HomeMy WebLinkAbout1998-010975 - re-roof PERMIT r
� G'�TY OF ORONO PERMIT TYPE: —;� {;; ;;t���K
2750 Kelley Parkway- P.O. Box 66 - �� --"
Crystal Bay, Minnesota 55323 PermitNumber: �.�:�{..'s'�-�.?; .
(612)473-7357 Date Issued: i � l i y'o`���_:
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE , /
� 'Total Fee: $ Date Received:
Entered By: �/; Permit#: /�' 9 ��
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER �R CONTRACTOR �
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JOB SITE ADDRESS: �-S-.S� �����i��-� (`�"" ZIP:
NAME OF OWNER:�f i�,r� ��� �'����� PHONE: (home) �7 c�- C%+�-� ;
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� (WOIk) ��-Sr � ���>
MAILING ADDRESS: /�S y ��,,� ti` CITY: (%�'`' ZIP:
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CONTRACTOR: C�:_.�(�-� ( ,C����fi,��Gr� PHONE: J��_� SJo�S
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS:�X'/ r � �(A ` CITY:(���_� ZIP:
STATE LICENSE: #'�'�?���
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�.-��1�"I' `lY�ta�. � �C-�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � ,�-�C� -'
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I hereby apply for a building pernut 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
pernut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNA � ��� DATE: II—��'C� � -
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
. `
Sec.13.04 RIGHTS OF SLJBJECTS OF D�TA
Subd. 1. Type of data. The rights of individual on whom the data is stored or[o be stored shall be as sec forth in this secrion.
Subd.2. Information reqirired to be given indiridual. �.n individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and incended use of tho requesud data wichia the collecdng"state agency,political subdivision,or sratewide sysum;
(b)whether he may refuse or is legalty required co suppty the requested data;(c)any imown coasequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)the idendry of other penons or enrides auchorized by state or federal law to receive the data. This requiremeat shall
not apply when an individual is asked to supply invesrigaave dara, pursuant to secdon 13.82, subdivision 5, to a(aw enforcement officer.
The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income tax or propem tax refund
instruccions instead of on chose forms.
Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subjecc
of stored data on individuals,and whe�her it is classified as public,private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown che da[a without any charge to him and,-if he desues, shall be informed of the content
and meaning of�hat data. Aher an individual has been shown[he priva[e data and informed of its meaning,che data need not be disclosed to him for
six mon[hs thereafter unless a dispute or acdon pursuanc to this secdon is pending or addiaonai data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require �he requesdng person to pay the accual cosu of makin¢, certifying,and compiling the copies.
The responsibie authoriry shall comply immediately, if possible,with any requesc made pursuant to this subdivision,or within five days of
the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canno[compty with the request
within chac rime,he shall so inform the individuai,and may have an addirional five days within which to comply wi[h the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure whea data is not accurate or complete. An individual may contest che accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in wridng ehe responsibie 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 noafy past recipients of
inaccurate or incomplece 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 staremenc of disagreement is included with the disclosed data.
The determinauon of the responsible authoriry may be appealed pursuant to the provisions of the adminiscrarive procedure act reladng 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 detemune 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 reques[) to review private data on yourself.
6. Your full name is required to process this application or perm.it.
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First �fiddle Lasc
Address
Ciry State Zip Phone
I understand m rights as stated above.
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Signacure