HomeMy WebLinkAbout1999-011768 - tearoff/reroof , PERMIT
� CITY OF ORONO
PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 - � :,;?i�?i;
Crystal Bay, Minnesota 55323 Permit Number: : ' --
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Date Issued:
(612)473-7357 _ :.`�`��`-`�::
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APP NT P M EE SIGNATURE ISSUED BY:SIGNATURE
. 4 � � I
Total Fee: $ � � � ' � Date Received: � �
Entered By: _�� Permit#: � I�1 � �
OR.ONO - BUILDING PERMIT APPLICA.T`ION � �
CI�'Y OF �
.A,ll in�orma�ion must be submitted in full before plan reviesv �-ill be started. .
� (please print all information) . . '
� APPLICA.3�TT IS: � � (circle one) . O�TNER OI�`S�I�TBA�.OR:�'' �
TFiE
JOB SI� �.nDxESS: J�� d -s'���/ �'v�/ /�cl Z�: !
NAI�IE OF OVY��►TER: r�G��f�/\ t�'�'j7� f'c^;_ f(J�� PH0�1E: (home) � �����'
. (work)
IYT.AlI.I�i'G A.DDF•ESS: CIT'Y: ZIP:
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CONTRAC'I'OR: �I� ��/' G��S� PHONE: rC�� >>��
CONTACT PERSON: MOBILEIPAGER:
MAILING ADDRESS: �.� I.� I�1 \- �,vc� 1(�U CIT'Y: � ��5�� l ZIP: �� � �-
STATE LICE�'SE: # �� �1 � �
ARCHIfiECT�EI�GI�i TEER: : . � Pt30��:. �
1�?.A.ILIi\'G ADDkLESS: CITY: ' ZIP:
. NAME: REGISTRA.TIO�T#
TYPE OF ti'VORK: New Addition Accessory Structure
Move Remodel/Alteration _ Land Alteration
�- �---- - �
PROPOSED'F'VORK(describe in detai�: �i��'�' �� r�� �' ' � �"'` ' �'�r����"
STORIES: SQ.F'EET OF EACH FLOOR: DET. � � �
NO. OF BEDROOMS: GA.RA.GE STALLS: ATT. _____ . . -
. . \ � � �
EST .Tl�i iA,TED CONSTRUCTION VALUATION (excluding land): $ �� - �
I hereby apply for a building perm.it a.nd I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry a.nd with
the State Buildi.n� Code; that I understand this is not a perrnit and work is not to start witUout a
permit; and th�c the work will be in accordance with the approved plan.
J � � ��� �
APPLICAi'�'T'S SIGNA'I'LTRE: .�� f DATE: ��
NOTE! �arade Q Homes events require sep ate permit approval by Poliee Department and
� City Counei160 days prior to tke event. Non permitted events wili not be allowed.
. . . � � .
;
Sec.13.Q4 RIGATS OF SUBlECTS OF DaT?, - _ - - • '
Sutd, i. ?ype oI data. The righcs of iadividual on whom the data is sooced cr oo be swced shalI be u sec focth ta chis secnoa
• Sutsd.2. Intormatioc nc�rrd to be givm indIvidual. ?.n iadividual uked to supply priva�or coafideacal dam coneerning himself shaIl �
be infor�:d o`: (a)the purpou and iamnded use oE che rsquesmd daa wichia the colIecang Ytace ageary.polidaI subdivision,oc samwide rysum; I
' '�(b)whe�e:he c.ay r.Fuse oY isulegalIy requir.d to supply the r:quesc:d dat�:(cj any Iaiovra eaauqu:nce uisiag ftvm his supptyiag or reCusiag to supply • .
. privac�oreo:i.�der.caI data;ar.d(��e ideaary o[ocherpersoas areaddu aa�ariz:d by sace orfe�e�":u ta r.t:ive t�e d3c�. This requ'uemeac shall
�not a�piy w::ea an ir.dividual u uked to dupply invesagarive dan,pursuaat ro secdon 13.82.subdivision 5.�a law entercemeat ofncer.: .� . •
'Ihe cenrttissiorter of reveeu�mav olaee che nacc� r�uir-d und-r this subdivision in the individual ineocrte tu or oroaercv eaz refuad
instrucaons cnstead of on those[orm.s. •
Sabd.3. Aeeess to data by iadIvidcul. Upon request to a�espoasible authoriry.aa'cndividual shall be�[orraed wDe�herhe is che subjecc
o[stot:d daa on Individuais.aad whecher It Is e(assifi:d u pubGc.privat�or coaF.deadal. Upoa his fur�hec cequest.aa iedividual who is tha subj::c
o!siore�i priva:e ar public daa oa�adividuais shail be shovru the dard wirhout any charge oo him and;if he desues�shali be intocmed o[the eoatenc
aad meaaing of dut dan. Aher aa lndividaal has beea shown the pcivate daea aad iaformed ot ics maaiag.the daa ne:d aoc be disclosed to him(oc
siz mondss chereaher unlas a dispute or acaon pursuanc to�his�ecdon is pending or addidoaal dac�on the individuai has been coIIecLd or erea`d.
The cespocuibte auehociry shatlprovide eop'ies o!the privac:or pubTic daa upon request by the Iedividual subject o[che dan. he respoaa3le auchoriry
may requics rhe requadng person to pay the accual coiu af making,eecafying,aad campiling�he eopia. '
The responsible authoriry shatl eompiy immedia�ely.if Qossible.wi�h aay cequest mada pursuant co this subdivisioa,or wichin C�ve days of
the dax o!the cequesc.exctuding Saaicdays.Sundays and legal halidays,if inuaediate compliaace is not possible. If he eanaot eomply with the request
wichin that acae.he shail so infocm the individual.and may have an addidooa!t►ve days withia which to comply wich the cequat,exeiudiag Saturdays.
Sandzys and legal holidays. . . . '
Su�d.4. Psocedure whw data ts not aeeurate or eompiete. M iadtvidual tnay eontest tke xeuraey ar eocnpleteneu of publIc or private
_ daea eoncernir�g htcasel! To execcfse d�is right,an tndividaal shnIl noafy in wcidng the aspoastbte audwriry daerlbing the oamce o[the dtsagteemeac .�
The nspoesibte audtoriry shall within 30 days ei�her. (a)cocrect che dan found to be inaccuate or iaeompiete and atumpt to nodfy past reciptencs o[
Inaceucate or ineomptece data.including nctpiencs named by the tndividual;or(b)aodfy the indiv{duat thac he believes rhe daca W be cocreet Daa
in dispuce shall be d'uclosed oaly if the individaai's sncemenc o!disagreem:ac is taetuded arith the diuloud data.
. The de�erminadon o!the respoasibte au�horiry inay be appealed pursuanc oo the provisions of tha adminisaadve pcocedum act relanag to
wntesmd asas. ' • • � ' '
DATA PRIVACY ADVISORY �
In accordance with M.S. 13.04�Subd.2, "Rights of subjects of data",we wouId like to inform you that your request
for a permit or license from the Ciry of Orono or any of ia departments may require you to furaish certai.n private or
confideatial information.
You are notified that:
1. The information you furaish will be used to decermi.ne your qualificadon for the permit orlicease requated.
2. You may rehue to supply data, but refusal may require that the City deny the permit or license. � •
3. The information may be shared wich other local�stace or federal�eacies to the etcent necessary to process
the permit or license. �
4. If your requested permit or licease requira Couacil action to approve, some iaformation may become
. pubiic. ' • . . . . . _ � ; . . � . . �
. 'S. You.have certain righa under M.S. 13.04�(availabie upon requat) to review private data oa.yourself. . . .
6. Your full name is required to process this applicacion or permic.
•����`vI �C�n r� .�-pr�R �� �
Fusc • �tiddlc I.asc •
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. _ .
Address
t,�v�S�- P 1 . � . �� �� �� •
Ciry Sate Zip P�oae
I understand my rights as stated a ve.
Signacur .