The URL can be used to link to this page

Home My WebLink About1997-008843 - tear off T � � PERMIT CITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 - � ��,;,-;. Crystal Bay, Minnesota 55323 Permit Number: (612) 473-7357 Date Issued: - SITE ADDRESS: _ _ _ '� <<`,';-_ _.�:�4�':�; � . _��.i - _ _ . ;. ....._. �..- . .... DESCRIPTION: i �F:e }��- _ �=}.,I1 1.F:3?tl;? �-`,-��;�;i ,�.. ..{: 9�i._� ._��=--f�;,'�J/E;;'.I��_�I�'�`�E.._ F��_�!� }.+=��a-�.�; l;t:_;:��:; , i;;_--F�'i�i!_!�� =1-`�r . .. ' ._.._..;i,��•.� i;::f�„-j;c� ;�:_�;-� �ai.,_T , �'�'_ �r �,-��.; .: . ...,_=3�l.»{ S.f"7�... REMARKS: FEE SUMMARY: ,:'�:�' �. - -= ;; �e{i..��' �:�°:'� �.t:»_ r . . � _, —i}~�-,` i-�7,i�_..J��- �..._......._�., — ' ' ' : f 1 i'.-i : '"F�:�:+ ..'��. CONTRACTOR: - :':�;-:�=:: i}�:��_. -- '_,±� . �._��: OWNER: _ - - - ;.... , - �.-:. - � _ �� .,�,;�'� W s.�,,.+ _ _. .. � w._. ._ _".._ _, . _ � , . ,,..�...�.;-,;,; _ _ :- . :..:,::�_ , , . .:;r,: � _ -,.-. _ - - ;.., _ ..._ _ - - - - , ;�.: ,.i.:-'r-�`-� t s 1 ..: �. �:.-j; _ T� .'r:; #, "€" i... aw f ��'` _. _�_ %__ . _ .{; �� :: . , ..._. _��- . � � _. � � _ _ .. . � ._. .... ...._ _. _ . .. � t • ��_ . � : e,.:•.�: _. _ . __. ._ • � , , ,�;,•.�� P"� _ _ __. . ._ . _ .. -i� � •� ,;,;,-; ..s ;'ty� -�- r t ' -;�� .._.,, ..._ ._ .. � 4.•��.,_ : ,: : , . _:,. , :: , . � .. : ._:q ..._. ._. _.._�..r . —._ t'�•..1i . t....•..: e �_e 5..:"'..� ! .�..«._ :k._,''.. . ._. . _ . . . _ ... .. .�?T.4 �_„._l..Ji ....._ r4 .. . . . .,_.._ .. ._ . . _. � F k� ' v{.'�- F.y�`.� _. ? . . .,. .. , �a �._ i_I I��. _ .. _ ._ . f=. _ _ _ _; _. . . . ..... ... . . ... . � _ . _ �. � " � t APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE � '�otal Fee: $ Date Received: Entered By: Pernut#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) -------------------------------------------------------------------- -�----e--------------R----------------------- THE APPLICANT IS: (circle one) OWNER Olb.CONT$AG�O�—�'1 t --� �� JOB SITE ADDRESS: �� , Gj ��J��R� �n.S�IP: �, ; �-> > NAME OF OWNER: ti��.uC�- i,,,;:�j.ti��1 PHONE: (home) --� 7I %�%� (work) MAILING ADDRESS: /,rf�,�=, ;'�;,-i ,>,.,y,�� - CITY: ��,��_�� ZIP: CONTRACTOR ,�:l��; i ✓�-`�Z PHONE: ��1_� !,3�.L; CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: ��7 /�' 1 � -� r c�--� CITY: �.�I,�j�, ZIP: ��>��-+ �� '- STATE LICENSE: # �j�./� � ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: -�t i�}6�� ,��" k'r��%�c-,�� !��, > �� i.-.- �c-+��'% L"'�j'� STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��%� � � 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: �� '� �j��__ DATE: � � � 7�-�� NOTE! Parade Qf Homes events require separate permit approval by Police Deparhnent and City Council 60 days prior to the event. Non permitted events will not be allowed. � _ , Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA Subd. I. Type of data. The righ[s of individual on whom[he data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information reqirired to be given individual. �1n individual asked to suppiy private or confidendal data conceming himself shall be informed of: (a) the purpose and intended use of the requested data within the collecting'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other penons or enriries au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesriearive dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the norice reauired under[his 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 confidendai. Upon his further request,an individual who is the subjecc of stored private or public data on individuals shall be shown che data withouc 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 its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or accion pursuant ro this secdon is pending or additional data on[he individuai has been coilected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual cosu of makine, certifying, and compiling the copies. The responsible authority shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and leea]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 with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsibte authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, inciuding recipie�ts named by the individual; or(b)notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administncive 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 pernut or license. 4. If your requested pemut or license requires Council action to approve, some information 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. � ��i �/�r�/—_� �.� '�f-7/I� �-A i� .�"C� .�- ��'�,C 4.'hJn� ✓ . � Firs[ , ' , yfiddle Last ��l N �%7 �� - � � AddCeSS ' � t� � �-t 7 � �-��l, 7 �'_' ') �< /L�� City �� State Zip Phone I understand my rights as stated above. �%' ��, -- �-` �� . Signature