HomeMy WebLinkAbout1999-012071 - windows/remodel �- PERMIT
� CITY OF ORONO
2750 Kelley Parkway - P.O. Box 66 PERMIT TYPE: _
Crystal Bay, Minnesota 55323 Permit Number: -
(612) 249-4600 Date Issued: _
SITE ADDRESS:
DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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PLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE �
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Total Fee: $ .��� 75 Date Received:
Entered By: ,Cp , 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 OR CONTRACTOR
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JOB SITE ADDRESS: �%/C�' C- c��'� � ,1- / ZIP:
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NAME OF OWNER: �c�i,i/ G�, .��-�/ PHONE: (home)
/� (work)
MAILING ADDRESS: ���/�� C�r �/����CITY: G�-z:�� c�% ZIP:
CONTRACTOR• ��T�� �� PHONE:_���`S>>�_
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CONTACT PERSON: �� r F-� MOBILE/PA�T 3�(� � ��-5
MAILING ADDRESS: /�/ �c: , � �°r,, CITY:,.�,G�. � c ZIP:��2-
STATE LICENSE: #��3��-
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition rAccessory Structure
Move Remodel/Alteration �' Land Alteration
PROP S WORK(describ in detain: •C�/'��� �'�.� t�- , Z�..�1�-�---� Ci�Z/
/i> ��� �� �1- t'J��C�� � � ��? �� i'C. <c-�' ' .rr�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ._.�jC��->"U /
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 Ciry 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•.`'-�/ �=`>=-L> �-- DATE: �� �- ��
NOTE! Parade Qf 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.
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Sec.13.04 RIGHTS OF SUBJECTS OF D�TA
Subd. 1. Type of data. The righ[s of individual on whom che data is s[ored or to be stored shall be as set forth in this secrion.
Subd. �. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requesrPd data within the collecring'stare agency, political subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply[he reques[ed data;(c)any known consequence arising from his supplying or refusing ro suppty
private or confidendal data;and(d)the identicy of o[her persons or enddes authorized by state or federal law to receive the data. This requirement shall
noc apply when an individual is asked to supply invesrigaave data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propem tax refund
instructions instead of on those forms.
Subd. 3. Access to data bv individual. Upon request to a responsible authority,an individual shall be informed whecher he is the subject
of scored data on individuals, and whecher it is classiFied as public, private or confidenaal. Upon his further requesc, an individual who is the subjecc
of stored private or public dan on individuals shall be shown che data wichout any charge to him 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 thereafter unless a dispute or acrion pursuant to [his secrion is pending or addidonal data on the individual has been collected or created.
The responsible authority shail provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesring person to pay the acmal 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 Sacurdays,Sundays and legal holidays,if immediate compliance is not possib[e. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,exciuding Sarurdays,
Sundays and legal holidays.
Subd.4. Pi'ocedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri��are
data conceming himself. To execcise this right,an individuai shall nodfy in writing the responsible authoriry describing the natttre of the disagreement.
The responsible authoriry shall within 30 days ei[her: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipienu of
inaccutate or incomplete 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 individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administrarive procedure act relating 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 pemut 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 permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5, You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your.fuli name is required to process this application or permit.
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First , M}c�d1e� Last
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Addre / � -� 2-� , �3 �" j ���!
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State Zip Phone
City
I understand my ri�hts as sta�d above.
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Signature