HomeMy WebLinkAbout1999-011280 - tearoff/reroof I'ERMIT
• C�Y OF ORONO PERMIT TYPE:
2750 Kelle y Parkwa y- P.O. Box 66 -:::+E,..�.:I;�v_;
Crystal Bay, Minnesota 55323 P e r m i t N u m b e r: '�:,� �.Y^:^;:�
, (612)473-7357 Date Issued: ,�}:_, _;.ti,.�,�.y�:_r
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE � �
Total Fee: $ Date Received:
Entered By: .L� Permit#: �'�'�'��"
CITY OF ORONO - BLTII�DING PERMIT APPLICATION
All information must be submitted in full before plan review svill be started.
(please print all information)
THE APPLICAI�'T IS: (circle one) OWNER OR CONTRACTOR
JOB SITE A.DDRESS: 'c1`��" jl�c�.�_Qu��c7r-cSl � Z�=
NAI�IE OF O`i�TER: C�({„�--.��,�. �1� PHONE: (home)
(work)
iV1AILING ADDP�ESS: A ci�'1�' -T.��. �c� �CITY: ;s�r� _ZIP:
��,a�—
CONTRACTOR: 52�t� , � ti.�e_t�c�� PHONE: �I�-d1\(�
C01�1'I'ACTPERSON: `� �OBILE/PAGER: cr, : - �aS`l _
MAII.I�'G ADDRESS: � � i� .� ' .IZ CITY: �1�,-��.����ti ZIP: S���" �
STATE LICENSE: # .' ' �;�S
ARCHITECT/ENGI�i TEER: PHO��:
��IAILING ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration ,% Land Alteration
PROPOSED WORK(describe in detai�: ;y� C��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTII�i iATED CONSTRUCTION VALUATION (excluding land): $ �l � 5 Cc7• ��
I hereby apply for a building pernut 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 starc without a
pernut; and that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE: j � -� _ DATE: -
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.
. .,
Sec.13.04 RIGHTS OF SUB.TEC'IS OF DaT?i '
Subd. 1. Type of data. The righcs of individual on whom rhe dara is stoced or to be swced shall be u sec forth in chis secdon.
Subd.2. Intormaaon reqtrired to be�irw individual. An iadividual uked w supply private or confidenrial dara conceraing himself shall
be informed o(: (a)the purpose and inmaded use of the requested data within the collecang 11•tate agency,polidal subdivision.or satewide rysum;
(b)whechu he may refuse oY is.legally cequired to supply d�e cequesud data;(c)aay latown coagequence arisiag from his supplying or rel�siqg to supply
privace or confidenda!data;and(d)the idenriry of othec peaoas or earides auchorized by stace or federal law to rrceive the data. This requiremenc shall
noc apply when an individual is uked to supply invesrigarive dan,pursuaac[o secdoa 13.82,subdivision S,w a law en€oc�emeac officer.
The coc�missioner of rcvenue mav vlac• che nodc- rauired under chis subdivision in the individual income tax or�rooem az refund
inscrucdons inscead of on those focros.
Subd.3. Aceess to data by iadividual. Upon requezc to a msponsible audiodry,an individual shall be informed whethec he is the subject
of stoced daca on individuals,and whether it is classified u public,private or confidenaal. Upoa his fucthet cequesc,aa individual who is the subjecc
of scored private or public dam on individuals shall be shown che dara wi�houc any charge m him and,-if he desires,shall be infocmed of the coatenc
and maning of that data. After an individual has been shown che private daa and informed of iu meaning,the daa need not be d'uclosed to him for
six months thereatur unleu a dispute or acdon pursuanc co [his secdon is pending or addidoaal data on the iadividual tias beea collected or created.
The cesponsible auehoriry shall pmvide copies of�he private or public dars upon nquest by the iudividual subjecc of the dara. The responsible authoriry
may require rhe requesring persort to pay the acaial cosu of making,ceaifying,and compiling�he copia.
The cesponsible authoriry shall comply immediacely,if possibte,wieh any request made pursuant co this subdivision,o�wi[hin five days of
the date ot die requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannoc compty with the requesc
wichin that time,he shall so inform the individual,and may have an addiaoaal five days within which oo comply wicb the request,excludiug Saturdays,
Sundays uid legal holidays.
Subd.4. Proeedure whea data is not accurate or complete. An iadividual may contest�he accuracy or completeness of public or private
dara eonceming himseif. To execciu rhis righ�an individual shall nodfy in wridag ehe respomible aurhoriry describiag the naeure of the disagreemenc
The respoasibte authoriry shall wiehin 30 days either. (a)comect the data fouad ro be inaccucate or incomplete aad attempc to nodfy past recipienrs of
inaccurace or incomptece data,iacluding recipieact named by the individual;or(b)noafy the individual thac he believes the daa to be correcc Data
in dispuce shall be disctosed only if che individual's statemenc of disagreement is ineluded with the disclosed data.
The decerminaaon of ehe responsible auchoriry may be appealed pursumc to the provisions of che administraave procedun act niacing to
contemd cases. •
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Righcs of subjecu of data",we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or
confidential information.
You aze notified thar.
1. The information you furnish will be used to detemune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license.
3. The inforrnation may be shared wich ocher local, scace or federal agencies to the excenc necessary to process
the permit or license.
4. If your requested permit or license requues Couacil 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 permic.
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Fint �tiddle ��
��a�c� 1 ���� C�1.�-��,z
Address .
N�;,�-,���� M� Ss�ns �t 2-o�io
Ciry Sa[e Zip Phone
I understand my rights a� scat d above.
Signaare
DATE TIME
CITY OF ORONO CALLED IN -�� 4'
INSPECTION NOTICE SCHEDULED �/�-
PERMIT N0.1/.�� D COMPLETED �
ADDRESS �
OWNER CONTR.
TELEPHONE NO. -���-O�� U
� DESCRIPTION �
� 01 FO TI G 11 MECH ICAL RI 18 EXCAV/GRADING/FILLING
Q RAMING 13 MECHANICAL FINAL 19 LAKESHORE/WEfLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
� 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 MEET YOU:_YES_NO
y COMMENTS:
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d �ORKSATISFACTORY:PROCEED � PROJECTCOMPLETE
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� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
iNSPECTOR WtIL RETURN
❑STOP ORDER POSTED.CALL tNSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73rJ7
OwnerlContractor
Inspector.
White Copyllnspector's File Canary Copy/Site Notice
DATF„ �,. . E
CITY OF ORONO CALLED IN � '� � � �� '
INSPECTION NOTICE SCHEDULED '� -' " `�y ` ���' D
PERMIT NO. ���_ COMPLETED � �
ADDRESS I��I� s��'l-�'=G�-' 'r tr``-c° �r,�f.
�' > �,,/�
OWNER �-' f � Q � CONTR. ���',l' 1���': �Et�t
TELEPHONE NO. � a �'� �`�
�,T ,� ,i; :. aUv�S.�.�,,. '
� DESCRIPTION � ,�.. . . ..._..-�f.,.�._, .r,...��,
l� 01 FOOTING 11 MECH �ICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 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
v 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
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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W
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Q
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Z
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d �WORKSATISFACTORY:PROCEED J�ROJECTCOMPLETE
W
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W�LL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor on s' -
Inspector.
White Copylinsp or's File Canary Copy/Site Notice