HomeMy WebLinkAboutpermit application Total Fee: $ Date Received: ��� q
Entered By: Perm.it #: � c�/
CITY OF ORONO - BUII�DING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
/� / .(pleas print all information)
----.�`!��_�_�r J14_�'�---����---------
-- --------------------------------------------------
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: �S��j�tST �i�,�u.s ��r ZIP: �S—`��cf
NAME OF OWNER: %L (��� jZ PHONE: (home) 9�- Y 7�-Sy3�
(work) 9s�- g y 7-� 9� 3
MAILING ADDRESS: _�S� �irrsr ��i 5 ,; CITY: ,,�� o ZIP:��
CONTRACTOR: �'��G PHONE: 9s�a- �`/7-7 9� 3
CONTACT PERSON: �E� � MOBILE/PAGER:
MAILING ADDRESS: 5�9.�E CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: Grrt� � r� PHONE: /�'so1 - y�S'-�'f�;—
MAILING ADDRESS: !Q/(v � Si it c la ;� CITY: /N o��� �p ZIP:,z s�(o y
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK(describe in detai�: �t�v u� ��o� . �2r���� t %sz��sr 3 �V�c�c� r�
STORIES: �"�z SQ.FEET OF EACH FLOOR: /Zo 0 4S ri-c�:� �/oo�-
NO. OF BEDROOMS: �_ GARAGE STALLS: ATT. 2 DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $� p c�O
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: DATE: Z
NOTE! Parade of 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.
9
Sec.13.04 RIGHTS OFSUBJECTS OFDATA
Subdivision 1. Type ojdat2 77te�ights ojindividua!on whom the data is stored or to be slored shall be as set jorth in lhis section.
Subd.2. Information required to be given individuaL An rndrvidual asked to supp[y private or canfidential data concerning himse f
shall be injormed oj (a)the purpose and intended use of the requested data within the collectrng state agency,political subdivision,or statewide
system;(b)whether he may rejuse or is legally requrred to supply the requesled data;(c)mry lorown consequence arising from hrs supplying or
refusinglo supply private or confidential data;and(d)the idenlity of other persons or entities authorized by state orjederal!aw to receive the data.
Thrs requirement shall no1 apply when an indrvidual is asked to supply imestigative dala,pursuant to section 13.82, subdivisron S, lo a Imv
enjorcement o�cer.
The commissione�ofrevenue may place the notrce requi�ed under this subdrvision in the indivrdual income tax or property tax refund
irutructioru instead of on those forms.
Subd.3.Access to data by individuaC Upon request lo a resporrsib/e authority,an rndrvidual shall be informed whether he is the subject
of stored data on individuals, and whether it is clarsrfred as public,private or confidential. Upon his further request,an individual who rs!he
subject ojstored private or public data on individuals shall be shown the data wrthout arry charge to hrm and,if he desires,shall be informed of
the conlen!and meanrng of that data. Ajter an individual has been shown the private dala and injormed ojits meaning, the data need not be
disclosed fo him for six months lhereajter unless a dispute or action pursuant lo this seclion rs pendrng or additroxal data on the individua!has
been collected or created. The responsible authority shal!provrde copres ojthe prrvate or public data upon request by the individual subject of
the data. The responsrble authority may requrre the requesting person to pay the actual costs of making,cert�rng,and compiling the copies.
The responsible authoriry shall comply immediately,rfpossible,wrth arry reques�made pursuant to this subdivrsron,or withrn frve days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate complrance is not possrble. Ijhe cannot comply wrlh the
request within that 1ime,he sha11 so inform the individual,and may have an additional frve days tivithin which to comply with the request,excluding
Saturdays,Sundays and lega!holidays.
Subd.4. Procedure when data is not accurate or complete An rndividual mcry contest the accuracy or completeness ojpublic or private
data concerning hrmself. To exercise this right, an individua!sha!!not�rn writing the responsrble authoriry describing the nature of the
disagreement. 77re responsib(e autharrty shal!within 30 days either: (a)correct the data jound fo be inaccurate or incomplete and attempt to notify
past recipients ojinaccurate or incomplete data,rncluding recipients named by the individual;or(b)notify the indivrdual that he believes the data
to be correct. Data in dispute shal!be disclosed only rf the indivrdual's statement of disagreement is included with the disclosed data.
The delermination of the responsibfe authority may be appealed pursuant to the provisions ojthe admrnistrative procedure act relating
to contested cases.
DATA PRIVACYADVISORY
Inaccordahcewith,Lf.S./3.Od,Subd.2,'Rrghtsofsubjectsofdata';wewouldliketornjormyouthatyourrequestforapermitorlicense
from the City ojOrono or arry of its departments may reguire you to furnish certain private or confrdential information.
You are notifred that:
!. The information you1'urnish wil!be used to determrne your qualificatron for!he permit or/icense requested.
2. You may refuse to supply data, but rejusa!may require that the City deny the permit or lrcense.
3. The information may be shared wilh other local,state or federa!agencies ta the extent necessary to process the permit or
lrcense.
4. Ijyour requested permit or lrcense requrres Council action to approve,some injormation may become publrc.
S. You have certain rights under M.S. 13.04(see jollowing pageJ to revieiv private data on yourself.
6. Your full name is required to process this application or permit.
PLEASE PRINT
S/�r��
First Middle Last
Address
Crry State Zip Phone
I understand my rrghts as stated ve.
Srgnat •
!0