HomeMy WebLinkAbout1996-008345 - tear-off/re-roof/fla PERMIT . .
�I�l� OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 F:t;��_r:,T�r�f;
Crystal Bay, Minnesota 55323 Permit Number: i;�y,�,.W,�,�
(612)473-7357 Date Issued: t 3,=�i c;rr=/,=�h
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPUCANTiPE MITEE SIG ATURE ISSUED BY:SIGNATURE
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' � Total Fee: $ � �: � ' Date Received:
Entered By: ,;� Permit#: �; y�
CITY OF ORONO - BUILDING PERNIIT 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"OR CONTRACTOR
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JOB SITE ADDRES� `��� -� `f�! �-U�S�z.(, �=fti fL. ZIP: S� 3`� �
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NAME OF OWNER: h�� � � � �-A' �--� __� . PHONE: (home) ���-� ��o�
�q (work)
MAILING ADDRESS:��`� K-�.t.SS��� 1ktA��- CITY: �,; � Z� ZIP:_�5�3�/ - ls� �6
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration 7G" Land Alteration
PROPOSED WORK(describe in detai��<-c�a- c�� •� ��_ ��cc� , !�:���--� ��«���� �'�v� ���'��s�^� � �5
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ .� ��' �' �
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 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 accorda�nce with the approved plan.
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APPLICANT'S SIGNAT . � �� � DATE: � ���-�
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NOTE! Parade o Homes eve s require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF Si1B.TECTS OF D�.T?.
Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be scored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given indi��dual. r1n individual asked to supply private or confidendal data conceming himself shall
be informed of: (a) the purpose and in[ended use of the requested data within the collecting'state agency, political subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing ro supply
private or confidenrial data;and(d)the idendty of other persons or enrides au[horized by srate or federal law ro receive the data. This requirement shall
not apply when an individual is asked to supply invesdeadve dara, pursuant ro secdon 13.82, subdivision 5, ro a law enforcement officer.
The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instruccions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
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 rhe data wichout any charge to hun and, if he desires, shall be informed of the contenc
and meaning of[hat data. Afrer an individual has been shown[he private data and informed of its meaning, the data need�ot be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to [his secdon is pending or additional data on[he individual has been collected or creaced.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the actual costs of makine, certifying,and compiling the copies.
The responsibfe 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 5aturdays,Sundays and leeal holidays, if immediate compliance is not possible. If he cannot comply with the reques[
within that time,he shall so inform the individual,and may have an addicional five days within which to comply with the request,excluding Saturdays,
Sundays and legat holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple[eness of public or pm�ate
data concerning himself. To exercise[his rieht,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b) notify the individual that he believes[he 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 authoriry may be appealed pursuant to the provisions of the administrative procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Ri�hts 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 pemut 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 ex[ent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
E. Your full name is required to process this application or permit.
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First �� le Last
���i 9�.s ��� 1( �,��
Address � �
�.��, �� ; �, `< �� ����r �- "����, ����- y�s��y�=�
Ciry ��State Zip Phone
I u erstand my 'ahts as stated above.
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Signa[ure _/
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