HomeMy WebLinkAbout1999-011823 (re-roof) PERMIT
CITY OF ORONO PERMIT TYPE:
� 2750'Kelley Parkway - P.O. Box 66 - -;;;�,`
Permit Number: '`- ! =-:-_
I Crystal Bay, Minnesota 55323 = ==��=�
(612) 249-4600 Date Issued: �- _�-��--. _
`i,:
SITE ADDRESS:
_ __ '�;��-'?_�:�= y'�r'
r,: - f�_ — —��_;,}� _ �
DESCRIPTION:
__... �; __..._. ._ _.� _
_..��:�_.-_�� . . .-.. ._i�_,-
'�'_�3 .i.+_7?1-�'.� 1'`:Y:'=:i I j�• i�'t f=�'r, »;�W._j;:�1?�:•,•''?'t'.+�I'�=_�i}�!
...: i�'i�._ tx�;"�i'�:; �°:[.�_' h'�._�i:�i�4{t-
� � . :
_ ;; r --
REMARKS:
FEE SUMMARY:
_ __ _. .- ��_.. . �=�, i ��ci;
_a:�:..� i=3,=�:;� — ___ . _
- -.'t.~'!=�`'_. - ._�_.._....._ ^:�.`.x:
iF�,ij�C,'�,� �"'_:__ �C'.f•,+ i W, , _�i�.
CONTRACTOR: __ .- - _ „�.�:-,;. - _ . . _.,V;-: OWNER:
� _._. . _i-�� �`�:�-�_- �t,it� . . _ _ .. _. .. _ ._.��;�a'=''� _ _ . ._. _ -.. _`�' -
— _ — i ',iv��lr;f._` i':'�:��.= w _ . . _ =;:�a'� _. '.'%�` r'•='
j;`T i�i1=i�__..___ _ — : ;�'�� _:r::_I 'sr�' _.- ` ...
,•�
.��.�:.'_.4 _ �...���`. � `j^._ ... _ . _
_. ,�. ,f �.. � ._ _ -
: : � • r;�;; ;:;-;1;- r�`t �i, _ _ _�1�_. _ ��(:�� . _. __. .... _ . �. . .... .
L::,:� ;. -4= ur- :�i
, :�: `� - �
-:,,; r
_ .._
, „ . _.. ___ : . . . _..,_ . _
�
_. . .
�.:�..��..e;';. _._...i �. 3�...� �'�i��lt�..i-._e+ ;j41 _ w��j_� _.. v i �.F . .. �'l .. ':�i� . _ . .. , , ... �
iur V . ' ' :� � t � .] .. � � .�S`.,
�._i .___ - � .. �
„ _.:;.. .; , � '
L i_l�'i_f�dt_{ _f';:�1 E i . .. •'_='_, r:t t _ t _. _ . . _s. .__ .�i _ _ __ .., _ .__. _. .. t�.. . ._ . �
...,.._.�,+..,.. .. �. �,. _" �-�f F i 3 �: ! F
A
t
�� � r� ^ �
�
A�' ICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fe�: � l� ' �� Date Received:
Entered By: 6'�'L�rY Permit#: j l � ,�,.'� � �
CITY OF ORONO - BUILDING PERMI�' A�PPLICATION � �
. � ;
A.11 informa�ion must be submitted in full before plan revie�v�-ill be started. . �
� {please prini all information) . .
�� - � � � --..,::�- . . . . 1
_ � � .: � . . � .
�
Z'HE APPLICA.�'T IS: � (circle one) . O�NER OR�LO��T�.ACTOR - �' � . � �
�-�.. . �__...,:
� , � ,��,_��. . i
JOB .� ..,�. . , ;J � ZIP• j;}';1-�Y..)�. !
SIT7E A.DDREss: � i � �"��>^,;�h,�i '�r°'.�,�—.
. ,,
�
;
� , �, � i_,: � ,��-r� PFIONE: (home) � � _ �(�L-' �
NAI1-IE OF O�'Y�ti�R: '�:, -?= .
� ' (work) ' �
� �' ,:.
NIAILI�TGADDF'.�SS: ,�1 ^�� I�����;'i; G��v CITY: ZIP: ���_ j.
� _i j
. �� I '1 ' � ?.' � �
CONTRACTOR: �,`��"�t,V'� �`-u��� °�i���,� PHONE: `,� �� �� �,�i �. - ',
� CONT'ACT PERSON: ,` °�,� , �YIOBILEIPAG��.:�� ,I
MA,TI.,TitiGADDRESS: �. - �',' ��' ��`� � CTTY: ��� . ���_hT-b'— i
STATE LICE�iSE: # '��-'��-ii E;� �
ARCHIfiECT(E\TGItii'EER: ' . PHOtiTE:.� .. I
iNAll�i�'G ADDRF,SS: C�TY: ZIP:
. ��ME: gEGISTRA.TION#
TYPE OF tiYORb: New Addition J Accessory Structure
Move Remodel/Alteration�_ Land Alteration _
- �,
n � �. '� ('
' � l ` � , ,�. � `'�',�1'�L;1;�
PROPOSED ti'�ORT�(describe in detai�: 15�� � i��v vc� ��.`�id�'�`� �
STORIES: SQ.FEET OF EACH FLOOR: DET.
NO. OF BEDROOMS: GARAGE STALLS: A'TT'. _____ -�- � . � . �
. . . �^
F„S'T .P'i IA,TED CONSTRUCTION VALUATION (exclucling 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 Ciry and with
the State Buildi.n� 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,a�proved plan. ,
�� D�.�: � ; � �_,�;
APPLYCA.��TT'S SIGNATURE: ���,�����.���,� ,�`�:. ti�1� .1
: � ,
,1+ .
� arade H me events require separate permit approval by Police �epartment and
NITE. �
� City Counci160 days prior to the event. Non permiited events will not be allowed.
Sec.13.04 RIGfITS OF St1BTEC?S OF DaTA • �
Sutd. i. Tyge oi data. The tighct of iadividual on whom thc daca is scored at oo be stor.d shalI be as set foah in t1�i.s secrion.
5ubd.2. Intormation req�rrd to be givea indtriduaI. �1n individuai uked to suppiy privam ur caafideaaal dam conceming himself shatI
be in.°ora:ed o,`: (a)[he purpose acd iac.nded usa of[he requesc�dan wichin ehe eollecdng��m agency.policcal subdivision,or samwide ryztm•
(b)whe4`.e:h_:.3y r_rus:or is_legalIy requir:d to supply.tfie r_qucsud daa;(c)aay Iciown eaasequcnce arisiag froa his supptyiag or refuing co supply .
privace orea:i::der.caI data;ar.d(d)c�e idcndry of o�ergersoas orec3a:s au�orizcd by sc��or f:ac�':�::;;r_ceive�e da�. Th;s rquiremeat s�a1
not a�ply w•::ea an i:dividuaI is asked to supply invesaga¢ve dae,pursuanc co s<caaa 13.82,si:Mivision 5.co a law enfdccemeat ofncer. . .
'[�e cenmissionec of revenu� mav oiace che nodc- r�uird und•r this subdivision in the individual ircome ez or orooem t�z refund
instrucdoru Lnsread of an those forrsu. . —'
Subd. 3. Aecess to data by individual. Upon request to a responsible auchoriry,an individuat shatl be inforzaed whether he is the subjecc
of star_d dsa on individuaLs,and whe�her it is et�uiFied u public,private or eanF.dena�l. Upaa his turcher r_quesi,an individaaI who is th:subjecc
oE stor:d priva;e or public data on individuaIs shali be shown ehe daa wichaut any charge w hiia and;if he desira,shall be infocmed o[the eoacent
and meaning ef chat daa. Afu�an individuaI hic been shown the private daci ar.d informtd o[ics meaniag,the dam ne:d no�be discIosed to him for
six monchs chereafter unless a dispute or acdon puesuanc co chis secdon is pending oc addidoaal da�on che iudividuaI has beea eolIecc:d or ercac�d.
Tae cespansibie aa�hociry shaIl�provida eopies of che priva�:or public daa upon request by the individual subjecc of[he daa. Tha responsible authoriry
may cequir. the r.quesdng peaon to pay the accual eosu o[m�kinz,eecafying,ar.d eompiling the eoQies.
The responsible authoriry shaIl eomply immediataty,if passible,wich any requat aude pursuant to this subdivision,or wichin five days of
the dac:of ctce reqaesc.ezciuding Sacurdays.Sundays and lcgal hoiidays,iF immedia�e compliance is not possibie. If he canaot compiy wich the requesc
wichin�hac arne,he shalt so inform che individual,and may have an addidonal five days within which to comply wich the request,exciuding Sacurdays,
Sundays and 1t3aI holidays. . ,
Subd.4. Froeedure when data Ls not accurata or complete. An icdividual may eont�st the accurdry or eompleceness oFpublic or pri��ace
dam eonceming tiim.self. To exercise this right,an individual shali naafy in wridng the tespoasibie au�horiry dacn'bing the aature of che disagreemeac
The respocuible auchoriry shalt wichin 30 days eict;er. (a)correct eha data fonnd to be inaccurac�ac incompiet-and aaempt to nodfy past recipiena of
inaccurate or ineomplece data, including recipien�narTsed by cbe individua.l;or @)noafy the individual tfiat he believes the dati to be correec. Dati
in dispa�e shall be disclosed only if the individuai's statemtnc of disagrcem:nt is included wi�h we d'uclosed dara.
The dacertrunaaon o!the responsibla auchoriry may bc appaaled pursuanc to the provisiorts of che adminisaarive procedure act reladng to
eontesmd cases. . •
DATA PRIVACY ADYISORY �
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjeca of data",we wouId like to inform you that your request
for a permit or license from the Cicy of Orono or any of its deparcments may require you to furnish certain private or
confidential information.
You are notified thar.
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to suppiy data, but refusal may require that the Ciry deny the permit or license. �
3. The information may be shased wich other local,state or federal a�encies to the extent necessary to process
the permit or license. �
4. If your requested permic or license requires Council action to approve� some information may become
. public, . _ . . . . . . .
�5. You have certain ri�hts under NI.S. 13.04�(available upon request) to review privace data onyouurself. .
6. Your full name is requ;�ed to process this application or permit.
, . ti; `
�', �%v�� 6�,�^v'� Ii�P;G�,�1,u
Fust `��� T � �• ��'ddle ,. I.asc -
!,�E' ^ f i � \ t � � �,
Address� �r�i4��`i��1, '�.t�j � _ �
�� �� �,\ !1'+4� ��.i�,; `''��1��� ; i:( �I l 1� .
Ci�Y Sate Zip ` P�ane
I understand my ri�ts as scated abov�. !;
�.
, , .
.E;�l`�4'`Y'��� ' !u V�;V�Yit��,;
Signature
t
•.J