HomeMy WebLinkAbout1998-010328 - land alteration PERMIT
,� G��►Y OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 #�:=;�-:�_�jE:��i:��=_;
Crystal Bay, Minnesota 55323 Permit Number: t_,j t.;_,��;_
(612) 473-7357 Date issued: t_j�,i����:;�;�
SITE ADDRESS:
�;�� �-I�_�iaT ��;ti°�= �.�j�
f:�
" , T , t,i. � :�i-1 f,�_—�:—� �—:t!'sii��
DESCRIPTION:
�.:: + z:i iF�T i: `;'�:��Ei°?
�_!'�k'1' ��"�'i'fi'i 1 �• �p�'3=' �._�-�:s;�� rl!_ � r t?�-i�T�JI'�
REMARKS:
� __�_I`:, l ��,,{ i.E_I�J�t� I �I_8�,�_. 1_f(- 'F;,',-`�-`;"t9_I;,��;� {,{f-' j:f�_.E_(f_llf �{;_:�J ,�,-',�'.''.,`.:����?�� .
FEE SUMMARY:
�.'�+.•�r� �� --_____ '��� �_�`'-�'
. ;,,T.y j, ��w�� ��;��iii�i
CONTRACTOR: — ;����s t : �=;�-y;_. — OWNER:
��;_;`�::��� i_; M��#°_���h°t'�_:.���W►��; i�= � - - _ . _ f•EE�'•.�t-3i?�i tv�'T i i=?s�`.i�`.�l'
z_�{}:!: t-��I �,F I�'�i-t ; �� � ��*-i 1�.. I���� ���1`.�� �'t�}'i!`� �.E 1
���=�LL_ �=`i t�I E�f� r.��,� c�,�_•f 1 ►t�'i�fi���i f'�s(� =��;='w
�� -:•) - —'r.=7 f:=
_. ._.._ . ._._,a_ ;..:,._,.� ._____
i��� :_.��riL 3�°=�i i;;;ir.#�. }-.�-_�;�i���`:� . .__. �._���_; : :�: z°_'�'�1� _ ��:1 t��i4 i i�t t�,=�;�::r= `:;-i;� i�:`:��i I;��°�;°� t�:��:t�;�.�� � °�
_. ����` _�...:� �.�!1 �-'�t�l"{h�.. � �Wff��t�'` i��.,.� i-�E'�}'?.t",. � {9 _��. ._ ..I I•'g`-.f .,i•.�^ � `�•��� '� � t`.T"" �_t;:.'
_•� _1 i _1 t'-�'�k�_�.._ :r �-i__ �s i �i
� i�1':,ii=y;_� E_It�:`�; ! t.�i�;:°,�i_.:�'�� t i - i:'�=. �_�� 4 i 1€:f(u�`_.;_I�..rt c�'_i�L_�f : �`ut; t.s_��i;- �i`t_�;,F:i `i�.'il-.�y ! :-
� _. . ��_. . �. _ . _._.�
�
A PUCANT% IT E SI ATURE ISSUED BY:SIGNATURE ��•
�
Total Fee: $ Date Received:
{ Entered By: �. Permit#: � %; -'�'Y
CITY OF ORONO - BUII.,DING PERNIIT AIPPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � ��S �c��� �fl�-I�I ,F�I ZIP:
NAlYIE OF OWNER: �i2y �-��n� ���c�N-F!j PHO�IE: (home)
(work)
MAII,ING ADDRESS: 7 ��.5 1'�c�� ���+� �ITY: �✓��r-L� ZIP:
CO�"I'RA.CTOR: �+J ris�u�� ^� PHONE: � ��� �3�3
CONTACT PERSON: }>�t �r�z-�� MOBILE/PAGER: ��� —G'7 y/
MAiILTtii'G A.DDRESS: r3 C�t� 1 �k'I I c PI�►�.���a•"� CI1'I': � ��e �'/.�'� ZIP: S(c'�';//
STAT`E LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAII.ING ADDRESS: CITI': ZIP:
NAME; REGISTRATIOti'#
TYPE OF tiVOR�i: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration �..�--
PROPOSED`VORK(describe in detain: � i�� ��n-� [c�)�� �I�Cc�.�
�.,-�-� �-c r-� �-� c� �
STORIES: SQ. FEET OF EACH F'LOOR: �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
EST1�I�ATED CONSTRUCTION VALUATION (excluding land): $
I hereby �pl :y for a building pernut and I aclmowledge 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 Buildin� 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 acc ce wi approved plan.
A.PPLICANT'S SIGNAT�7RE: DATE: � � �''��
NOTE! Parade of Homes events require epar e permit approval by Police Department and
City Council 60 days prior to the event. Non p�rmitted events will not be allowed.
�
' �
Sec.13.04 RIGHTS OF SilB.iECTS OF DATa
Subd. 1. Type of data. Zhe righcs of individual on whom[he data is stored or to be scored shall be as se�farch in this secdon. -
Subd.2. Information reqirired to be given iadividual. An individua!acked to supply privare oc confidendai dara concecning himseif shall
be iafocmed of: (a)the purpose and inrended use of the requested dara wichin the collecting ttate agency,poticcal subdivision,or satewid�syscem;
(b)whether he may refuse or is legaliy cequired to supply the requesud data:(c)any}�own caasequence arising from his supplying or refusing to suppty
private or confidendal data;and(d)che idendry of o�her persoos or enddes aucharized by seate or federal law to teceive the data. This requiremen�shali
noc apply when an individual is asl:ed to supply invesdgadve dam,pursuan�to secdon 13.82,subdivision 5,to a Faw enforcemenc o�cer. -
The commission�r of revenue mav place che nodce rauired unda this subdivision in the individual income ax or orooern rax refund
instiucdons instaad of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible au�horiry,an individual shall be informed wherher he is rhe subject �
of stored daca on individuals,and whecher it is classified as pubiic,private or confidenaal. Upon his furthec raquest,an individual who is the subject
of stored priva�e ar public dara on individuals shall be shown ct►e dara wichouc any charge to him and;if he desires, shall be infoaned of the content
and meaning of chat daca. Aher an individual hac been shown che priva�e dara and informed of iu meaning,the dara need not be disclosed ro him fo�
six monrhs ehereafur uniess a dispute or acaon puauanc to [his secdon is pending or addiaonal dara on the individual has been collecced or creaced.
The responsible au[horiry shall pmvide copies of the private or public data upon cequest by the individual subjecc of the data. The responsible authoriry
may requin the requesring person to pay the actual costs of making,cerdfying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request mada pursuant to[his subdivision,o�wirhin five days of
the dace of che request,exciuding Saturdays.Sundays and legal holidays,if immedia�e compliance is not possibie. If he cannot comply with the request
wichin cttat time,he shatl so inform�he individual,and may have an addirional five days wirhin which to comply wirh the request,excluding Saturdays,
Sundays and legal holidays.
Sabd.4. Procedure whea data Ls not accurate or complete. An individual may contest et►e accuracy or compieteness of public or pri�ate
dara concerning tiunself. To exercise�his ri¢hc,an individual shall noafy in wridng the respoasible au[horiry describing the nanire of the disagreemenc.
The responsible auchoriry shall within 30 days eieher: (a)cocrect the dam found ro be inaccurdte or incomp[ete and attempe to nodfy past recipieau of
inaccurdte or incomptete dara, inciuding cecipiencs named by�he individual;or(b)aoafy the individual thac he believes rhe data to be cocrecG Data
in dispute shail be disclosed oniy if che individual's scatement of disagreement is includad with the d'uciosed daa.
The decerminadon of the responsible auchoriry may be appealed pursuant m the provisions of the administrarive procedure act relating to
contesad cases.
DATA PRIVACY ADVISORY
In accordanee wich M.S. 13.04, Subd.2, "Ri�shts 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 zequire you to fumish certain private or
confidential informacion. .
You aze notified that:•
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, buc refusal may require that the Ciry 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 permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5, You have cer[ain 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.
Firsc Middie �c
Address .
Ciry Srste Zip Yhoae
I understand my rights as stated above.
Signature