HomeMy WebLinkAbout1999-011976 (re-side) . , PERMIT � 'i
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number: �s��'��`�'
Crystal Bay, Minnesota 55323 - - - - � -
(612) 249-4600 Date Issued: _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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ICANT� IT NAT ISSUED BY:SIGNATURE
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 CONTRACTOR
JOB SITE ADDRESS: �� �J � C A-s C.O C Y- ZIP: �S3� I
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NAME OF OWNER: � �- �fl C�,��-- PHONE: (home) '`7�7/- ��9'S
(work)
MAILING ADDRESS: ���j� ��-�i�0 �yCITY: n„ZIP: v.��3�}�
CONTRACTOR: J . G � C.-oo�-�_ PHONE: � ? / — a o P S
CONTACT PERSON: � ( MOBILE/PAGER:
MAII,ING ADDRESS:��'is /{���� CITY• ZIP•
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAII,ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain:� S �e �- � -�.-az.��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ / .�O � /�
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 in a ord ' the approved plan.
APPLICANT'S SIGNATURE: DATE: ,1D �� /�
NOTE! Parade of Homes even require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SCJBJECTS OF DATA
Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be stored shall be as sec forth in this secaon.
Subd.2. Information reqirired to be given individual. P.n individual asked to supply privace or confidendal data concerning himself shali
be informed of: (a) the purpose and in[ended use of the requesied dara within the collecting"state agency, policical subdivision,or sratewide system;
(b)whe[her he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply
priva[e or confidenrial data;and(d)the idenrity of ocher persons or enrides authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieadve dara, pursuanc to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enuz mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown[he dara wichout any charge to hun and, if he desires, shall be informed of the conten[
and meaning of that data. Aftzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six monchs thereafter unless a dispute or acrion pursuan[to chis secdon is pending or addidonal data on the individual bas been collected or created.
The resPonsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry
may require che requesting person to pay the actual costs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to 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 canno[comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply wi[h the request,excluding Sarurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individua!may contest the accuracy or completeness of public or pri�•ate
data conceming himself. To exercise this rieht,an individual shall norify in writing the responsible au[horiry describing the narure of the disagreement.
The responsibie authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incompiete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individuai's statemen[of disagreemen[is included with the disclosed dara.
The de[erminadon of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relacing to
contested cases.
DAT�, 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 furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to detemune your qualification for the pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pemut or license.
4. If your requested permit or license requires Council action to approve, some informa[ion 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.
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I un erstan my r' ts as stat above.
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