HomeMy WebLinkAbout1995-007317 - re-side � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ;!r, _ ' -
Crystal Bay, Minnesota 55323 Permit Number: '.^,_;,:`_'�`�`` `�
(612)473-7357 Date Issued: - - -
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: - . . . _ _ _ _... ., -- _ .:_ OWNER:
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PPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
� F pRONO - BIIILDING PERMIT APPLICATION
CITY O �
i ��-"
,� � Date Received:,� ' fu " %
Total Fee: $ ��� �\
Date P.pproved:
. r '
�ntered By: Permit Q: %.=3 � 7
AI.L INFORMATION MIIST B$ SUBMITTL�D IN FIILI' 8��� p�N �I� ��'�' BB STAR�F�
(See Check-aff List Enclosed) _________________
-----------�-�- T
� AppLI�A�7� IS: ( circle cne) OWNER or CONTRAC_OR
. ,_. '` -7 v�c:'2���5�'�(���- � '"L--� ZIP:
JOB SITE ADDRSSS: � ' �
(work)
� � - � ��j���� PHONE: (home)
N�ME OF OWNEK: � -'
� ��� ��t �� CITY: ��f2-ii'--'(� ZSP: � S ���_�_____
MATLING ADDRESS: �- (� �� �SG��.� -_s�
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CONTRACTOFt: ����T�L:.' � '`�''•'`�' PHON$:
. 2.���> /�J��6� � L;� cz�: � � ���'���/ zzP: ���(�—,
?�ATI,ING ADDRESS.
STATS LICENSE: � `rt �� `
PHONE:
ARCHITECT/ENGZNEERs
CITY: Z2P:
MATLING ADDR$SS-
R.BGISTRATIOA u
N�:
TYPE OF WORR: New
Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
�f�`�j� �3 �'��,
PROPOSED WORK (describe in detail) : �
STORIBS: SQ. FEBT OF EACH �LOOR:
NO. OF BSDROOMS' ��� STI�LLS: ATT. DET.
� ( � Ooo
ESTIMATED CONSTRIICTION VALIIATIoN (eacl}lding Iand) = $ �
: hereby apply for a buil.ding pe�i the work ill be in conf rmanc£�"�lthtth.
above is complete and accurate; that that
ordinances and codes of the City and with the State Building Co e=�it; an�
understand this is not a permit and work is not to start without a p
that the work will be in �cordance with the approved plan. . C �
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� ���%�� DATE:
APPZICANT'S SIGNA�URE:
�
�
� CI7��' of ORON�
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
� .
� _ � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
��In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of
data , we would Iike 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:
l. The information you furnish will be used to determine your
qualification for the permit or Iicense 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 iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review prica��
data on yourself.
6. Your full name is required to process this applicatian or
permit.
�lb�� �/I� ` `' �-�`�
First Middle Last
�75�� � ����� �-� �
Address
��' ��' ,�SS`��
City State Zip
91� ., ��� ` ��C�� -
P�one
I under tand my rights as stated above.
,
Signatu e �
BUILDING&ZONING—473-7357 • ADMINISTRAITON�FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
.�r --�-- -- ---- �
�G� OF �g�C� OF DATA �
S13.04
Subdivision L Z�
of data- The rights of individuals on whom the data is
stored or to be stored shall be ss set forth in this section. An.individual asked to
to be given indivi�uaL
Subd. 2. �or�a�On �d himself Shall 5e informed of: (a) the
� � supply private or confidentiel data concerning
g ency,
d intended use of the requested dat whether he ma� refusesortes g g�y
purpose an tem; �b� uence arising from his
political subdivision, or statewide sys �own conseq
required to supply the requested date, ��� �y end (d) the identity of
in or refusing to supply private or confidential data;
supply g 'ties authorized by state or federal law to rice��e St gative da a
other persons or enti
requirement shall not apply when an individuel is asked to supp y
P
ursuant to section 13.82, subdivision 5, to a law enforcement officer.
' ioner of revenue mav lace the notice reQuired under this
The commiss or ropertV tax re und instructions insteed o
subdivision in the individuel income tax —
on those orms. " onsible �
Subd. 3.
Access to d�ta bY ����" UPon request to a resp
individusl shall be informed whether �f�ateeor confident el.e UPan tus
authority, � fied as publ�c, P rivate or public data on
indivi�u8ls� g�d Whether it is class1 if he desires, shall
further request, an indi`nd� �hO � the subject of se to him �d� been
individuals sha11 be shown the data witho of�hat da a• After an indi�dual h�
the dats need not be disclosed La
�e informed of the content and mea�ung ursuant to this section is
shov�m the private data end informed of its u���action p
him for six months thereafter �� a �P or u�lic �ta upon request by
'tional data on the individusl hes be�en collected or created. T Q
� pending or aa� Sh� proyide copies of the privat P TeQuire the
responsible authority onsible authority may �ln the
the individuel subjeet of the data• The r�P �Ertifying, and comp g
requesting pe�on to pay the actual costs of making,
y if ssible, with anY request
copies. uest,
The resoonsible ausubd��o�or w thin f ve�days of the date of the req
ma de p u r s u a n t t o t h�s �d le g a l h o l i d e y s, i f i m m ediate compliancQ is not
excluding Saturdays, SundgYs
Q ��ot �mpiy with the request withi�i��ntwhich tohcomPlY fw n the
possible. If h �ve � additicnal five daYs
individual, and may Sundsys and legal holidays.
request, exeluding Saturdays,
te or complete. An indivi�u� To
Subd. 4. Procedure �►hen data is not ac�8 �mself.
- or completeness�of public or private data conee o�lble authority
contest the accuracy in y�i�ng the resp
exercise ihis right� an individual eQ�n�°tTh resp��sible authority shall within 30
describing the nature of the disagt' lete and attempt to
days either. (a) co�'ect the data found to be i�e dataeinclud�ngPe talte be correct
notify p85t recigients of inaccurate or incamP eement is
the individual� or (b) notify the inc3ividual that he believes the da
ute shall be disclosed only if the individual's statement of disagr
Data in disP e�ed p�u�t to the
• included with the �isclosed data• �ible authority may be aPP
� The determination of the respo to contested cases•
provisions of the administ�'ative procedure act relating .