HomeMy WebLinkAbout1998-010154 - reside PERMIT
CITY OF ORONO PERMIT TYPE:
27y0 Kelley Parkway- P.O. Box 66 �t;�1 A i �i T i:�t;
� Crystal Bay, Minnesota 55323 Permit Number: ;,f�����
(612)473-7357 Date Issued: ��� .r i;_::,:�;;
SITE ADDRESS:
���;r�..�, i_t_s's.�(ra �i�a��tt� i=�VE
r�:�
�''. � . � . . i 3�w�—� f f—y:��—'�;':;:--f_1C f.t.t:.°
DESCRIPTION:
��°=��.�,�
����i 1��i a-�=� t=`�r rr�i t� T.�_�.� °=��—�a�.��C�r��i i�+;��L
�:�Lil �.�:f31t� �,!S��F�'��: i `+¢'�' 3'��—_���.7�
i;,:F?il':.�Lt`.a t'_i�,7i�� i�.:,�t+ i-��� . #'t�`�=1���V�f�i�...
REMARKS:
FEE SUMMARY:
'.�t'-��(Jj�i T t_���,� 5�'=i;i 7i it i
�'L'��'.3'�' �}°� `�S} s}�} , �.'_4
'-1:i'i I E%i�''�::` '�sl�' �it1
_ _" ------�._.—.... .�•.ti�
1r�4.:a� Ft�� �� C�s i ,
CONTRACTOR: — ���=s 1 i�._���T. -- '��T . �I i� . OWNER:
�"�IC•I ::TTY �=:�TF��'jt��i'=: ��:�'�.�.,`'::�' i:_`�=:� i��'=�TE:;;'E�F�`�� !I�'�
°�t_�F.�; ������-i�=��'Y 4..� P�i a,t�;�..5 !titlra +i t�i�ai-i H'�E
i'�j-ii''�...L, ��,{�i'i_�t:f�t f!�„ Ct;_:i�;��,� lvCFi►f.f.ilt �'7.°� ��_'��z=��
�.��i.::.! i =—+fi���! ti%��'`-'j,`t��j':��
i �T��; 'r,C. S^._' �%'r7 _ � 1 — ` -'f.��1_ ;"L_i% ' ^i 9�i���e"�t:�:t:l�-i`,S 3 :
F'•� -� -=_'��-t."_��t�:�e...�1 �-;}�h;��:'p` �;'F_i�1:°;e'.r���`.�� !-`f=t':. ,�f'_. _;},i_;s,':, i f_ i'Ii-ia••.�. . .__ . .`..:�-it. _. .. . ._. . _. . �
_��`'�.������.�'1 �'-1�°��t �-it.�i ..._3:_" _ �'•�! �iS'Y �i i {:�'_�i i�'�. s�! _� � s ._ _. Er �+_:'•_1=°ii``a.._�i-lii�i_:�.. �:�:�.�!i� s�:_y_` _:'���{ (�I�-
� t_i�`i�t�'°,(!�i 1_i�i�)�fi.:i=j�„t'�:�:�. tzi;iL� ��< t'-t�� 1_.(:� a"I I;�.{E•:;����F,�:.a:: �-:;_: : ;_<i i;`.r. _�_i' '_.. �`.1-t:=;! : , ,�,�'�€3,-,:s1 i�'.=; , �.l
C ��
AP LICANTiPER EE SIGNATU E ISSUED BY:SIGNATURE
CiTY OF ORONO � 6124730510 04/24/98 08:59 � :01/02 N0:368
Total Fee: S /�`�. �� Date Receivcd• _ � ,J�'
� + �?ntered BY� Petmit�!: D/ �
.�
CITY QF URONO - BUII.DZNG PERNIIT APPLICATION
All iniormation must be submltted in h�ll before plan reveew will be started.
(pleast prtnt a11 l�'arntation)
_..__...._..-----------_.w_.____------------------------- - - ------------------
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
�os srrE AnnxEss: 1���' dC��n��,C�,�� �/� zrn: .SS�
NAME OF OWNER:�nr,�y �,-��,Q�,e� PHONE: (home} � - 8 �3
{work) 4s�Oi�t� ��s.
MAlLII�G AUDRESS: �f�/yI� CTY"Y: ZIP:
C�NTRACTOR: r S PHONE: y�S�7��
CONTA�T PERSON:�'L i O$ILE/YAGER:
M,A�ILING ADDRESS: CTY'Y:���,QvJ�ZYP: s�
STATE LICENSE: N
I1RC]I�IT'CCT/FNGIN�ER: PHONE:
MAILII�tG ADD�SS: CTTY: ZII�:
NANlE: REGISTRATION#
TYPE OF WORK: New Additioa Accessory S�ucturc
Move RemodeUAlteration Land Aluratioa
PROPOSED W4RK(des�ribe tn cktai�:_,(�� �S/ �
SiTOR�.9: _______ SQ.FEET OF EACH FLOOR:
NO. OF BEAROO1ViS: GARAGE STALIS: ATT. DET.
ESTIMATED CONSTRUCTrON YALUATION(qccludla�lancn: $
I hereby apply for a building permit and I aclmowledge that the informatton above is complete and �
�te; ttu�t the work w�l be in conformauce with the ordinar�s and codes of the Ciry and with
tha 5tatc Huitding Cade;-that I understand clils is not a permic and work is not to start wlthout a
perrn.jt; and that thc work will bc in accord�acc wi c appro ed plan.
APPI.ICANT'S SIGNATURE: � DATE:
NUTE! B�4d�Df Ilomes events quire ae �permit approval by Polle�Depa�hnent and
C�ty Council 60 days pr�tor to the �v�nt. Non-penr�lttad sv�nl.t wtU�ot ba allowad.
CiTY OF ORONO � 6124fSU510 04/14/9S US:59 [� :02/02 N0:368
r ,
Sea.i3.�ItiGtCl'S OF SUBJECT'S�F D.ITA
SubQ. 1. 'T�of data. T6e d;6cs of individwl on wbom�c Cata is stoted or to be scortd shaD bo as ut focth la Ctis sectioa.
Subf.2. iotvriaatloa rcqulra!to be d�ea!ad!►ldutl. M iudirldual ukcd to fuppty privam or co�desaai dsn coneerniq;aimself sbaU
ps intntat�d of' (t)the purpox ud iateaded usc of the[eQttesmd daq witlflu dte coqadae Snte a;tocy.polioc�l abdtvision,or�arowide sysmm:
(b)wAeeher he msr rclUse ot u Ie;�Ur requErod ro suppir�he tequeaeed�an:(c)ury knowe connqus�e arisa=trom bis wpplyin`ec rcMsia�eo supplY
• pe�rax o�eonlfdeno�t dw:aeid(d)rhe i�ieadry of oduc panons or eaodes suthorised Dy sna or iedenl taw ro recei�c rhe dan. 'Ihts rsquiremenc s6alI
not�pply�n�n individual h ut�ed.to supply inveitrpdw dan,pueivaa�w ucoon 1�.a2,wDdivi�ion S,w a Iaw eatozssment vfCicer. -
'ri►�eommiisi;,er of rcvcoue mav nlace�he nodce f�Qy�lttd Ufu1lT d115 tiubdivifiOrt in tht IM11VidUl11 UIC4rt14�X Q�onfpCLtY dx �e1��
4nnttedoru ituuid of on�o�e fomu.
� Subd.3. Acaa�to dsto py ladldduol. Upon nQueas w s responsibie audwriry,an u►dividual sAaU be infonnect whed►ec he a tb��ubjccc
ot�rond dus oe►indiriduat�,and whecber fc n elsssitKd u publk,priv�K or confidentid. Upon hts NrtAer reques�,sn iadividual who It the suDjec�
of�rond pdvan or pubttc dzn on inQividuali chdl b�shown du d�a wid�ouc Rnr clueQe oo him snd,if he dmere�,s6all be lnfoemed of du conans
md mN�nip�o[iAac dw. Aher an indivalu�t hu baa sHowa the pdrau data snd inlormed v(ia meutin�.the daa uced noc be dlseloled te hfia for
�i�a�4b�thehther un]ps a dispuee or aedoa punuanc so chis roction is pe�ien or addidoml d�n oa uie indi�idual h�s Deen eollecttd or ers�md.
'I11s ewpoatible authoeity�hUl provide copies ot d�e privace oc public dau upon aqwst by the indlrldunl sub)ecc ot ehe data. Tha�espoosible wihoriry
utay rsq+tln du requeoMnj p�non to pay th�aetusl cosu v!makin�.cerafyfo�,and comyilin�the eopies.
Tht t�nponfibl�authoriry thdl eomply inuned'utely,if pouiblt,with aar requts[made pursu�nt co this sulxii�ision,ur widila Avs dsys of
IW dur af I�s tequeu.eaeludinj S�aird�ys.Sundays aM fepl sol�ys.U im�dhu eomplianee u noc possible. if Fie etnaoc comply wlthh dK nquex
withiti dpt ti�e.be�lull m intom�rhe iadividwl.�nd mty tutve an sddieionat dve d�ys wid►in Whieh to cumply xn�h tGe requesc,excludior sswrdays,
Sundq��nd I•;tt hotid�ys.
Subd.4. Proetdun wMn data b aot aawst�or compkt�. M indlridwl aKr conasc d�e�tcur+ey o�compteteneu of public or pdva�e
d�a eoAmtenfn�hinwtL To.�nmlx�his rithc.aa Sealividn�l sA�ll nocly in wriri�y d�e ro�poatlbte w�Aoriry deutibini du namre ot du disyreta»at.
'11fs n�pon�lWs wrhonry t!u!I wi�hin 30 day��itlu�: (a)cvrtect�t+e dan found to be in�ecunte or iruomptea and�aempt m aotify psit reeipiean ot
Iq�eeuna or ineomptea dan,iacludia{cecipien�s named by tlw individwl:o�(by nonry IAe individus!thac h�e betleves the data m De cort�e�. Daa
1n dlipuq fhsp be df�closcd oNy tf the irufividuil'i sotemeat of disa=taenxnc!s IncLded�ith the d'ucloted din.
7'F►�d�artninsaon o!�he mspansibla xu�horiry ttWy be�ppcal�d punuuu to du provisione of dw uiminisazave procedure ut telsdu�w
CQIIIlfRd ui�s.
�ATA PRIYACY ADVISORY
In accor�dence with M.S. 13.04,Subd.2, "Rights af subjecu of d�ta",we would like to inform you chat your request
tot s pen�tit or licea�a trom the City of Orono or atiy of iu departmeats may require you to turnish ctrtain privue or
confideadv intonuatioa.
You are notJflcd that:•
1. The informatton you furnish will be used to detecmine youc qualification for the permit or ticense requested.
2, you may refuse co suQply data, buc refusal may rcquire that the Ciry deay cbe perauc ot licease.
3. 'Ihhe infornution may be shared wich other local.scace or federal agencies to the excecc neceuary to process
the permit ar liceate.
4. 1!your requeated pecmit or lic�se requtres Couacil �ctIon to apptove, some iaformatioa may beeome
Qubtic.
S. You bave certain rights unde�M.S. I3.04(ava�lable upon reqaesc) �o�eview prlvace data on yourseli.
b. Yo�tr tull aune is required co process thts appl'►cuieu ot pertaic.
\ — � � .
F►M �� 'a`� - �'
, �
"°d �,� �/1/ �2s�--�7-3�
�d San Zi� Pboae
I umde tsnd my ri�hcs �a stu bov .
1
Si= »