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Home My WebLink About1996-008348 - land alteration � PERMIT CITY OF ORONO PERMIT TYPE: ' 2750 Kelley Parkway- P.O. Box 66 t l�::r r: [i=.��=��•,i�::i.i Crystal Bay, Minnesota 55323 Permit Number: �;4�;::_�_; (612)473-7357 Date Issued: - - - i)°�J i_:=�/'=:t�. SITE ADDRESS: ��'�_�?-�. �:.=�°�;�_:�s �`a=E T t��l" �#� t:H F' . j . td. . '��_�—j. 1 r—�:=;—:�;�.—;��ij:�;y DESCRIPTION: ; ��t i �'�L i�F;�'�i I�_��v �_!s=�� =°,�}trsi 1 T• Tv�'N ��C�j�a �i_i'��.r�T I E�r�� REMARKS: FEE SUMMARY: �.n�.F� �"�J�± _.�......��.._.�..�.1 L tar #i Si �i�ki._�i i I"'t.:rfi �'�i��„3y�_�tj CONTRACTOR: OWNER: — �:;c:�•7. �r�i-i�. _;7 �'�'_#'•. �' 7�nn�r SGi l(��` ��-� ::�,:=:�_:�_E ��t_��.r�� :_, i ii;'I iC�if_E i'1�`� _�+::`�1 ?!—��'_ s_t't�f1�I'•"��T!_�I`•�i�.`__IJ ��=Ci��t�=..�, ��.�� !_��-...��_ �,��.f��s=;�Y;L s;�� E j f.�t:-it�.�: i s"� ':�:�-1�_. z I'i�"'1`t!_!`z�i_�'i!=i'•i�'.�: —�-`G i:?r— i :—:} ��i's }-:[j�i�•- — i i I �_}I f r; } u!i II—�}: i,(v —� i �i!(: �:f ti'�—`' i_4�i f:F- �i i�-: r�t 3 i:T i�;' ! ; �.. _ . _. _..._ . . .. ...._ _ _. ..:L_.. _. . _. . . . . _. i� � f'�_ . t�:• . � . _ . _F � �:#;y;;ih��a �;�r;�:i i ivs�f�li=:;�°_: H€l�u� ��1':�T?�. s:y� ��t i h�tJ?�'�:=�+�Ti� ;_;�1 i.1_€3 i.t�l;, t��G�i �;r_i:E'=.;I�°�;:��t�i�T'=� . � APPLICANT%PE ITEE SIGNATURE ISSUED BY:SIGNATURE �, . ,.� ' Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- .�-., THE APPLICANT IS: (circle one) O�N�R OR CONTRACTOR /�;� �,�� -�.,- -, � ,-,'�C- , JOB SITE ADDRESS: �7��7 � `�,�`. � �" �� ZIP: �"? -� � ' r, �_ ,.,, NAME OF OWNER: � ��i� J Y �� 'C� � PHONE: (home) �t �I �' 7� (work) MAILING ADDRESS: �/ �i �� CITY: ZIP: CONTRACTOR: � ' r'• PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY� Z�� STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration x. n '�v�U� 5�,�%C'�' t'�vL-r�`�' ��"�!�;'�`� PROPOSED WORK(describe in detai : �=� , �.. ..r, �� . ��,� � �- r ,a, ��'�;'� � ; � — l .� STORIES: ' SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ �� 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 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: ,� '�i. ; L" �� !-f - � DATE: �f �` � � `�� NOTE! Parade gf Homes events require separate pernzit approval by Police Department and Ciry Council 60 days prior to the event. Non permitted events will not be allowed. La. � . Sec.13.04 RIGHTS OF Si.TBJECTS OF DATa Subd. i. Type of data. The righcs of individual on whom the data is scored or to be stored shall be as set for[h in this secrion. Subd.2. Information reqirired to be given individual. rUi individual asked to supply private or confidenaal data concerning himself shall be informed of: (a) the purpose and incended use of the requested data within the collecting'state agency, po(itical subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any}:nown consequence arising from his supplying or refusing to supply priva[e or confidential data;and(d)the identity of other persons or entides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppty invesngadve dara, pursuant to secdon 13.82, subdivision�, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund instructions ins[ead of on those forms. Subd. 3. Access to data by indi�ldual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals, and wherher i�is classified as public, priva�e or confidendal. Upon his furcher request, an individual who is the subjecc of stored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the conten[ and meaning of that dara. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuan[to this secaon is pending or additional data on[he individual has been collected or crea[ed. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subjecc of che data. The responsible auchoriry may require rhe requesting person to pay che ac[ual cosu of making, cerdfying, 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 Sacurdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he 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 oot accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise chis rieht,an individual shall notify in wriang the responsible authoriry describing the nacure of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienrs of inaccurate or incomplete data, including recipients named by [he individual; or(b)notify the individual that he believes[he data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data. The determination of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act reladng 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 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 other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. j. 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. i�` ' ;1,i ` ' �,�, �'� , Middl� Last First�� ✓��`�� ,�i�.� � � Addr s �� _ ; � —. � � .` _ ,� i /�`�� ('�� _; � ` � i/ L' � �. _ �� C�ry State Zip Phone I understand my ri�hts as stated above. �'l��G!/`' ��/��' � � Si acure