HomeMy WebLinkAbout1988-010788 - re-roof PERMIT
' C�TY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 T�t�T L_�z����i�
Crystal Bay, Minnesota 55323 Permit Number: -
Date Issued: �!�i"�`�-��"� -
(612)473-7357 s,}'�%'��`=,:''`_��-;
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT,'PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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` Total Fee: $ DateReceived:
Date Approved:
Entered By: Permit#:
CITY OF ORONO - BIJTLDING PERNIIT APPLICATION
ALL I�YFORMATION MiJST BE SUB�IIT"I'ED IN FULL BEFORE PLAN REVIEW WILL �
BESTARTED
THE APPLICANT IS:�~(circie one) OWNER OR NTRACTOR
JOB STTE ADDRESS: �` �D /C6CC�P �tJOaC� C<✓' ZIP:
NAME OF OWi�TER: Lo � erv ('!�U 5 �7 PHONE: (home)
(work) g g!- 86 3�
MAILING ADDRESS: GD q �� /`�vG 5 CITY:��—ZIP:. �za
CONTRACTOR rj� C��vs PHONE: ��� .3 S ��
NIOBILE PHONE/PAGER: �/6 �3 3 .3
�a��.�rGanDxEss: I b�/ (� ��s t S ouf�- crrY: �,�wy zrn:��
STATE LICENSE: # 3,�6
� ARCH�iiTCT/ENGINEER: PHONE:
� MAII.INGADDRESS: CITY: ZII':
N�,�: REGISTRATION #
�
� TYPE OF WORK: New Addition Ac,cessory Stiucnu�e
' Move RemodeUAlteration � I.and Alt�ration
� . �fi � � 4
PROPOSED WORK(descnbe mdeta�l)• �t�l�' ���� � U
�
�
� STORIES: SQ. FEET OF EACH FLOOR:
l� NO. OF BEDROOMS: GARAGE STALLS: A� DET.
�/g, �-
ESTIMATED CONSTRUCTION VALUATION(escluding land): � C�7 G
I
� I hereby apply for a building permit and I acknowled?e that the information above is complete
and accurate; that the work wi11 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.
N APPLICANT'S SIGNATLTRE:�/h.� � �— vi DATE: � 'Z�� � �
� .
� NOTE! Parade of Ho�nes events require separate permit approval by Police Department and
� City Council 60 days prior to the event. Non permitted events wi11 not be allowed.
- :�. .. : .
Sec.13.04 RIGHTS OF S[JBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be srored shall be as set forth in this secrion.
Subd.2. Information required to be given individual. An individuai asked to supply private or con5dential 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 stacewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the idendty of other penons or entides au[horized by state or federal law to receive the data. This requirement s6all
not appiy when an individual is asked to supply invesogadve data,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 rax or property_taz refund
instnicdons instead of on rhose 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 co�dendal. Upon his funher request,an individual who is the subject
of stored private or public data on individuals shall be shown the daca wirhout any charge to him and,if he desires, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of i[�meaning,the data need not be disclosed to him for
siz months thereafter unless a dispute or acuon pursuant to this secdon is pending or addidonal data on the individual has been collecud 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 authoriry
may require the requesting penon to pay the actual cosu of making,certifying, 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 immediau compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which ro 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 notify in wriring the responsible authoriry describing[he nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate�r 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. Dara
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The detecminacion of the responsible authority may be appealed punuant to the provisions of the adminisaative procedure act relaung co
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 pernut 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 a;encies to the eztent necessary to process
the permit or license.
4. If your requested pernut or license requires Council action to approve, some information may become
public.
$, 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.
I�Yw��� G i�/�OrP� ,v �P `SGy1/ ��• -
First Middle ��
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Address ���SL/� / �? 3 �7 J 2�
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rySta� Zip Phone
I understand my righ as stated above. �
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