HomeMy WebLinkAbout1999-012039 - tear off re-roof � �. . PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 = . �:_�;�c�����
Crystal Bay, Minnesota 55323 Permit Number: �•� _�: _�..,
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(612) 249-4600 Date Issued: _ -
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ ��� ' � v
Date Received:
Entered By: Permit#: � a 3�"!
CITY OF ORONO - BUII,DING PERIVIIT APPLICATION
All information must be submitted in fu11 before plan review will be started.
(please print all information)
---------------------------------------------- ---------------------- -- -----------------------
THE APPLICANT IS: (circle one) OWNER OR�TRAC
JOB SITE ADDRESS: p���(� -Su�G Ue��j��ZIP:
NAME OF OWNER: PHONE: (home)
(work)
MAII.ING ADDRESS: CITY: ZIP:
CONTRACTOR: l,,,��.s'�' G PHONE: ����D
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS:,9T00 ,�_�Qll�: /✓ CITY: ,�Gyrr�vr� ZII':
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N�,�; REGISTRATION#
.��Q9b�+
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: �/Z �/�' /Z��/20�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /v���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 ord'inances 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 th approved plan.
APPLICANT'S SIGNATLJRE: 7�^^-' DATE: lO""�iZ'��
NOTE! Parade qf Homes events require separate permit approval by Poliee Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF S[TBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information req�ared to be givw individual. An individual asked to supply private or confidendal dara concecning himself shall
be informed of: (a)the purpose and in[ended use of the requesred data within the collecting§tate agency,polirical subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequeace arising fmm his supplying or refusing w supply
privau or confidenrial data;and(d)the idenriry of other persons or enrities auchorized by state or federal law to receive the data. Ttus requiremenc shall
not apply when an individual is asked to supply investigadve data,punuant co section 13.82,subdivision 5, to a law enfoccement o�cer.
The commissioner of re�enue mav vlace the norice reauired under this subdivision in the individual income rax or aroDertv taz refund
instnicdons iastead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public,priva[e or confidendal. Upon his further request,an individual who is the subject
of stored privau or public data on individuals shall be shown the data wirhout any charge to him and,'if he desires, shall be informed of the content
and meaning of rhat dara. After an individuai has been shown the private dara and informed of iu meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuanc to [his secdon is pending or additionai 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 the data. The responsible authoriry
may require the requesting person to pay the actual cosu of making,cerdfying,and compiling the copies.
The responsible authoriry shail comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of
the date of the roquest,excluding Satucdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with ihe request
within that time,he shall so inform the individual,and may have an additionai five days within which to comply with the request,excluding Saturdays,
Sundays aad legal holidays. � '
Subd.4. Prpcedure 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,wridng the responsible authoriry describing the nature of the disagreement.
The responsible au[horiry shali within 30 days either: (a)correct the data found m be inaccurate or incomplete and attempt to nodfy past recipients of
inaccumte or incomplete data, inciuding recipients named by the 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 determinadon of the responsible authority may be appealed pursuant to the provisions of the administrerive 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 Ciry 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.
g, 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.
��ri-' ��a� ��r�
First ,.�/ u�d e Last
/�l� �or ' �v� �
Add�G��Q�r� ��� ��-��
City State Zip Phone
I understand my rights as stated above.
Signaare