HomeMy WebLinkAbout1998-011076 - part tear-off/re-roof PERMIT
G'��Y OF ORONO PERMIT TYPE:
� 2750 Kelley Parkway- P.O. Box 66 _ ,;�"i.,.;::3��w�_;
Crystal Bay, Minnesota 55323 Permit Number: _
Date Issued: �"'t �`"''�`��-
(612)473-7357 �'�::�#`��`'=�:�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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� APPUCANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
E Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII,DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforncation)
THE APPLICAl�'T IS: (circle one) WNER R CONTRACTOR
JOB SITE ADDRESS: �`1�����.Q��//Y� �i�''� ZIP: ���9'/
NAME OF OWNER:V�l�ief� 7/��y�Y PIiONE: (home) ��I— ����
/' (work) �
MAILING ADDRESS: C k� ��—> CITY: ZIP:
CONTRACTOR: %" PHONE:
CONTACT PERSON: l�%� � MOBILE/PAGER:
MAII..ING ADDRESS: r CITY: ZIP:
STATE LICENSE: #/
ARCHITECT/El�'GINEER: PHONE:
MAJLING ADDRFSS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � �
. ,�/ � �c s -'�
STORIES: / SQ.FEET OF EACH FLOOR: �P��
NO. OF BEDROOMS: ��" GARAGE STALLS: ATT. DE .
__=
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ ��� � 4 .
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 pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: /Z/'����
NOTE! Parade qf Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
, !
Sec.13.04 RIGHTS OF SCTBJECTS OF DAT.+►
Subd. 1. Type of data. Ihe righcs of individual on whom[he data is stoced or ro be stoczd shall be as sec forch ia this secdon.
Subd.2. Information reqirired to be givea individual. An individuai asked w supply privace or confidenrial data concecning himself shall
be informed of: (a)the purpose and imm�ded use of�he requuud data within the collecdng Stare ageacy,polidcal subdivision,or scacewide rysum:
(b)whecher he may refuse ot is tegally cequired to sappty che requesud data;(c)any Imown coasequence arising from his supplying or refusing to supply
private o�confidenoal dara:and(d)che idenary of orher penoac or enddes authorized by srace or federal iaw to ceceive the data. This requiremenc shali
not apply when an individual is asked to supply invesogadve dan,punuant ro secdan 13.82,subdivision 5, w a law enforcement officer.
The commissioner of rcvenue mav vlace the nodce �zwired under rhis subdivision in the individual income tax or propem tax refund
instrucdons instead of on[hose forms.
Subd.3. Aecess to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of swred dara on individuals,and whe[hu it is classified as public, private or confidendal. Upoa his further request,an individual who is the subjecc
of store�i private or public daa on individuals shall be shown rhe dara wichout any charge to him and;if he desires,shall be informed of the contenc
and meaning of rhat data. After an individuai has been shown the privace daea and infarmed of ics meaning,the daa need not be d'uclosed w him for
six monchs thereafur unless a dispute or acdon pursuanc to this secdon is pending or addiaonal dara on the individual has been collected or created.
'Ihe responsible authoriry shall provide copies of[he private or public data upon request by the iadividual subjecc of the dara. The responsible authoriry
may require the requesdng person ro pay the acaal cos�s of making,cerdfying,and compiling the copies.
The responsible auchoriry shall comply immediately,if possible,wich aay nqucsc made purruant to this subdivision,or within five days of
the date of rhe request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with�he requesc
wiehin that ame,he shall so inform the individual,and may have an addiaonal five days within which to compiy wich�he request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or completeness of public or private
data concerning himself. To exercise[his right,an individual shall nodfy in writing rhe responsible au�horicy describing the naare of the disagreemenc.
The responsible auchoriry shall wirhin 30 days either: (a)correct the data found to be inaccurate or incomplae and atumpc to nodfy past recipienu of
inaccurate or incomplece dara, including recipiencs named by che individual:or(b}notify the iadividual thac he believes[he dara to be correct. Data
in dispute shall be disclosed only if che individual's stacemenc of disagreement is included with the disclosed data.
The decerminadon of the responsible auchoriry may be appealed punuanc to the provisions of the admuusaadve procedure act relating w
contesud cases.
. DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rig.hts of subjects of data",we would like to inform you that your request
for a pemut or license from the Ciry of Orono or any of its departments may require yo�to fumish certain private or
confidential information.
You are notified that:
1. T'he 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 shazed wich other local, stace or federal agencies to the ex[ent 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 permi�.
V i�'YD�iR � �o � �v� �y
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I understand my ri s as stated above.
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Signature