HomeMy WebLinkAbout1995-007534 - tearoff/reroof , . PERMIT
' CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: - - - "�
Crystal Bay, Minnesota 55323 � "
(612)473-7357 Date Issued:
SITE ADDRESS:
DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: - � - - � -� � - - � � - '-'`- OWNER:
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APPLIC / ERMITEE SIGNATURE �� ISSUED BY:SIGNATURE ���'��
Total Fee: � i '�� '� ` DateReceived:
Date Approved:
Entered By: �; Permit#: `f ��-��/
CITY OF ORONO - BUII.DING PERNIIT APPLICATION
ALL TivF'ORIVIATION I�IUST BE SUBI-IITTED I�i 1 FULL BEFORE PLAN REV�W VVII.,L
BE STARTED
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THE APPLICAIVT IS: (circle one) O`VNER OR ONTRACTOR
JOB SITE ADDRESS: �(�� ��Ca ��t QCI� l��G�u � ZIP: 3���l�
Y`7�
NAME OF OW�1ER: �D r'' C- �� rl �'1 PHOi�tE: (home) �`� 90 9.S
(work)
NiAILINGADDRESS: ilvyc� Sl�ady�'c"�c� � CITY: Qr��rc� ZIP: 5��3r �i
CONTRACTOR: �G�-l�i�r l��c'���C �-�� T�C PHONE: 7��- � 3��
i' B1LE PHO AGER: S 7��- 3.�s'�
MAILING ADDRESS:.�'7O/ 3!�r�j s4v c' ��> CITY: ,�'j' !S . ZIP: ,�'�-�/4!`o
STATE LICENSE: # �/;,'2��%
ARCHIT'ECT/ENGPi tEER: PHONE:
MAII,ING ADDRESS: CITI': ZIP:
���,�: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration �� Land Alteration
PROPOSEDWORK(describeindetail): �TC�z.r -��t (,��tG/ /�eroU � h�'�t`�t _
tc.���t'� nc'w hGiiC� s ��� C�'�ar s-/[G�i KPs �Pp•al 6d rr►:/l !`o �a� ra�* r
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOv1S: GARAGE STAI.LS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(escluding land): $ �� �/D�`��
I hereby apply for a building permit and I acknowled�e that thz information above is comlplete
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 woric is not to start
without a permit; and that the work w' 1 be in a cordance with the approved plan.
APPLICANT'S SIGNATURE: � • G��=�' DATE: �� -- I�` ��
NOTE! Parade o�Homes events re� ire separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be aldowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial 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 sratewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the idendty of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individuai is asked to supply invesrigative 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 taz or pmpertv taz refund
insuucrions instead of on those forms.
Subd.3. Access to data by individual. Upon reqaest to a responsible authoriry,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�dencial. Upon lus further request,an individual who is the subject
of stored private or public data on individuals shall be s6own the data without 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 its meaning,che data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been coilected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authority shall comply icnmediately,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 immediate compliance is not possible. If he cannot comply with the request
within that time,he s6a11 so inform the individ�,and may have an addiaonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays. �'
Subd.4. Procedure when dat�is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data conceming himseif. To exercise thissi�ht,an individual shall notify in writing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30�ays either: (a)correct the data found to be inaccurate or 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. 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 authority may be appealed pursuant to the provisions of the administrative procedure act relating 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 aze notified that:
1. The information you fumish 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 agencies to the extent necessary to process
the pdmut 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 request) to review private data on yourself.
6. Your full name is required to process this application or permit.
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I understand rights as stated ove.
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