HomeMy WebLinkAbout1997-009664 - tear-off/re-roof/sid - PERMIT
CrTl�O�`bRONO PERMIT TYPE: __ _
_/ �5t� Kelley Parkway- P.O. Box 66 _.t...�_�:.�����
Crystal Bay, Minnesota 55323 Permit Number: -
(612) 473-7357 Date Issued: -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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AP ICA T ITEE SIGNATURE ISSUED BY:SIGNATURE
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, , �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 information)
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THE APPLICANT IS: (circle one) OWNER OI�ONTRAC Z}�
JOB SITE ADDRESS: �� �j �(9�3gs BAY � � Z�� � �3J��Q_
NAME OF OWNER: j�V� ���/U`�5 PHONE: (home) y 7�3--�/,35 7
(work)
MAILINGADDRESS:�„D� s7U8f�5 8i4-Y R1� CITY: �7,��/� ZIP:_���,��
CONTRACTOR: p T' PHONE: �,/7 �J— ��$
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CONTACT PERSON: �t,J MOBILE/PAGER: — 7
MAILING ADDRESS:��'C/� �� !��9� ND CITY: �IP: J�'' S 5
STATE LICENSE: # �p 353 y0
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
1vAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration� Land Alteration
PROPOSED WORK(describe in detain: ^i1/�W ,QfJ�D� q� �S�1�C.�' R.��i4-.T2.
STORIES: j� SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: 3 GARAGE STALLS: ATT.�_ DET.
ESTIMATED CONSTRUCTION VAL�JATION (excluding land): $ ��D O
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 accordanc with the approved plan.
APPLICANT'S SIGNATURE: DA'TE: /�V� 7, g7
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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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The righa of individual on whom the data is stored or to be scored shall be as set focth in this secdon.
Subd.2. Iaformation reqirired to be given individual. An individual asked to supply private or confidenriai data concerning himself shall
be informed of: (a)the purpose and intended use of the requesud data within the collecting§tate agency,polidcal subdivision,or sracewide system;
(b)whether he may refuse o'r is legally required to supply the requested data;(c)any Irnown consequence arisiag from tus supplying or refusing to supply
private or confidential data;and(d)the idenriry of ocher persons or endaes au[horized by state or federal law to receive the data. 'This requirement shall
not apply when an individual is asked to supply investigadve dara,pursuant to section 13.82, subdivision 5,to a law enforcement o�cer.
The commissioner of revenue mav place the noace required under this subdivision in the individual income rax or propertv tax refund
instructions instead 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 scored data on individuals,and whe�her it is classified as public, private or confidendal. Upon his further request,aa individual who is the subjecc
of stored private or public dara on individuals shall be shown che darn wi[hout any charge to him and,if he desires,shall be informed of the content
and meaning of that data. After an individual has been shown the private dara and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acaon pursuant to[his secdon is pending or addidonal dara on the individual has been collected or created.
The rosponsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actuai cosu of making,cerdfying,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,exctuding Samrdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within wtuch to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure whea 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 nodfy in writing the rosponsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompiete and attempt to nodfy past recipienu of
inaccurate or incomplete data,including recipients named by[he individual;or(b)notify the individual that he believes the data to be cocrect. Data
in dispute shail be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
The determinadon of the responsible authority may be appealed pursuant to the provisions of the adminisaadve 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 fumish will be used to detemune 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 eztent 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 ri hts as stated above.
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