HomeMy WebLinkAbout1999-011904 - tearoff/reroof PERMIT
C�„TY OF ORONO PERMIT TYPE:
� 2750 Kelley Parkway - P.O. Box 66 -
Crystal Bay, Minnesota 55323 Permit Number: �`�._�:=;i'�'�-
(612) 249-4600 Date Issued: ::`-`, �`�=`�_'��
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: _. - - _;,-,,, _..
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PIICANT/PERMITEE SIGNATURE �✓� ISSUED BY:SIGNATURE �
, ' Total Fee: $ ,�'%� ��°> Date Received:
Entered By: ,�� . Pernut#: �i>c� ��
CITY OF ORONO - BUII..DING 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 ADDRESS: � � �.,-��-- ; ' ' ZIP: -S `��- -� c� I
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NAME OF OWNER: %G�`2�_;� ��.Z,,. PHONE: (home) 1 ��"�
(work)
MAILING ADDRESS: . ; `���y_ CITY:l�.'�'�-� � , ZIP: ;S � l /
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CONTRACTOR: �� ,�'�..�k.r,��'� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILIvi G ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
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TYPE OF WORK: New �ion Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � - ���.r r�� � �'=� - ,�� % — -�����%/'��� ;E=�� -�n-
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STORIES: SQ. FEET OF EACH FLOOR: �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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 accordance with the approved plan.
__ �, c.
APPLICANT'S SIGNATURE: � �=c_,n>r� DATE: � - �' �-- f �
NOTE! Parade o�'Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
,
Sec.13.04 RIGHTS OF S[TB.JECTS OF D�T,�
Subd. 1. Type of data. The righrs of individual on whom che data is stored or to be stored shall be as set forth in this secaon.
Subd.2. Information reqirired to be given individual. P+n individual asked to suppiy private or confidendal dara concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within tbe coilecting"state agency,polirical subdivision,or sratewlde system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any known coasequence arising from tus supplying or refusing to supply
private or confidenrial data;and(d)the idenrity of o[her persons or enriaes au[horized by state or federal law to receive the data. This requuement shall
not apply when an individual is asked to supply invesrieadve dara, pursuan[ro secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue r�av place the noace reauired under this subdivision in the individual income tax or propertv rax refurni
instruc[ions instead of on those forms.
Subd. 3. Access to data by indi�zdual. 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 confidential. Upon his funher request, an individual who is che subject
of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed oi�he content
and meaning of[hat data. Afre�an individual has been shown the private data and informed of ics meaning,the dara need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal data on the individual has been collected or created.
The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of rhe dara. The responsible authoriry
may require the requesting person to pay the acrual costs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possibie, 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 immedia[e compliance is not possible. If he cannot comply with rhe request
within that time,he shail so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this rieht,an individual shall nodfy in wricing the responsible authoriry describing[he nature of the disagreemenG
The responsible authoriry shal(within 30 days either. (a)correct che data found ro be inaccurate or incomplece and attempt to norify pasc:ecipients of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual[hat he believes the data to be correcc. Data
in dispute shali be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant ro the provisions of the adminiscrarive procedure act relating 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 reauest
for a permi[ or license from the City of Orono or any of its departments may require you to fumish 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 agencies to the extent necessary to process
the pemut 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.
(, Your full name is required to process this application or permit.
� C.. �-c_ .�y,�-�
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First / Middle � Last
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• Address �
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City .� 5tate Zip Phone
I understand my rights as stated ahgve.
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Signature
ATE TIME
CITY OF ORONO CALLED IN � ��'�'/�
INSPECTION NOT CE SCHEDULED G/�.z/ci �
PERMIT NO. ��9��� COMPLETED
ADDRESS ��o �
OWNER � CONTR.
TELEPHONE NO. 'S�7/ ' �/C� 3
� DESCRIPTION =�.�-txc�{
�
01 FO 11 CHANICAL RI 18 EXCAV/GRADING/FILLING
QFRAMIN '' 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEEf YOU:_YES_NO
� COM ENTS:
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W� ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� �ORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. L� pHOTOTAKEN
INSPECTOR WILL RETURN
C' CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnedContractor on site:
Inspector.��Gc.-� (,G�-�1 ��
White Copyllnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN =�
INSPECTION NOTICE SCHEDULED •��
PERMIT NO. ���G/_ O� COMPLETED
ADDRESS ��
OWNER CONTR. ��.. �6 -��`�i
TELEPHONE N0. �7 I' -1�/ ��
� DESCRIPTION
��\� 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMIN 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� W L BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q F 14 SEWER HOOK-UP 06 PROGRESS
� SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d �IORK SATISFACTORY:PROCEEO C PROJECT COMPLETE
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� �CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. �- pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. `�
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Call for the next inspection 24 hours in advance.
OwnerlContractor on site:
� � �
Inspector. i'U<�� y r
White Copyllnspector's File Canary Copy/Site Notice