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Home My WebLink About1995-007599 - partial tear-off � - _ PERMIT �ITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 Permit Number: Crystal Bay, Minnesota 55323 . : . _ ... .. (612) 473-7357 Date Issued: 'i, • �n��: .} ._ ',j .__ ... ..,,— + t - ! 3 i.:�.:..' ...o��..�! -� If':i�: i � �...��., � �_.,.. �" ,,�..a y_.. =.=:G.__iy__,�..,� :,._...trii jl !i".: 9� - -. ;t;.:i..,: �`.•.`_:� ,_.�__� 7 i`i; t'�C1 lJi`�Y•E:` ; 'v L�s�= �i�:_.1-.`'t�iE�fF- .. _'i! F i'_.f{4 . .. r = _ .. •"�f� . , i,: .— - ___..___ .._......�.._i':L.�.7E: CONTRACTOR: _. - _ � - : _ OWNER: ,�.t .. _ _.. C : - . - .. _ , _ �� . .T u.-. _ _.__ , .'i�, . _.. . ._:(��: - r-= - r. i�- -- .. .� , :,_ �..... �: r— .. : ,. _ — . ,. .. �.rf..�.. ,. �: : . � . . ' . ... f .. . .. . , . :. , .� �r�z^.. l . . . . . _.. .... . ..__. . . :-. _. _. � . _ .. .. ..,�... . . . ... � L _ ....._. ... �/ / ' [,�G� ) �J' APPLICANUPERMITEE SIGNATURE ISSUED BY:SIGNATURE � , , � Total Fee: $ DateReceived: DateApproved: Entered By: Permit#: CITY OF ORONO - BUII.DTiVG PERMIT APPLICATION ALL I�YFOR1ti�ATION v1UST BE SUB�IITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED -- -- ----------------- ---�--- THE APPLICANT IS: (circle one OWNER CONTRACTOR JOB srrE Ann�ss: l ( �5 �-� �;'in�� I��i v�__ z�: 5`�s�' NAiti�E OF OW�TER: � � .��`� �� PHO�IE: (home) (work) NIAII.INGADDRESS: � �Z� �'�� CITY: ZIP: 5535� CONTRACTOR: �C� � �'��-- ��'` � � PH0�1E: `��'.�k��% NI ILE PHONE/PAGER: �IAILINGADDRESS: �� l !�i,"1�^� CITY: (�-t � l, �!� ZIP: SS 3� STATE LICENSE: # ARCHTI'ECT/ENGINEER: PHONE: �iAILING ADDRESS: CITY: Z�� ,�: REGISTRATION # TYPE OF WORK: New Addition Accessory Structure Move RemodeUAlteration Land Alteration PROPOSEDWORK(describeindetail): ��1,� l�0 " -- STORIES: SQ. FEET OF EACH FLOOR: _ NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION(escludingland): $ �;�,G' z; ' ` I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be ' onformance with the ordinances and codes of the City and with the State Building Code; t I understand this is not a permit and work is not to start without a permit; and that the wo w� 1 e in accordance with the approved plan. DATE: �Z � S �� APPLICANT'S SIGNATURE: - NOTE! Parade of Homes events require separate permit approval by Police Deparlment ancl City Council 60 days prior to the event. Non permitted events will not be allowed. J� • � Sea 13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidenual data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the coilecting"state agency, political 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 confidenrial data;and(d)the idenfity of other persons or enddes authorized by siate or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nouce required under this subdivision in the individual income tax or oroperiv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data wichout 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 its meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been coilected or created. The responsible authority shall provide copies of the private or pubtic data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay the actual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possibte, wi[h 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 additional five days within which to comply wiih 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 notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall wichin 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b)notify 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 discfosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the adaunistradve 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 permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3, 'The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested pernut 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. �'�!��fi � ��S-�-C� First Nliddle Last ��R 1,"ti"� l l�Vv �v►v'-� Addre �� 1�1 v� � ss 3s�� 3 c��- � Ciry State Zip Phone 0' I understan my � as stated above. i ' ----- Signature