HomeMy WebLinkAbout1999-012204 - re-side z _ PERMIT
�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number: c �.
Crystal Bay, Minnesota 55323 �� _
(612) 249-4600 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:SIGNATUR C
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Total Fee: $ Date Received:
Entered By: Permit#: )ZZv
CITY OF ORONO - BUILDING PERNIIT 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 CONTRACTOR�
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JOB SITE ADDRESS: �� � � '-` ZIP: �S 3�3
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NAME OF OWNER: ` ..� — �� ,,, PHONE: (home)� —c���.3
(work)
MAILING ADDRESS: C ZIP:
CONTRACTOR -- `�� ��S PHONE: �--�,I�—��� 3�c'7
CONTACT PERSON: S MOBILE/PAGER:
MAILING ADDRESS: � r GJ CITY: J „�;.�(�ZIP: ¢�-�.3�
STATE LICENSE: # �'"�-���E�
ARCffiTECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: / � ���
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �,a�� —
I hereby apply for a building pemut 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 unders this is not a permit and work is not to start without a
permit; and that the work will be in a co ce ' e approved plan.
APPLICANT'S SIGNATURE: DATE: ���J�/ �
NOTE! Parade o 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.
� 1
Sec.13.04 RIGHTS OF SUBJECTS OF D?�TA
Subd. 1. Type of data. The righ[s of individual on whom the data is s[ored or[o be stored shall be as set forth in this secrion.
Subd.2. Informa[ion required to be given individual. ?.n individual uked to supply private or confidenrial data conceming himself shall
be informed of: (a)the purpose and inttnded use of the requested data wi[hin the collecting'state agency, polirical subdivision,or sracewide system;
(b)whether he may refuse oi is legally required to supply the requested data:(c)any lrnown consequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)[he identiry of other persons or enrities au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigadve dara, pursuan�to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav lace the notice reauired under this subdivision in the individual income tax or ro ertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data b�indi��dual. Upon request co a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals, and whe[her it is classified as public, private or confidenrial. Upon his further request, an individual who is the subject
of stored priva[e 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. Afrzr an individual has been shown the private data and informed of its meaning, che data need not be disclosed to hun for
six months thereaTter unless a dispute or ac[ion pursuant to this secdon is pending or addirional data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry
may require [he requesting person to pay the actual cosu of making, cenifying, and compiling the copies.
The responsible authoriry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Sarurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with[he request
within that time,he shall so inform che individual,and may have an addirional five days within which to comply with 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 pm•ate
data conceming himself. To exercise this right,an individual shall noafy in wriang the responsible authoriry describing che 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 noufy past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual thac he believes the data to be correcc. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The de[erminadon of the responsible au[horiry may be appealed pursuant to the provisions of the administradve procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Riahcs of subjects of data", we would like to inform you that your request
for a pemut 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 pemut 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 certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(, Your fuli name is required to process this application or permit.
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First -��
Midd �� Last
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Address ' � � _
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State Zip Phone
City
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I understand m rig
Signature