HomeMy WebLinkAbout1998-010681 - tearoff/reroof/reside PERMIT
� ��ITY OF ORONO PERMIT TYPE: -
2750 Kelley Parkway- P.O. Box 66 `'`-'-` �-�-����`"�
Permit Number: i=i�.:i:�,i:�1
Crystal Bay, Minnesota 55323 __ _ .�.
(612) 473-7357 Date Issued: t i,_.:���.�r�,�:��,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — r��=�=='s i t��.k-�t� — �1 f� . 4 i= .OWNER:
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APPUC PERMITEE SIGNATURE ' ISSUED BY:SIGNATURE ,��,C,.�.
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To�.al Fee: $ Date Received: ,
Entered By: � Permit#: /p ro p/ �
CITY OF ORONO - BUILDING PERMIT A�'PLICAT`ION �
All information must be submitted in full before plan review will be started.
� �_ � � _--_'_�Iease print at1 information) ----- --
i�� �v L�CJ C:�� �.� � , � �. �
THE APPLIC�NT IS: (circle one) OtiYNER OR CONTRACTOR� � � . �
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JOB SITE ADDRESS: 1 �o I U � �'1 ' �,v� �, ZIP: S �3�"l I
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� NAME OF Oti�NER: � � � d n U/ � PHO�IE: (home) � � � /
(work)
( ' ��, 7`lfiZIP: S_'�,-�
I1�I�.TLII�TG ADDRESS: (-� 1 C-� S �cAr �,.Lr �r�r�;�CITY: (�._ J� � �
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co��x.A.cTox: �� A U �I2 t C 1% �nti'��rxo�: `-�`�� 7��� � i
CO�'TACTPERSON: � _a,�- MOBILE�PAGER: � 1 ��' �� '
���TG�nnx�ss: r 2 �� � ' c�crrY: ��,�v���'r zrP: �— � 1
STATE LICE�'SE: #_ � ���-, .
ARCHITECTIEi�TGINEER: PHONE:
1�•iA.II�ING ADDRESS: CITY: ZIP:
I�'AME: REGISTRATION#
TYPE OF ti'VOR�i: New Addition / Accessory Structure
Move � � Remodel/Alteration 1� Land Alteration
PROPOSED'��O (describe in detain: 2. — �o o � c �r �
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STORTES: SQ.k�EET OF EACH FLOOR: � -
NO. OF BEDROOMS: GARAGE STALLS: AT�'. DET.
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ESTII�i IATED CONSTRUCTION VALUATION (excluding land): $ c� � � � �. �
I hereby apply for a buildin;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 �ity and with
the State Buildin� Code; that I understand chis 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.
APPLICA.NT'S SIGNAT'URE: DATE: �" 1 � / �
NO�'E! Parade Q Flome� events require separate permit approval by Police Deparlment and
� City Council 60 days prior to the event. Non permitted events wi11 not be allowed.
�
Sec.13.0:RIGHTS OF SiJB.TECTS OF D:�Ta
Subd. 1. Type of daca. The righct of ir.dividual oa whom[he data is srored or to be s�rd sha[l be u set forth in this secdoa.
Subd.2. Information reqirired to be�ven iadicidual. .'�n iadividual azked to supply private or coafideaaal dara concecn�g himsetf shall
ba ieformed of: (a) �e purpose and inmedcd use of the rzquesr�daca wi�in che collecdag�tate ageacy,poiidcal suFdivisioo,or sacewide rys.:m;
(b)whec'�er he may r_.`use or is legally rcqui;:d to supply the r.quesud data;(c)any fmown eonsequence arising from his supplying or refusiag to supply
priva:e or conridendal dzra;and(d)che ideedry of ocher pe:soas or enodes aachoriz:d by s�ce or federal law to receive the dara. This r:quirement shall
noc apply when an i.dividu3l is asked ro suppty invesdgadve da�,pursuanc to s:cdon 13.82,subdivision 5, to a law enfotcemeac of�ccer. -
'ihe eom^,.issioner of re�•enue mav olace the norice r_ouir_d under ehis su�division in che individu�l incone ax or orooe;cv taz refued
ins:rscdor.s insc_ad of on�hose foRns.
Suhd.3. Access to data by inditiidual. L1pon request to a responsible auchoriry,an individual shall be infor,aed whech=r tie is the subjecc �
of s�rcd dsc�on individuals,and whcther ic is classifi:d�s pubtic,private or conFdenaal. Upon 6is furcher tequest,an i*.dividuaI who is the subje:�
af s:ored private or public dac►on individuaIs shall be shown the dac3 wichout any charge to tiim aad;if he d:sires, sh�1l be informed of the eoncent
and meaning of that data. Aher an individual h�s been shown the privac;data and informed of ics meaning,the data need not be dis:losed to him for
six monchs a':erea[Lr u:iless a disput.^.or acdon pursuanc co chis sccdon is pending or addiaoaal dan on the individual tas beea coflecc�d oc ereared.
The r_spons:bte au�horiry shall provide copi:s of the privace or public da�upon request by che individua!subjecc of the da�. The responsible auc�oriry
may rtquire che reques:ing peaon to pay the accual coscs of making,cerdfying,and compiling che eopies.
The responsib(e auchoriry shall conpiy immedia�e[y,if possible, wich any request madz pursuant to this subdivision, or wichin five days of
the c'ace of�he requesc,ezciudir,g Sa[urdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the�equesc
wichin�hat time,he shail so inform[he individuai,and may have an addidonaI five days within which to comply wich the requesc,ezcitding Sa[urdays,
Sundays and legal holidays.
Subd.4. Procedure r�hea data u not accurate or complete. An individual may contest tht accuracy or completeness of public orprivate
dac�cor.cerning hir.:self. To eze;cise this ri¢hc,an individuai shail noa'ry in wridng[he responsibte auchoriry describing the na�ure of[he disagre:meac.
Zhe responsibfe aucnoriry shall wichin 30 days either: (a)corr•a che dsta found to be inaccucate or incomplete ar.d attcmpt to nodfy past recipienes of
inaccurate or incomplece da�a, including recipiencs narr;:d by the ir:dividual; or(b)aotify the individual that he bclieves the data to be correcc. Data
in dispute shalt be disclosed only if the individual's s�acem�nt of disagr:er,.ent is included with the disclosed dac�.
The determinadon of the responsibl� authoriry may be appealed pursuanc to 4�e provisions of the administrarive procedure act relaang to
contesced cas�s.
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 Ciry of Orono or any of ics departments may require you to fumish certain privace or
confidential informacion. �
You are notified that:-
1. Zhe information you furnish will be used to determine your quatification for the permit or license requested.
2. You may refuse [o supply data, buc refusal may require that the City deny the perm.it or license.
3. Zhe informatioa may be shared with ocher local, state or federal a�encies to the ex�ent necessary to process
' the permit or license.
4. If your requested permic or license requires Council actlbn to approve, some information may become
public.
5. You have certain riQhts under M.S. 13.04 (available upon reqaest) to review private data on yourself.
6. Your full name is required to process this applicatioa or permi�.
L-� !'�-I�Y �U f-��" ��('�-C� .
First , � �fiddlf ...� Last
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Addre � 1 �, � �,/
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Ciry Stace Zip Phoat
I understand my ri;hhcs as stated above.
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STATE OF MN DEPT. �OF CQMMERCE ,
«1,,,,,,,,,,, ;,, STATE OF MINNESOTA .. ;�'�E��:.:
��;��9 DEPARTMENT OF COMMERCE 133 East Seventk��1'- :��� �' Ri�
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ry� 133 Fast Seventh 3t S't.paul,MN S51 U1 I, :
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��`�:, v �t St.Pau1.I+�N 55101 (612)296-6319 �� ., �
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CORPORATION _
Expires: 03/31l199$ Expires: 03/31l1998
C3�REC�QRY D SNdW GREGORY D SNOW
7 Hrs 4E due�y 3/31/98 7 Hrs CE due by 3/31/S8
MAVERICK CON3TR II1C DBA:MAVERICK CONSTR iI�C
11227 RIVER R� 11227 RiVER R�
gpNp�t MN 5 S 341-0000 ��p��S S 341=00A0
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�'�M : �'.�R�' �SEN.� PHONE N0. : 612 536 1010 Jun. 20 1998 02:50PM P7
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