HomeMy WebLinkAbout1991-003967 - bedroom remodel I'ERIVIIT V
�ITY OF ORONO PERMIT TYPE: F;,��L_�;�;,��;
�335 Brown Rd. South • P.O. Box 66 ' � - - '
Permit Number: �:.it:i:;°�ai�,;
Crystal Bay, Minnesota 55323 Date Issued: ;s=;::�c.;�'�:i
(612) 473-7357
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APPUCANT-PERMITEESIGNATURE ISSUEDBY:SIGNATURE ���1
� CITY OF ORONO - BIIII,DItiG P�MIT APPLICATION
Tot�i Fee : $ �`�� -��) � . Date Received:
Date Aporoved:
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Entered By: ��� �c��?
Permit�: l
7�T•T. INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIgf+l WILI, B$ STARTED
(See Check-off List Enclosed )
--------------------------------------------------------------------------------
Z'HE APPLICANT IS: (circle one ) OWNER or CONTRACTOR
JOB SITE ADDRSSS: ��C1c� � (c.S�'-�; r--�'� �C� . �.c�li-HZ_v_��� /ytw� ZIP: �J3c1 �
(work)
NAME OF OWNER: �CE rc.,-, 1�� • �' �^'��r�.b�.�t� PHONE: (home) �7/ ' 7��(P
MAII,ING ADDRESS: � 7GlGl �G.SC� {�-�. ��. CITY: l,c_�Cp y Z.«�--c` ZIP: SS3�? (
CONTRACTOR: �p4/►'\�S 1�-UGG� =Nsi74Lu47�0/� PHONE:_ �J7J- �JI ClD
MAILING ADDRESS: �I�v WtST �Q-R-w� CITY: ,S{�,�.�.�� �i��I� ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration_� Renovate Land Alteration
PROPOSED WORK (describe in detail) : �E(Jt�Ao w� Q.EY►�t-o�GL
STORIES- � SQ. FEET OF EACH FLOOR:
�(�� pF Ftg�R�lK�; y t �e.ti GARAGE STALLS: ATT.� DET. '
�STIIKATED CONSTROCTION VALIIATION (egcluding land) : $ s L G r' � ��
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 in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: ��� "��' �ll
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�� - Yost Office Box 6fi•Crystal Bay, Minnesota 5�323•Municipal Offices
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,� _ � . ,�. On the North Shore of Lake Minnetonka
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 furnish certain private or confidential information.
You are notified that:
1. The information you furnish wil.l 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 Iicense.
3. The information may be shared with other local , s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Councii ac��or.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is reguired to process this application or
permit.
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First Middle Last �
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Address
l..ti' Ct..- z c��r-. /l�1 /�� . � �J�Ct (
City State Zip
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Phone
I understand my rights as stated above.
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Signature
BUILDING& ZONING—473-7357 • �DMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359
ASSESSING
�.p4 RIGSTS OF SIIB�7ECTS OF DATA
Subdivision L 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 to be given in���' An.individuel asked to
� supply private or confidentiel data concerning himself shall be informed of: (a) the
purpose and intended use of the requested data within the collecting state agency,
politic8l subdivision, or statewide system; (b) whether he ma� refuse or is legally
required to supply the requested dat8; (c) any Irnown consequencQ arising from his
supplying or refusing to supoly private or confidentiel data; end (d) the identity of
other persons or entities authorized by state or federal law to rece�vvesti ataive data,
requirement shall not apply when an individual is esked to supply g
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue or Rropert tax re�und instr�uctionsu nsteadhot
subdivLsion in the individuel income tax
on those orms. _ __ -
Subd. 3. Acc�ss to �ata by in�ivi�el- Upon request to e resaonsible �
authority, an individual shall be informed whetbhlic h r VBteeor confidenUalre UPon �
individuals; and whether it is classified as p : P ublic data on
further request, an individuel tin►ho is the subjecc�ge to himrlande if he desires, shall
individuals shall be shown the data withou�f an at �ta. �ter an individual hes be�n
�e informed of the content and meaning the data need not be �isclosed to
shown the private data snd informed of its meaning, �u�t t� this sectian is
him for six months thereafter unless a dispute or action p
, � pending or additional data on the in�of the hr vate or p blic dataruponarequest by
responsible authority shall provide cop P
the individual subject of the �ta•co� of making,i certifyingy and c mPiling the
requesting person to pay the actusl _
copies. ssible, with any request
The responsible authority shall comoly immediately, if po
made pursuant to this subdivision, le witholideys,�f Simmediateat ompliancQ ei�.su not
excluding Saturdays, SundaYS and g�
possible. If he cannot comply with th�e r�eQ�i et �� withintw ch toh omplynfw h the
individual, and may hsve an additi
request, excluding Saturdays, SundaS'S and legal holidays-
. Subd 4. Proced�e when �of ublic o��p ivate datla concerning himself•mTo
contest the accuracy or complete P the res onsible authority
exercise this right, an individual shall notify � ��e euthor ty shall within 3 0
describing the nature of the disagreemen� The respo
days either: (a) correct the data found to be inaccurate or incomplete and attempt to
notify past recipients of inaccurate a?'vidual that hea belie esdthe datalto be correcty
the individuel; or {b) notify the indi
Data in dispute shall be disclosed only if the individual's statement of disagreement is
• included with the �isclosed data• ealed ursuant to the
' The determination of the responsible authority may be aPP P
provisions of the administrative procedure act relating to contested cases.
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