HomeMy WebLinkAbout1997-009294 - tear-off/re-roof PERMIT
�ITY OF ORONO PERMIT TYPE: - ° -� -
� 2750 Kelley Parkway- P.O. Box 66 {,;�_;��`V:�{�```W
Crystal Bay, Minnesota 55323 Permit Number: « ,�
(612) 473-7357 Date Issued: ���`-�;'� -; `'-� '
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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A LI NT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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� ' Total Fee: $ ' � Date Received: ) i � /
Entered By: Permit#: � >=°-
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all infor�ation)
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THE APPLICANT IS: (circle one) UWNER �R CONTRACTOR
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JOB SITE ADDRESS: � % J -•+� ��� ``, � (.1 ' ZIP• S �
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NAME OF OWNER �,.<-�-f#� C��l"L��C t�_; PHONE: (home) r�� ��- �j �� �
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: (work)
MAILING ADDRESS �' ! :;� S�1�-C���u-PC:��� � CITY: ,:� �<:' ;,�' s'�� ���. ZIP: �.. c-- . 3/
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CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
'I TYPE OF WORK: New Addition Accessory Structure
I Move Remodel/Alteration �.� Land Alteration
PROPOSED WORK(describe in detain: ' -_ � �� '�" ' ��-; �. � ` %'�
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STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ `r' `� �`i ` �
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 acr.�rdance w�th tY�e approved plan.
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APPLICANT'S SIGNATURE: � � ,� � � ' (.,�,��.�! DAT'E: � � ,, �
NOTE! Parade of Homes events require separate pernzit approval by Police Deparhnent and
City Council 60 days prior to the event. Non perntitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLJBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is swred or to be stored shall be as set forth in this section.
Subd.2. InformatIon req�rired to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data withu►the collecting State agency,poliacal subdivision,or statewide sysum;
(b)whether he may refuse oY is legally required to supply the requemd data;(c)any ffiown consequence arising from his suPP1Y�8 or refusing to supply
private or confidential data;and(d)the idendty of other pecsons or enddes authorized by state or federnl law to receive the data. This nquirement shall
not apply when an individual is asked to supply invesdgadve data,pursuant ro secdon 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the noace rewired under this subdivision in the individual income tax or arovem raz refund
insnucdons instead of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject
of swred data on individuals,and whe[her it is class�ed as public,private or confidenaal. Upon his further request,an individual who is the subject
of stored private or public data on individuats shall be shown the data without any charge W him and;if he desires,shall be informed of the content
and meaning of that data. Afur an individual has been shown the private data and informed of its meaniag,the data need not be disclosed to him for
six months thereafter unless a dispuu or action pursuant to this section is pending or additional data on the iadividual has been collecud or creaud.
The respoasible authoriry shall provide copies of die private or public data upon request by the imdividual subject of the data. The responsible authoriry
may require the requesting person to pay the.actual costs of making,ceitifying,and compiling the copies.
The responsible authority s6all comply immediately,if possible,with any request made pursuant to this subdivision,or withia five days of
the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the iadividual,and may have an addiaonal five days within which to comply with the request,excluding 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 conceming himself. To exercise this right,an individual shall norify in wridng the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to noafy past recipienu of
inaccurate or incomplete data,inciuding recipients named by the individual;or(b)notify the individual that he believes the data to be correcc. Data
in dispute shall be disclosed only if the individual's statement of disagmmeat is included with the disclosed data.
The deurminadon of the responsible authoriry may be appealed pursuant W the provisions of the administradve procedure act relating w
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.Z, "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.
(, our full name is required to process this application or permit.
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First ` Middl�c J`-v`�C`►— �t
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Address /f . �/G, 5.��� � / / /"_ 9�� �
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City � Smte Zip Phone
I understand my rights as stated above.
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