HomeMy WebLinkAbout1997-009394 (add/remod.) PERMIT
ClTY OF ORONO PERMIT TYPE: .
2750 Kelley Parkway- P.O. Box 66 _.
` Crystal Bay, Minnesota 55323 Permit Number:
(612)473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APP�ICANT,%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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'Total Fee: $ ��� , :.l S� Date Received:
. Entered By: _��.�i Perm.it#: �-; t1�l
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CITY OF ORONO - BUII�DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: .���� ('�C_'f�i�"�� ZIP: ,S.�J�/
NAME OF OWNER: �f/PPr°7 �'"`/i���.9�1�' PI30NE: (home)_�,��f /`' �-�/3�
(work)
MAILING ADDRESS: y��/�;���.�Y���l'�P CITY:�,�'dl�'J ZIP:
CONTRACTOR: , ��-'�� PHONE:
CONTACT PERSON: � MOBILE/PAGER:
MAILING ADDRESS: .� CITY: ZIP:
STATE LICENSE: #
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 detain:� i'S`j ��SRl����77`��-�l /7orJ�v�C�e��'-"
:
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 acl�owledge 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 SIGNATLTRE: �G�J DATE: > 7
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF S[TBJECTS OF DATA
Subd. i. Type of data. "Rie rights of individual on whom the data is stored or ro be stored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and inteoded use of the requested data wichin the collecting'state agency,po(idcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to suppiy che requested data;(c)any imown coasequence arising from his supplying or refusing to suppiy
private or confidendal data;and(d)the idenary of other persoas or enaaes authorized by state or federal law to receive the data. This requiremenc shall
not apply when an individual is asked to supply investigadve dara,pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav pface the nodce reauired under this subdivision in the individua] income tax or propem tax refund
instrucrions instead of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of scored data on individuals,and whecher it is class�ed as public, private or confidendal. Upon his further request, an individual who is the subjecc
of stored private or public dara on individuals shall be shown the dan wirhout any charge to him and,�if he desires,shall be informed of the content
and meaning of that dara. Aher an individual has been shown che private data and informed of its meaniag,the dara need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual has been collected or creared.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesdng person to pay the actual costs of making, cerafying,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 Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shail so inform the individual,and may have an addidonal five days wi[hin 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 concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature 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 recipienu of
inaccunte or incomplete data, inciuding recipients named by[he individual; or(b)nodfy the individual thac he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's stacement of disagreemenc is included wi[h[he disclosed data.
The determinaaon of the responsible authoriry 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 Ciry 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 perm.it or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the perm.it or license.
3. The information may be shared with other local, state or federal a;encies to the exten[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 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.
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I understand my rights as stated above.
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