income tax or propem tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shail be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wi�hout any charge to him and,if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for
six months thereafrer unless a dispute or acrion pursuant to this secdon is pending or addiaonal 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 requesang person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately, if possible, wich any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sanirdays,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 addirional five days within which to comply with the request,exciuding 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 pri�•ate
data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreemeat.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccunte or incomplete and attempt to nodfy past recipiencs of
inaccurate or incomplete data, including recipiencs named by the individual; or(b)nopfy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual'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 administradve procedure act relaang 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 deternune 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 extent necessary to process
the pernut or license.
4. If your requested pernut 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature