HomeMy WebLinkAbout1996-007665 - reside '�"" �'ERMIT
, . �OF ORONO PERMIT TYPE:
�r�u`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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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE �p� ^
, Tc�tal Fee: $ DateReceived:
Date Approved:
Entered By: ,�:-/, Peruut#: '7r ,� �
CITY OF ORONO - BUII.DING PERMIT APPLICATION
ALL I�i tFORMATION NIUST BE SUBi�1ITTED IN FULL BEFORE PLAN REVIEW WII�L
BESTARTED
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THE APPLIC�'�1'T IS: (circle one OWNER OR CONTRACTOR
JOB SITE ADDRESS: g� c�ac cs� Ac nts ���-� /Now.�d /'1� _ ZIP: S� � 3�e�
NAME OF O�Wi ER: �oc� e�"G s�uo c�l PHOi�1E: (home) y7d2-(�1 a�—
^ (work
l�7AILING r1DDRESS: �1- �o c�„S�' Q�rts LtiN�. CITY: I'7a�.�. r'1,�J ZIP: 553��
CONTRACTOR: �• _�v rn�e t���prS .�G-- PHOi�1E: `78'`-f " �a�
NIOBILE PHOiVE/PAGER:
MAILING ADDRESS: 7 �� [ CITY: 1��4�„J co ZIP:;�s�..��
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY' ZIP'
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration _� I.and Alteration
PROPOSEDWORK(describeindetail): � �C> S'��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOIVIS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(escluding land): $ �(„p .,�0 0
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 SIGNATLTRE: _ DATE: � Ge q�
NOTE! Para=o Homes events require separate pernzit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SIJBJECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the dara is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required 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 requested data wirhin the collecang'state agency,polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the idendry of other pecsons or endries authorized by state or federal law to receive the data. Ttus requirement shall
not apply when an individual is asked ro supply investigadve data, pursuant to secnon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue maV P1ace the nodce required under this subdivision in the individual income t� or propertv taz refund
instructions 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 confidendal. Upoo 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[o him and, if he desires, shall be informed of the content
aod meaning of that daEa. 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 action pursuant to this section is pending or additionai data on the individual has been co(lected or created.
The responsible authoriry 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 costs of making, certifying, and compiling the copies.
The responsible authority shail comply immediately, 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 additio�al five days within which ro comply with the request,excluding Saturdays,
Sundays and]egal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple[eness of public or private
data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority 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 notify past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)norify 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 disciosed data.
The determination of the responsible authority may be appealed pursuant ro the provisions of the administrative 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 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 yourseif.
6. Your full name is required to process this application or permit.
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I understand my rights as tated a e.
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