HomeMy WebLinkAbout1997-009641 - tear-off/re-roof PERMIT
CITY OF ORONO PERMIT TYPE:
27�0 Kelley Parkway- P.O. Box 66 Permit Number: ���"
Crystal Bay, Minnesota 55323 - - - w £
(612)473-7357 Date Issued: ^ . ,��m;�;:,,=�-�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICAN /PERMITEE SIGNATURE ISSUED BY:SIGNATURE
DATE TIME
CITY OF ORONO CALLED IN �
INSPECTION NO CE SCHEDULED � �� 1 '�11 °
PERMIT NO. COMPLETED _� �
ADDRESS /g 3 S �'/y+�/J y c�,,,�oa d
OWNER Sw't"T (-��-rre�r CONTR.
TELEPHONE NO.
� DESCRIPTION 1� �s C,.,ss �"'�� ��=� o�= ��,��
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� 01 FOOT1NCi 11 MECHANICAL RI 18 IXCAV/(3RADIN(3/FIWNd
y �2 RAMINO 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UP O6 PROGHESS
F` 07 DEMQ�ITE 27 SEPTIC MAINT. 27 COMPLAINT
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W 07 DEMQ-FINAL 75 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBINO RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
+� 10 PLUMBINQ FINAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:�YES_NO
� COMME TS:
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� . VORK SATISFACTORY:PROCEED - PROJECT COM LETE
W C'CORRECT WORK 8 PROCEED �- ISSUE CERTIFICATE OF OCCUPANCY
� Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL REfURN
O STOP ORDER POSTED.CALL INSPECTOR -CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next spection 24 hours in advance.473-7357
OwnedContr or it :
inspector.
White Copyllnspecfor's File Canary Copy/Site NoHce
Total Fee: $�� �5� Date Received:
' Entered By: � Permit#: �(o y/
CITY OF ORONO - BUILDING PERMIT 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 R CONTRACTOR
JOB SITE ADDRESS: I��5 �F�GI(,�U 1.•�'?G'� ��%�, ZIP: ���� � �
,
NANIE OF OWNER: J�l?t'�' j �`�N'C�- �'��. PHONE: home) �- 1 ��Q/� �
,� (work) ��.�j---�'�a
MAILING ADDRESS: ����j}�� ��� j�0 ,� �"�ITY: ' ZIP: ' �� �
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: �#
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N�'�� REGISTRATION#
TYPE OF WORK: New �_ Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �, ��j�
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.
APPLICANT'S SIGNATURE: C� ' �� DATE: I�--���I�7
NOTE! Parade of 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.
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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 required to be given individual. An individual asked to supply private or confidential data conceming himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecring state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data; (c)any known consequence arising from his supplying or
refusing to supply private or confidential data;and(d)the idenriry of other persons or enddes authorized by state or federal law to receive the data.
This requirement shail not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or�rooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority, an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidentiaL Upon his further request, an individual who
is the 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
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to hirn for six months thereafter uniess a dispute or action pursuant to this secrion is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual costs of making, certifying, and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant ro 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 shall so inform[he individual, and may have an additional five days within which ro comply with the request,
exciuding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data concerning himself. To exercise this right, an individual shall notify in writing the responsible authoriry describing the namre of the
disagreement. The responsible authoriry shall within 30 days 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 statemen[of disagreement is included with the disclosed data.
The deterrnination of the responsible authoriry 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 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 permit 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.
l�a�c1 /�1����� l-��,�'��
First � Midd Last
���� ��'1�l �I �U � � ("� �('��
Address, <�� �
�� l�� lvl-� ��� � �7/- �� �
C�ty State Zip Phone
I understand my rights as stated above.
Signamr
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