HomeMy WebLinkAbout1996-008641 (re-roof) PERMIT
CI�Y OF ORONO PERMIT TYPE: - -
2�5C�i�elrey Parkway- P.O. Box 66 �`-' '��-`' #�F�`''
Crystal Bay, Minnesota 55323 Permit Number: ����.�����-'�?
(612) 473-7357 Date Issued: _ . �, . _ .
SITE ADDRESS:
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REMARKS:
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AP NT%PERMITEE SIGNATURE , ISSUED BY:SIGNATURE
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„Tczal Fee: $ Date Received:
� Entered By: Permit#:
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: J � Z- I �S L� � � r c, 1 -� ZIP:
NAME OF OWNER: M�tr k �p uq a� 1 `� PHONE: (home) 3 3 3—� S��
� s�,,�� (work)
MAILING ADDRESS: 7D � z^� ��e �3 2- CITY: {Melf - ZIP: S s�d z
CONTRACTOR: T h �� r�n �' k C-o� � PHONE: S`7�t�Q,�S
CONTACT PERSON: �o,-,,� ��r�2 v� k M BILE/PAGER:
MAILING ADDRESS: 3(0 3 d 1Jor�-�.e.ar h �v 2.. CITY: �l✓�iyZ�.�a ZIP: 5 �3 R�
STATE LICENSE: # Z-�v Zdc� 3 g
ARCHITECT/ENGINEER: PHONE:
1VIAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration x' Land Alteration
PROPOSED WORK(describe in detai�: ►�e ruc� � �a t'c� �h ew 5����eS
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 2' d���
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 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: DATE:Iz'J�—�/C�
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.
6
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secaon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be infocmed of: (a)the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is leeally required to supply the requested data;(c)any Imown consequence arising fmm his supplying or refusing to supply
priva[e or confidendal data;and(d)che idendry of other persoc�s or enddes authorized by state or fedecal law ro receive the data. This requirement shall
not apply when an individual is asked to supply invesrigaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcemen[officer.
The commissioner of revenue mav place the nodce required under this subdivision in the individual income [ax or propem tax refund
instrucrions instead of on[hose forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whecher he is the subject
of stored data on individuals, and whe[her it is classified as public, priva�e or confidential. Upon his further requesc, 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 meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending or addidonal data on the individual has been collected or creaced.
The responsible auchoriry shall provide copies of the private or public data upon reques[by the individual subject of che data. The responsible auchoriry
may require the requesting person to pay the actual costs of making, certifying, and compiling the copies.
The responsible au[hority 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 immediare compliance is no[possible. If he cannot comply with the request
within that time,he shail so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Sarurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accu:ate or complete. An individual may contesc the accuracy or completeness of pubfic oc private
data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall wichin 30 days either: (a)correc[rhe data found to be inaccurate or incomplete and attempt to noafy past recipients of
inaccurate or incomplete data, including recipienu named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shal(be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The de[ermination of the responsibfe authority may be appealed pursuant to the provisions of the administradve 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 fumish certain private or
confidential information.
You are notified that:
1, The information you fumish will be used to deternune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested pernut or license requires Council action to approve, some information may become
public.
j. 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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Ciry State Zip Phone
I understand my'rights as stated above.
Signanire