HomeMy WebLinkAbout1999-011660 - tearoff/reroof PERMIT
� .�'Y OF ORONO PERMIT TYPE:
�750 Kelley Parkway- P.O. Box 66 _ � - �� -
Permit Number: � �`� -
� Crystal Bay, Minnesota 55323 Date Issued: `�'`� �`="�``�:t.v'u
(612) 473-7357 i"i-`i i �=,'°=:;=
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: -- : . �== �_�_�{�'- — �� . f_I'=: .OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE.
T;��;�e; � l�� . �'�' Date Received: 7� — �
Entered By: �� Permit#: D
CITY OF ORONO - BUILDING PERMIT APPLICAT`ION �
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All information must be submitted in full before plan review will be started. . �
(please print all information)
THE A.PPLICA1ti'T IS: (circle one) O�NER O CONTRACTOR �
JOB SITE ADDRESS: l� �t� ��r-1 i�i�� "c���;'] l� � ZIP: ���
i�'A.NiE OF Oti�'ER:�o�1 ���� �; PHOi�tE: (home) � � ( -- �17�3 �
(work) �
I1�IAII�L\TG ADDFFSS: 1�c1 C� Si-t�4 �yw�,7� CITY: CJ2��o ZIP:
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CONTRACTOR: t"k�(� 2-��5�„} �,.�s�z R _ PHONE: �Lv`� �l 1�`� .
COiv'TACT PERSON: i���� �fl i�-�j E 2��5� MOBILE/PAGER: 5�3�- ���'�
M A Z L�T G A D D R E S S: '��4 ZA�� �a��- �L CITY: ��y 5�t;��. Z�: 5��+z�z
STATE LICE�'SE: # �S�t�- �
ARCHITECT�ENGII�'EER:` PHOti'E: �
MAII�I�'G ADDRESS: CTTY: ZIP:
��ME: REGISTRATION#
TYPE OF tiYORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED'�'YORK(describe in detai�: �,�rL ��Fr= ������
STORIES: SQ.F'EET OF EACH FLOOR:
NO. OF BEDROOVIS: GARAGE STALLS: ATT. DET. �
ESTIitiIATED CONSTRUCTION VALUATION (excludi.ng land): $ �`v 5v �=v .
I hereby apply for a buildina pernait 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 a.nd with
the State Build�n? Code; that I understand this is not a permit and work is not to start without a
permit; and thac the work will b ' a dance with ihe approved plan.
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A.P�'LICAI�t'T'S SIGNA :I, i.�.- DATE: �l �" �� " �� �
NOTE! Parade of Homes events require separate permit approval by Police Department and
� City Counci160 days prior to tke event. Non permi�ed events will not be allowed. �
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Sec.13.Q4 RIGFiTS OF SUBJECTS OF DATA '
Sntd. i. Type of data. The righ�s of individuai oa whom the data is stored or ro be stnr•d shall be as sec forrh ia this sccaoa.
Subd.2. Information reqiured to be given indiridual. An individuaI uked to supply privare or coafidendal dam conceming himsetf shall
be infora::d a,`: (a)the purpose aad iateaded ust of the requested dara wichin the colleccing Satr agenty�poliQcai subdivision,or smGwide rys�m;
. (b)whet�er he tray reEuse or u.legaily requir:d to supply.che r_quesud data:(c)aay Icaown caasequence arising from his supptying or retiesing to supply
privace or eoa=�der.dal daa;ar.d(d)che idendry of o�erg::�ors oreeddes aa�ori.zed by stau.or fedecal!aw to re:eive t�e da�. �i.s r_quiremeac shalI
no�apply wt.en an ir:dividual is uked co supply invesdgadve daca,putsuant ro secdon 13.8?,subdivision S, w a law enfac�emenc afncer. . �
Tte cenmissionec of revenue mav piac� che nodce r_�uir_d under this subdivision in the individual income ez or orooem taz refund
inscrucaans instexd of on chose forms.
Subd.3. Access to data bp individual. Upon requcsc to a responsible auchoriry,an individuai shall be informed whecher he is rhe subjecc
of star.d dan on individuals,and whecher it is class�ed as public,privace or conF.denaal. Upan his funhcr r_qu�s�,aa individual who is che subje:c
of stored priva;e or public data on iadividuals shall be shown chc dae wichaut any charge to him and;if ha desires,shalI be infocmed of the contenc
ar.d meaning of that dara. Aher an individual has been shown the privace dat�and informtd o[its meaaiag,the data nead not be d'uclosed to him for
su monchs chereaher unless a dispute or acdon pucsuanc to this secdon is pending or addidonal daa on the iadividuaI has been coilecmd or ereac�d.
The resporuible authoriry shall�provide eopies of the privac�or pubfic daca upon mquest by che individual subject of che daa. The respansibie authoriry
may requir_ che requesdng person to pay che accua!coscs oi making,eertifying,and compiling the copia.
The responsible auchoriry shall eomply immediacely,if possible,wich aay requesc made pursuant co chis subdivision,or wichin five days of
the dace of the tequesc,ezcluding Sacucdays.Sundays and legal halidays,if immediace compliaace it not possibie. If he eannoc comply wich the requesc
wichin that ame,he shall so inform the individual,and may have an addidoaa!five days wichin which to comply wich the reqaesc,excluding Saturdays,
Sundays and legal holidays. .
Subd.4. Procedure when data is not accurate or complete. An icdividual may eonc�sc the accuracy or complet�ness oFpublic orpriva�e
dara conceming tiimsetf. To exercise this righc,an individual shaIl aodfy in wridng ehe responsible auchoriry describing[he nature of the d'uagreemea�
The respoasible au�horiry shall within 30 days eict:er: (a)correcc che data found to be inaccuraG or incomple�e aad aaempc to nodfy past recipiencs of
inaccurnce or incomptae data, including recipieacs named by�he individu�l; or(b)noafy the individual thac he believes the dara to be correcc. Daa
in dispu�e shalt be disdosed only if the individual's scatemenc of disagreemenc is included with the disclosed data.
The determinadon of the responsibla au�horiry may be appealed pursuan�to the provisions of che admiruscrarive procedure act relating to
eontesud cases. •
DATA PRIVACY ADYISORY �
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your requesc
for a peraut or license from the City of Orono or any of its deparcments may require you to furnish certain private or
confidential information.
You are notified thar.
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 shazed with ocher local, scate or federal a�encies to the excenc necessary to process
the permit or license.
4. If your requested perm.it or license requires Council action to approve, soaie information may become
public. �
5. You have certain ri�hts 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 permic.
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