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Home My WebLink About2004-A08083-JOB NOT DONE py Dc '- Total Fee: $ Date Received: /U'(Y'- Entered By: Permit#: yn p&cA%3 CITY OF ORONO - BUILDING PERMIT APPLIC • "ION All information must be submitted in full before plan revie will be started. (please print all information) THE APPLICANT IS: (circle one) OWNER%° CONT ' - CTOR JOB SITE ADDRESS: air• ORCt}/ J /W.Y ; RD ZIP: S53S(0 Will this be a Par de of Ho es,Remodelers Showcase Ho • or other Display Home? Yes P7 No yes, a special event permit is equired with Police Department and City Council approval 60 days prio to the event. Non permitted events will not be . llowed. NAME OFOWNER:MMIt-5 \\bill �S °F JttNET E \N & HONE:-(home) OISZ-g76-O373 \\ ,�^ (work) ciSZ q33-273-7 ex4-• Z3o MAILING ADDRESS: 500 O12 H A pPriet t CITY: LONG LA Kt ZIP: SS .(4.. LadatAs ® toe.11 d7.OVI wi 0.tic .CDwt CONTRACTOR: JEL-F\ PHONE: UU CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: 5E L F PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition \ Move X Remodel/Alteration Land Alteration PROPOSED WORK(describe in detail): 1O L1'(- NEW -FO 1 AT1 O N SND MO Q 140wt•E fR20w4 EXIS-rG S ITE *o CEN re le_ OF Pizo 7Ei'* ' STORIES: I. SQ. FEET OF EACH FLOOR: 720 NO. OF BEDROOMS: 3 GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 12- 1 0 0 0 I hereby apply for a building permit and I acknowledge that the information above ids 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:1/44W .047 41.0 A,w DATE: I o/ie/2001 Aipsk-4,ckver- `o4/gM 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. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,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 data 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 individual 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 additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority 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 determination of the responsible authority 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 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 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. First Middle Last 11-1-0w4 PrS EDr(el C\L ADA-Ms Address 500 0gu+etg-DI P ik RCA City State, Zip Phone I understand my rights as stated above. �� '�S`� -2.9,s -1476-OS 73 Signature E)U s-t Irv, ;Jo l srs: (q-- zx8-12 -f o 61(C. BEfiM Pi- Z;tB-l2/ , CoaCRETE WWltia_ Au. lb"O•C. I ) , -t_- , ) a } 1 1 101 IC/I" SPAW Q 13 'L. 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