HomeMy WebLinkAbout1999-011119 - reside PERMIT
' CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: `��''`= �'`�'��'
Crystal Bay, Minnesota 55323 _��= � 1 i`�
(612)473-7357 Date Issued: i;;; ,;;.?�f;,�{,�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE � �l
Total Fee: $ /�;': d 2= Date Received:
Entered By: �i Perm.it#: /'/ << `%
CITY OF ORONO - BUII..DING PERMIT APPLICATION
All information must be submitted in full before plan review �vill be started.
(please print all information)
--------------------------------------____ _____----------------------- ----------------------------
THE APPLICANT IS: (circle one) OWNER O �CONT�RACTOR
R'�_ _�_._
JOB SITE ADDRESS:�`�� �Y/T �` �✓��1.%G'l.kl ZIP:
NANIE OF OW�'ER:f��� u 1L2 Pxorr�: cnome� y%�-�.3/�.5�
(work)
l�IAILPi 1G ADDF.ESS:��1�,2�rIC��'' CITY: .����{n� _ZIP:
, ��p�/
CONI'RACTOR: % ,�?�'r 5' PHO�:(���- 'S / / J���
CONTACT PERSO�'• c� So �s� MOBILE/PAGER:
MAII.,I�i'G ADDRESS:.3�/� �, 3 ' � �
CITY• �i�re�5�, ;�/�� zIP: ,��_3�>
STATE LICENSE: #:.,` �.`�' /��'s�'�S
ARCHITECT/EI\'GItii TEER: PHONE:
�1ATI..Pi iG ADDRESS: CIT'Y: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
. Move Remodel/Alteration Land Alteration
,� , s �
PROPOSED WORK (describe in detain:d��'S/�"�-' // �
STORIE�: �_ SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
/ �J
ESTII�i IATED CONSTRUCTION VALUATION (excluding land): � �%�/��� �f �
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 Buildin� Code; that I understand this is not a pernut and work is not to start without a
pernut; and that the work will be in c�ordance with e approved plan.
�
�� � � � t�'�YL DATE: ��� �
APPLICANT'S SIGNAT'URE ��' ��� < �
NOTE! Parade Qf Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permilted events will not be allowed.
,
. Sec.13.04 RIGHTS OF SUB.JEGTS OF DATA '
Subd. 1. Type o[data. The righrs of iadividual on whom the data is scoced or ro be swred shall be u sec forth in rhis secrion.
Subd.2. Informaaon reqirired to be�rm indiridual. An iadividuaI ufced w supply private or coafidendal dara coaceraing himself shall
be infocmed of: (a)the purpose and iarended use of the tequested dan withia the collecting State agenry.poliaeal subdivisioa,or sa�ewide system;
(b)whechec he taay refuse or is_legally required ta supply the requesud data:(c)any lacown coacequence arisiag from his supplying or retluiag W supply
privace oc wnfidendai data;and(d)the ideadry of o�her persaos or eaddes auchacized by stace or feden!law to ccceive che data. 13is requirement s6a11
not apply when an individual is asked to supply iavesdgadve dan,pursuaac to xcdon 13:82,subdivision S,cu a law entoc�ement officer.
The commissioner of revenu- mav olac- the naric- ceauired under chis subdivision in the individua! income taz or ocooem ax refund
insciucaons inscead of on�hose forrtu. �
Subd.3. Accas to data bv iadividual. Upon request to a responsibte authoriry,an individual shall be informed whether he is the subject
of stoced data on individuals.and whecha it is classitied as public,private or confidenaat. Upon his[ucrher«quesc,aa iadividual who is the subjecc
of smred private or publie daa ot►individuals shall be shown the data wichouc any charge ro hita and;if he desires,shal]be informed of the eontenc
and meaning o[chu data. Aher an individual has been shown�he privare dara and informed of irs meaniag.che dara need noc be d'uclosed to him[or
six mondu thareafter unleu a dispuu or acaon pucsuanc w�his secrion is pending oc addidonai dam on the individual has been collecced or ereared.
The tesponsible authodry shall provide copies of the privace or public dara upon nquest by the individual subject o(the dan. The tesponsible authoriry
may require the requesdng pecson to pay rhe ac�ual coses of making,cerrifying,and compiling the copia. ,
The responsible authoriry shall comply immediately,if possibte,wich any cequesc made pursuant w chis subdivision,oc wichin five days of
the date of the cequesG ezcluding Saturdays,Sundays and legal halidays,if immediace compliance is not possible. If he cannot comply with the requesc
wid►in ehat dme,he shall so inform rhe individual,and may have an addidoaal five days wirhia which to eomply wich the requat,excluding Saturdays,
Sundays aad legal ho(idays.
Subd.4. Ptocedure when data is not aeeurate or eomplete. An individual may contest the accuracy or compteteness of public or private
dan conceming himsetf. To ezercise[his right,an individual shal!nodfy in wridng the responsible surhoriry describing the nature of the disagttemenc
The cespoasible auettoriry shall within 30 days either. (a)correcc[he data found ro be inaccurate or incomplete and attempc to aodfy pasc recipientt of
inaccurate or incomplete data,including recipiencs named by the individual:or(b)noaf�the individual thac he believes the dara to be correcc Data
in dispute shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data.
The determinadon of che responsible auchoriry may be appealed pursuant to the provisions of the adminisaaave procedure act nlaaag ro
contemd 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 pemuc or license from the City of Orono or any of ics departmen[s may require you to furnish certain private or
confidential information.
You are notified thar.
1. The infocmation you furnish will be used to determiae your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license.
3. The information may be shazed wich o�her local,state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested pecmit or license requires Couacil 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 nazne is required to process this application or permit.
Firsc �tiddle I.ast
Addreu
Ciry Sate Zip Phone
I underscand my rights as stated above.
Sigtuture