HomeMy WebLinkAbout1997-009762 - tearoff/reroof � � � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -.
Cr�stal Bay, Minnesota 55323 Permit Number:
(612)473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
CONTRACTOR: - - ._ _. _ OWNER:
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APPLICANT�PERMITE IGNATURE ISSUEDBY:SIGNATURE '���
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Total Fee: $ Date Received:
Entered By: ,�;'/,.
Pernut#: �l '7��-
CITY OF ORONO - BUILDING PERMIT 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 O CONTRACTOR>
JOB SITE ADDRESS: �� ��`(�,(T� �� ZIP:
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NAME OF OWNER: � f. l �)� . L`�t PHONE: (home) f 'J � �� � �
� ,� (work)
MAILING ADDRESS: �S �(h,� � �-�� CITY: ��YLk'�V�� ZIP:
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CONTRACTOR: : �� � I�''��� PHONE: �{'`7 �'3� f �
CONTACT PERSON: (�' �'n� MOBILE/PAGER: '_'�'U �i?�:.;+�� �?7-�'��-�
MAILING ADDRESS: ��7.�r�.S �, �d a�f CITY: r'��.t^ti=�!.t-#..,�� ZIP: �� �7
STATE LICENSE: # ��5� �
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP: ,,
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
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PROPOSED WORK(describe in detai�: f11�0�� C5 L-�D �k ` � ' C�'! �` -
`i v�s fr,x �'� (�,�t- ������� -�--C� Ix� ��'�'rr ►�PV.� �{'�f ��� s t p U,���i�1s ����"`
��� tel =s� f�s p �,.(.�`s�'�� n�i
STORIES: SQ.FEET OF EACH FLOOR: �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $�'�,.�� �
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 pe t �,work is not to start without a
permit; and that the work will be ' cor ce . ith the ap lr�o�, c� plan.
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APPLICANT'S SIGNATURE: ', `� . ���'` ''' �' :��� �-�ATE: ��'`� / %� �
NOTE! Parade of 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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Sea 13.04 RIGHTS OF S[JB.TECTS OP DATA
Subd. 1. Type of data. The rights of individual on whom che data is stored or to be sto�ed shall be as set forth in this secdon.
Subd.2. Information reqiric�ed to be given individual. An individual asked to supply private or confidendai dara concerning himself shall
be informed of: (a)the purpose and inunded use of the requesred data within[he collecting�tate agency,polidcal subdivision,or statewide sysum;
(b)whether he may cefuse oY is legally required to supply the requested data:(c)any Irnown consequence arising from his supplying or refusing to supply
privace or confidential data;and(d)the idendry of ocher peaons or enriaes authorized by stace or federal!aw to receive the data. This requirement shall _
not apply when an individual is asked[o supply invesrigadve data,pursuant ro secdon 13.82,subdivision 5, to a law enforcement o�cec.
The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income tax or nroDerty_taz refund
instrucdons inscead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is class�ed as public,private or confidenaal. Upon his further request,an individuai who is the subject
of stored private or public data on individuals shall be shown the dara without any charge to him and,�if he desires,shall be informed of the content
and meaning of that dara. Aher an individual has been shown the private dara and informed of its meaning,the data need not be disclosed to him for
six mondu thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual 6as been collected or created.
The rosponsible authoriry shall provide copies of the private or public data upon request by the individual subjec[of the data. The responsible authority
may require the requesdng person to pay che actual coscs 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 immedia[e compliance is not possible. If he cannot comply with the request
wirhin that time,he shall so inform[he individuai,and may have an addidonal five days within which to comply wirh the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure whea data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement.
The nsponsible authority shalt within 30 days either: (a)correct the data found to be inaccucate or incomplete and attempt to nodfy past recipienes of
inaccurate or incomplete dara,including recipients named by[he individual;or(b)nodfy the individual that he believes the data to be correct. Data
in dispute shali be disclosed only if the individual's statement of disagreement is included with the disciosed data.
The determinadon of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act reladng 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 pemut or license from the City of Orono or any of its departments may require you to fumish 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 pemut or license.
3. The information may be shazed 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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