HomeMy WebLinkAbout1997-009760 - re-side � PERMIT
Y OF ORONO PERMIT TYPE:
_i'S0 Kelley Parkway- P.O. Box 66 '= ��-:�
(�rystal Bay, Minnesota 55323
Permit Number:
(612) 473-7357
Date Issued:
���"E .�DDRESS:
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��SCRIPTION:
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PLI NT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � S 1 � � U y f L� � � ZIP: ��3 ��
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NAME OF OWNER: S u 1���� J�/ �� PHONE: (home) I7� " ��y 1—
(work)
MAILING ADDRESS: S�� � CITY: �,J� L 1 ZIP: �'3
CONTRACTOR: PHONE: ����°j�
CONTACTPERSON: � P�1�'1�: � MOBILE/PAGER:
MAILING ADDRESS: /y 9 ���^� � s 4�� CITY: r-�N� L�� ZIP: 5'S .�
STATE LICENSE: #
ARCHITECT/ENGIlVEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detai�: � � y S/� � �� �A ��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $�� G �
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 SIGNATURE: DATE: �I -� ��
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.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.
S�bd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself
shall be informed of: (a)the purpose a�intended use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refitse or is legaUy required to supply the requested data;(c)any lmown consequence arising from his supplying or
refusing W supply private or confidential daha;and(d)the identiry of other persons or en6des authorized by state or federal law to receive the data.
T4is requirement shall not apply when an individual is asked to supply investigadve data,pursuant to secdon 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revernie mav olace the noace rewired under this subdivision in the individual income taz or orocertv taz refund
inswcdons 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 confidential. Upon his further request,an individual who
is the subject of stored private or public dara on individuals shall be shown the data without any charge to him and,if he desires,shall be informed
of the content and meaning of that data. After an individuat has been shown the private data and informed of its 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 addidonal data on the individual has been
collected or created. 'ft►e responsible authority shall provide copies of the priva0e or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediarely,if possible,with any request made pursuant w this subdivision,or within five days
of the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that dme,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedui�e 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 audioriry shall within 30 days either: (a)correct the data found to be imdccurate or incomplete and attempt to notify
past recipients of inaccurate or i�omplete data,i�luding recipienu named by the individual;or(b)noafy 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 disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant to 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 pernrit or license from the �ity of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze notified that:
1. The information you fumish 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 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 pemut or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04(ayailable upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signature
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