HomeMy WebLinkAbout1999-011906 - tear off/re-roof _ � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 _ - _
Crystal Bay, Minnesota 55323 Permit Number: - ^ _ _ _-
(612) 249-4600 Date Issued: _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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PLI ANT/PERMiTEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ Date Received:
Entered By: Pernut#:
CITY OF ORONO — BUILDING PERNIIT 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 OR CONTRACTOR
JOB SITE ADDRESS: �v�������jp�� �3 �j(� Sh�oQ6N��2IP: �.�� / r�-
NAME OF OWNER: �,��0�! 0� t`��I�/�lv PHONE: (home) �7`%�� � 7�1
, (work)
MAILING ADDRESS: �.�j�j �o C� 5 f'��c2�'��o,t� CITY: �/64�/�-2i2� ZIP: �Sr3
CONTRACTOR: � PHONE: L� 7/� 9 L� ��
CONTACT PERSON: ,���o ��, MOBILE/PAGER:
MAILING ADDRESS: .3�3Io r� 5 kfa�2c� �.iar� CITY: 11 it�-l/�>21�2� ZIP: �3 �
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New ��a� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�:
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
c�C1
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��00
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 wiqth e approved plan.
APPLICANT'S SIGNATURE: � 'L DATE: �—��� l I
NOTE! Parade Qf 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 RIGFiTS OF SUBJECTS OF D�T.�
Subd. 1. Type of data. The righu of individual on whom the data is s[ored or�o be stored shall be as set forth in this secaon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial dara concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecang'stare agency,polidcal subdivision,or sntewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any Irnown consequence arising fmm his supplying or refusing to supply
private or confidendal data;and(d)the idendry of other persons or enriries auchorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdeadve dara, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is ciassified as public, priva�e or confidendal. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wirhout any charge to hun and, if he desires, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acaon pursuanc to this secrion is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry
may require the requesting person to pay the acrual coscs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding 5aturdays,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 individuai,and may have an addidonal five days within which to comply with the request,excluding Sarurdays,
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 pri��ate
data concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry 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 nodfy past recipienu of
inaccurate or incomplete data, including recipients named by Ihe 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 statement of disagreement is included with the disclosed data.
The detecmination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng ro
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 detem�ine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. The information may be shared with other local, state or federal a�encies to the extent necessary to process
the pemut 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.
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Sigiiature