HomeMy WebLinkAbout1995-007577 - repair roof PEI�MIT � '
CITY OF ORONO � � '� PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: -:;-:7=�;*"=�
Crystal Bay, Minnesota 55323 � � - � �
(612) 473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: � '
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APPLICAN /PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ v� I• � " ` ' DateReceived:
Date Approved:
Entered By: �;t�rJ Permit#: �S��
CITY OF ORONO - BUII.DING PERMIT APPLICATION
ALL INFORMATION MITST BE SUBMTI'TED IN FUI-L BEFORE PLAN REVIEW W1LL
BESTARTED
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THE APPLICANT IS: (circle one OWNER R CONTRACTOR
JOB SI'I'E ADDRESS: -35� �7 Sh��'e..I�'�� .p�'1��-e- ZIP: 5�3� 1
NAME OF OWNER•��rv�S �, ?�t��-�0.U� PHONE: (home) 7��gf`�/
� (work) �' " 7$
MAILINGADDRESS• �S7�S�ore..j�°N�. �ri�. CITY: �o. Z ZIP: 3�1
CONTRACTOR: PHONE:
MOBILE PHONE/PAGER:
MAILING ADDRESS: CITY: Z�:
STATE LICENSE: #
ARCHTTECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z�:
NAME: REGISTRATION #
TYPE OF WORK• New Addition Accessory Structure
Move RemodeUAlteration Land Alteration
PROPOSEDWORK(describeindetail): ��-��t f l�-�►�5 (�� �oo�
STORIES: �_ SQ• �T OF EACH FLOOR: .�OC�
NO. OF BEDROOMS: D GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(eYcluding land):
�.�- _..�-;�-- ��""60. �0
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 with the approved plan.
APPLICANT'S SIGNATURE: -�.�'�1` DATE: I �J�O ���
NOTE! Parade o 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.
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Sec.13.04 RIGATS OF S[JBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is swred or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shatl
be informed of: (a)the purpose and intended use of the requested data within the collecting�tate agency,political subdivision,or statewide system;
(b)whether he may isfuse or is legally required to supply the requested data;(c)any lmown consequence arising from lus supplying or refusing to supply
private or confidential data;and(d)the idendty of other persons or enaties authorized by state or federal law to receive the dara. This requirement shall
not apply when an individual is asked to supply investigaave data,pursuant to section 13.82, subdivision 5,to a law enforcement officer.
The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or propertv tax refund
inswcrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request[o a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on i�ciividuals,and whether it is classified as pubiic,priva[e or co�denrial. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires,shall be informed of the content
and meaniag of that data. After an individual has been s6own the private data and informed of its meaaing,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuant to tlus section is pending or additional data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible aurhoriry
may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that titne,he shall so inform the individual,and may have an addidonal 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 notify in wriaing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed otily if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administ�ative procedure act relating to
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 determine your qualification for the pemut 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.
6. Your full name is required to process this application or permit.
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I understand my rights as stated above.
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