HomeMy WebLinkAbout1996-007776 - tear off �� PERMIT
� CITY OF ORONO PERMIT TYPE: =,i��� ������
2750 Kelley Parkway- P.O. Box 66 Permit Number: i ii`�7��h,
Crystal Bay, Minnesota 55323
(612)473-7357 Date Issued: f�;:;;��,����:,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — �����I ���}��� �' '=�� � �-I�-� OWNER:
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APPLICANT-PE MITEE StGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ DateReceived:
Date Approved:
Entered By: Permit#:
CITY OF ORONO - BUII�DING PERNIIT APPLICATION
ALL INFORMATION MUST BE SUB1�iTTTED Tiv FULL BEFORE PLAN REVIEW WILL
BESTARTED
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THE APPLICAPIT IS: (circle one OWNER O CONTRACTOR
JOB SIT'E ADDRESS: G�Q�fIt LIJCk�� /��i� (������ ZIP: .�5 3� /
NAME OF O`VNER: �Ct,�� ���0 T� J PHONE: (home) ��-��l �S
(work)
MAILINGADDRESS: �� rvl r��"Lt)0� �'� CITY: �j/�6tit� ZIP: �5"3�
CONTRACTOR: �� �UO��OL�l �� P�-IONE: ��.3-.3 3 �7
� MOBILE PHONE/PAGER:
MAILPi 1GADDRESS: ��Sas �0 I�� �y CITY: (���/1tiU ZIP: .�5
STATE LICENSE: # Dp0 5 3 5�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z��
N�,�,�: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration � Iand Alteration
PROPO ED WORK(describe indetail):� �fI Y� (�t+ (�i�'�( r�S�l l v1� 'f G�l�1 ti �1 (�;!��
���,�d E�,� L�� �u� b�� r.���s
STORIES: 2 SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTT�i �ATED CONSTRUCTION VALUATIO�t(escludingland): $�/ �Q� �
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 w will be in accord ce ith the approved plan.
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APPLICANT'S SIGNATLTRE: �
NOTE! Parade of 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.
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Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on w6om 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 confidendal data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency,polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known coasequence arising fmm his supplying or refusing to supply
private or confidenaal data;and(d)the idenary of other persons or enddes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative dara,pursuant to section 13.82, subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the nodce required under this subdivision in the individual income c� or property tax refund
inscructions 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 confidendal. Upon his further request,an individual who is the subject
of stored private or pubtic data on individuals shall be shown the da[a without 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,che data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secrion is pending or addirional dara on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by rhe individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of making, cerdfying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with 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 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 private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the 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 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 disclosed data.
The deternunation 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 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 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.
6. Your full name is required to process this application or permit.
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I u erstand�'tny r' ts tat d bove.
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Signature