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Home My WebLink About2003-Bldg permit application not approved Total Fee: $ Date Received: �C � � �� Entered By: Permit#: �� y c� CITY OF ORONO - BUILDING PERNIIT 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: �� l��' C'�SGf� N�] G(ki� Z�: NA1�1E OF OWNER: ��v'�� JG�r�r� PHONE: (home) . (work) �-IS,�-2 3`� -�9�`�i MAILING ADDRESS: �� <��P( (�%i.(,��CITY: �/�.b�Jv ZIP: CO`�'RACTOR: /r� (�4/�a.�1 �.Dit15•�v��7�,� PHONE: (v,s j _2l(� `�� COr�T'ACT PERSON: �(�r� C'��.,�2.p�,,.1 NIOBILE/PAGER: �.;�� -t?x>�� M.4II.,ING ADDRESS: " "?� i�A!�t.a r�� {'i�r vc,' CITY: G��v.G'3.!>3 rL�* ZIP: �S-7 Z,S' ST�iT'E LICENSE: # 2o�i"7�'t D S A.RCHITECT/ENGINEER: ° ��,►�„�.� C�`�S i�`� PHO�TE: �'S�i - �`�Z •7`��c� ��II.,�1G ADDRESS: i�� C. u1�-� �j� CITY: ti�=.�'i�'Sv,/l� ZIP: ` 3 ' NA�`IE: �ri! �"� J %✓�//�s REGISTR.ATION# TYPE OF `VORK: New Addition Accessory Structure Move Remodel/Alteration�_ Land Alteration PROPOSED WORK(describe in detai�: i�G�ew„-� r� /�•c� �',•{ts�n+r�� /.u�z��s n�� f�rG" � G�--� - STORIES: Z SQ. FEET OF EACH FLOOR: 2�c�c> NO. OF BEDR00�1S: � � � GARAGE STALLS: ATT. DET. ESTLI-IATED CONSTRUCTION VALUATION (exclud.ing land): $ �'�/C�, t- 1!�. c3� _ 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 Buildin� Code; that I understand this is not a permit and work is not to start without a permit; and that the work wilI be in ac � ance w' �i th ppro �plan. APrLIC ANT'S SIGNATURE: ` � DATE: � � �v U f 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. P� lJ� �� '� 5 /5,�� °�� ` � /� � Sec.13.04 RIGHTS OF SUB,TECTS OF DATA . 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 section. + Subd.2. Information required to be given individual. An�individual asked to supply private or confidenaal data conceming himself shal]be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide rystem;(b)whzther he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his suppiying or refusing to supply private or confidential dara;and(d)the idenaty of other persons or entioes authorized by state or federal(aw to receive the data. This requirement shafi not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. 'Ihe commissioner of revenue mav lace the nocice re uired under this subdivision in the individual income taz or ro em tax refund instrucrions instead of on those forms. Subd. 3. Access to data by indiridual. Upon tequest to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidencial. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data without any charge to hun 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 iu meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or action pursuant to this secrion is pending or addirional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or pubfic data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay the actual costs of making,certifying, and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant[o 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 dara conceming himself. To exercise this right,an individual shail nodfy in writing the responsibie authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to aoafy past recipien�s of inaccurate or incomp(ete data,including recipients named by the individual;or(b)nocify 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 determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administraave procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance wi[h NI.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 o[her local, 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 certai.n 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 � ,1 r_� Last 5��- 1�r-� - Address C�ry State Zip Phone I unde an y rights stat ab e i Signature 6