HomeMy WebLinkAbout1997-009123 - re-side/new windows PERMIT
�IT�(�``OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 "�:��°�:�
Crys�`al Bay, Minnesota 55323 Permit Number: _-
(612) 473-7357 Date issued: �.- - - _ _
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APP ANT;PERMfTEE SIGNATURE ISSUED BY:SIGNATURE
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� 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)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: /f r�`i f�l f."•�'Nf,5.5 ,� �G� Z�: .5'.�.3 ��' �
NAME OF OWNER: �J�� ��,�,�(�l1`�i PHONE: (home) y7�- 9,j �'�
(work)
MAILING ADDRESS: /���f`� f.91£'.�✓£-5�,� 631.�f�7 CITY: U,�T��cz ZIP: �' S
CONTRACTOR: �I L Q(J ��v L PHONE: /���,o(IQ�
CONTACTPERSON: �?��i�i,/ MOBILE/PAGER: ;�q_ �Q�
MAILING ADDRESS:�L�.1.,�/`,�.�,���,--Tc�kn /��.c% CITY: �77K� ZIP:s,�,�'
STATE LICENSE: # ;�y��
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration X Land Alteration
PROPOSED WORK(describe in detai�: Rf'h�c/� €xi.sTi�G ���.���� S�i���
yr � C�,O.c�l1 �sr��,���'`��,�.,.� �:��-f � s�n� _ k'frra/F, � �fi°taC� �1���ovn/�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ j�'( ,S�JO
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: 6'�C.�� � �
/
NOTE! Parade Qf Homes events require separate pernzit approval by Police Deparhnent and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
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Sec.13.04 RIGH'TS OF SUBJECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shall
be informed of: (a)the purpose and intended use of the requesred dara within the collecting'state agency,political subdivision,or statewide system;
(b)whether he may refuse oY is legal(y required to supply the requested data;(c)any 1�own consequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)the idendry of other 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,pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertv tax refund
instrucaons instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is classified as public, private or conFidencial. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown the data without 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 pursuanc to this secrion is pending or addidonal data on the individual has been collected 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 requesdng person to pay the actual cosu of making,certifying, and compiling the copies.
The responsible au[hority shall comply immedia[ely, 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 cannot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal five days within which to compiy 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 concerning himself. To exercise chis right,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreemeot.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incompiete data, including recipients named by the individual;or(b)nodfy 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 determination of the responsible authority may be appealed pursuant to the provisions of the administraave procedure act relaang 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 pemut or license from the City of Orono or any of its departments may require you to fumish certain private or
confidential information.
You are notified that:
1, The information you furnish will be used to detemune 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.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
�4 i S`i�£� / ���'��/�'
First
Middle Last
Address �
C�Ty State Zip Phone
I understand my righ as stated above.
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Signamre