HomeMy WebLinkAbout1999-011793 (building- add./remod.) PERMIT
. CETY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: - ';'�-'``=`�"`=�
Crystal Bay, Minnesota 55323. '--`i 1��"-'�
(612) 4�9-�3�—��q_ c�(Q p� Date Issued: _ _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT PERMIT SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $
Date Received: �S��S�
Encered By: Permit#: 1 i`7q 3 �
Ci'T'Y OF ORONO - BUILDING PERMIT APPLICA.TION' � �
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.A.11 i.n�ormafi3on must be submitted in full before plan review�-ill be started. .
� {please print all information) . .
. . . - ____ ;
1� APPLICA.2��'I' IS: � (circle one) O�VNER O CONTRACTOR � ;
JOB SI�'E ADDRESS: ��a a q O Cti S�o Gi'c lP Z�� ':
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NAIti� OF Oti�1ER: �r�� .�.pi�S�/� PHONE: (home) Y 7�- 7/00 �
. (work) ' i
NIAILI�►G ADDF.ESS: �a a 9 � Cr�Sco Gi: CTTY: D�a� ZIP: _ i
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CONTRACTOR: G��s�!'n c�,r' I� PFlONE: SY��3o�1
COi�TTACTPERSO�: /�✓'enf' OBII�E/PAGER:
MALLTtii'G ADDRFSS: 4 7� /3'�`' �� it/. _CIT'Y: P v�o��ZIP:
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STATE LICENSE: # �ZD/SS.S��o �
� A.RCHITECT/ENGIl�TEER:� . PHO�'E:. ��
M..A.]I,Itii'G ADDRESS: CTI"Y: ZIP:
� NAME: RECISTRATiON#
TYPE OF '4'YORh'.: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED ti'YORK(describe in detai�: c a�F��cz��
STORIES: _ SQ.FEET OF EACT3 FLOOR:
NO. Ok' BEDROOMS: GARAGE STALLS: ATT'• DET. � . .
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EST11-IAT'ED CONST'RUCTION VALUATION (excludina land): $. a� �39�- �
I hereby apply for a building permit a.nd I acknowledge that the infonnation above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Build�n� Code; that I understand this is not a permit and work is not to start without a
pernut; and th4c the work will be in accordance with the approved plan.
APPLICA��"T'S SIGNATITRE: DAT'E: 8�a�?�
NOTE! Parade o Homes events require separate permit approval by Police Department and
� Cily Counci160 days prior to tke event. Non permitted events wi11 not be allowed.
. .
Sac.I3.Q4 RIGSTS OF SUBJECTS OF D�TA •
Satd. i. Type o[data. The righcs of individual on whom the data is swced or ro bc stnr.d sha.11 be as sec forth ia this secrioa
Subd.2. Information rtquired to be given iadiridual. �1n individuaI asked to supply privam or eaafideaaal dam eoncerning hirsself shalI
be iafo�¢::d o,`: (a)the purrose acd inceadcd use oE the rzqucst-�3 daa wit�in the eollecdag Eti�a3eaty.poliacal suL+division,or stimwide ryst,m;
(b)wh:c,`.e:he--.=y r.�us:o;is,le3alIy requir:d to n:pply_the r_quesud daca:(cJ aay Yaawn eaase�:ecce uisi.e3 from his supptyia3 oc refusing co suPPtY
privace or eo:i::der.�a?daa;ar.d(d)c�e ideadry of o�er persoas ore�dces auc�orse3 by sca�ocfe'_cz'��::.o r:c:ive c�e da�. Zhi.s r.quircneac S�aI
not a?pIy wcez an ir.dividual is�sked co suppiy iavesrigadve daa,pursaaac to secdon 13.82,sti:bdivisioa 5,w a law enfaccement o�cer. . -
'l�z ce;zmissioner of rcvenu� mav olace ch- nodc- rauird und-r this subdivision in the individual ircome ez or orooertv t�z tefund
instrucdocu L*�stead of an those forms. . "
Subd. 3. Access to data by iadivfdual. Upon tequesc to a responsible auchodry,an individaal sball be informed whe�hec he is the subjecc
of stor.d dati on individuals,and whecher it is el�uiFied as public,privatn or eonF.dend�l. Upaa his furcher r_quest,an icdividual who is the subjecc
of s.or:d priva,e or public dam on individuaIs shall be showa the daa wirho¢t any eharge to him ar.d;if he desiru,shall be infocmed oE the eontent
ar.d m:aning of chat daca. Ahe�an individuaI has been shown the priva�.dan az:d informed o[ic�meaaing,che daa need not be disclosed to him far
six monchs�her.afur unless a dispuce or acaon purneant to this se;aon is Qending oc addirioaal daci on tfie individuat has been eollectd or erca�d.
The cespansible authariry shal!'provida eopies of che priva�or public daca upon rcquest by ehe individual subject of che daa. Tha responsible auchoriry
may requir_ che r.quesang person to pay che accual eosu oi makinz,ee�dfying,aed eomp'lIing che eapia.
The respo�uible auchoriry shall eampiy irnmediataty,if possibie,wi�h aay request rsude parsuaat tn this subdivision,ar wichin five days oF
the dace of the req:cesc,ezcluding Sacurdays,Sundays and legai hotidayi,if inmedia:e compliaace u not possible. If he eanaot eomply with the requesc
wichin chat arne,he shall so inform che individual,and may have an addidoaaI five days within which to compty wic�the tequesc,ezciuding Saairdays,
Sundays and 1e3a1 holidays. . . .
Sutd.4. Praeadure when data is not accurate oc complete. M icdividual may eonmst che accurdcy oc eompleteneu o[pubiic or privace
dara coaceming himself. To ezercise ti�is right,an individual shaIl aodFy ia wridng�he respoasible auchoriry descnbing the nacuce o[the ditagreemeuc
The respoasible authoriry shalt wichin 30 days ei�;er: (a)eorrecc�he data found w be inaccurdt�or ir.compiet�aad atc:mpt to nadfy past recipiencs of
inaccurace or incomplae data,inciuding recipiea�s named by the individu�t;or @}nodfy the individual that he believes the data to be correce Daa
in disputc s�.all be disclosed onIy if�he individual's stacenenc of disagreem:nt is included with the disctosed dara.
::::dacecminadon of the rtsponsibia auchoriry may be appealed parsuanc to the provisions of the adminisQadve proc:dum act relaang to
eoncer�d cases. . •
DATA PRiVACY ADVISORY �
In accordance with M.S. 13.04,Subd.2, "R.ights of subjeccs of data",we wouId like to inform you that your request
for a percnit or license from the Ciry oE Orono or any of its depanments may require you to furnish certain private or
confidential information.
You are notified that:
1. Zhe information you furnish will be used to determine your qualificadon for the permit or license requested.
2. You may refuse to suppty data, but refusal may require that the Ciry deny the permit or license. �
3. The information may be shared with o�her local,state or federal a�encies to the ettent necessary to process
the permit or Iicense. �
4. If your requested permit or licease requires Council action to approve, some information may become
. public. � � � . . ,
�5. You have certain rights under M.S. 13.04�(availabte upon requesc) to review privace data on.yourself. . .
6. Your full name is,required to process this application or permit.
Fus� � �(iddle I.asc •
Address �
Ciry Sace Zip P�oae
I understand my ri� stated above.
Signamre