HomeMy WebLinkAbout1999-011918 (tear off/ re-roof) . � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number. - - �--"�`�v'�
Crystal Bay, Minnesota 55323 Date Issued: � - - = �� � I
(612) 249-4600 " -
I SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT ERMITEE SIGNATURE ISSUED BY:SIGNATURE
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'otal Fee: $ ��� Date Received: ��02`�
�ncered By: Perm.it�: i A ��/� �
CITY OF ORONO - BUILDING PERMIT' Al'PLICA.�`ION � �
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All in�orma�ion must be submitted in full before plan reYie���R�ll be started. . �
. (please print all information) . , . - . .
i.3E A.PPLICA.�"T IS: � � (circle one) .� O�VNER OR CONTRACTOR � � - � .
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J`JB SiT`E ADDRESS: -3 � 3 I � C/�-'� C o �', �- � zrn: .�J 3
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_ _ �D p -- PHOiYE: (home) � �/� � $Q��
ti'A11�� OF O�'Yti'ER: ��Y . .
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NL4II�I�G AD��.ESS. . �
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CONT'RACTOR: S c''L . PHO�TE: '�7/ - ��'9 S. - '
MOBILE/PAGER: --""
CON'TACT PERSO�: �:
�YIA.ILIti'G ADDRESS: ,5� CTI'Y:
STATE LiCE�SE: # -
.�RC�IITEC'�lE�TG .Itii TEER:� . . " PHO�TE:.� �
1�7AILTi\TG ADDRESS: . CITY: ZIP:
NA.ME:
gEGiSTRATION�
TYPE OF '4YORK: New Addi[ion Accessory Structure
Move � Remodel/Alteration� Land Alteration
PROPOSED ti'Y4RK(describe in detai�j:
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROO�SS: GARAGE STALLS: �1TT• _ DET. . _
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ESTI1�i TATED CONSTRUCTI�N VALUATION (excludina lanc�: $ .
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that Lhe work will be in conformance wich the ordinances a.nd codes of the Ciy and with
the State Buildi.n� Code; that I stand this is not a permit and work is not to st��wit�iout a
permit; and th�c the work wil e in accordance th pproved plan.
�T'T'S SIGNA . D�'�: � /
APPLICA.�
NOTE! Parade of Home� eve ts require separafe permit approval by Police D p artment and
� City Counci160 days prior to t ke even t. N o n p e r m i t t e d e v e n t s i v i 1 1 n o t b e a l l o w
Sec.13.04 RIGFiTS OF SUSTECTS OF D?,T?, - -- - • �
Sutd. i. Tppe of data, The righct o!iadividu3l an wham�e dasa u srortd or co be sm�:d s..it be u�s foc�h in chis scerion,
Su�d.2. Intorma�an nqcrirrd to be givm iadiridval. �;i�divi�.ial uYed w supPtY Pri'n�c:pnfid===�I daca eonceming hiLsseif sh�I
be informed of: (a)the purpase and in�nded use of the rcy�s:scxi daa wic�ia[he eollecdng S�m a3eacy,FeLacaI rL-divisioc,ar sam�.r.ce s�st�;
(b)whet�e:he r�y r_acse or is_le3ally requir:d to zscPPtY.the r_quesccd da�:(ej aay 1�a.va eo�_quecce ar's:_3 f•nca�:s si�ptyiag or refusiag ta sup�Iy
privac:oceaar:dcr.=z2 daa;a:.d(��e ideaery a[a�4erpecsors er eaaca au•�oriz�by sac�orf:�e='!_��;:cei+a�.e d33. This r_quirc�eat s;�.�_'I
noc a�ply w;:ea ars i:dividuaI is uk:d co supply iavuagadve dan,purr�at ro secao¢13.82,subdivision S,m a la:+eafaczemant ofncec. .� . -
Tte cer.urtizsioner of rever.ue mnv iace [he nadce r_ruir_-c ur.der this sutdivision in the ir.ci.�ual ir:�:ae ez or orooercv tts refiar_3
inmucdans i*uuad of on�hose Cocros.
Subd.3. Accas to data by iadivqdual, Upon requuc to a cts�raas3ie auchoriry,aa'mdividuaI s�be ir�ar�ed whtcher he is the subjeet
of scor:d dsn on individuats,aad whuher it is eL�uiFied u pubiie,priva�oc eanF.�eaaai. Upaa his furc.`.e:r_�uerti u irdividual who is t�:subj�:
of stor.d priva:e or public dara on iadividuaIs shall 6e showa che daca wic4oat aay charge to him and;it he�:sir.s,s3�1 ba in(ocmcd ot the eanteat
and m:aning of e�ac data. Afur an individual ha.s beca shown the priva�:dit�aad iatarmed oC ia�eaai:3.�e daa�--d not be d'uclosed�him far
six monc�s cherafcec unless a dispuce or aeaon pursuanc to this seccon is pe:diag a�addiaoe3l daa on�i�divide:aI has been eoUee�d or ereaL-�
The tespaasible au�:oriry shallpcovida eopies of�he privace orpublie daa apan tequ:st by the iadividual st:z;.-:t oC�e�. The respoasi'ble auchociry
may cequir_ che toctuacing person to pay che acaia!casu aF rsukinz.ee�sfying.ar.d comp�ling�he eapies. � �
The responsib(e auchoriry shaIl eomply imct:ediataly,if Qossible,wich aay request czade pursus.:n efus s.:�ivision,oc wichin five days of �
the da4 0[�he ceq�est,ezcluding Satutdays,Sundays and 1e3a1 holidays,if irainedi�:complia�ce is notposs'�T�. If�e e3aaot compiy with tha reques: ;
wichin dzat acne,he shall so inform the individuaI,and may have an addicoeaI five days wichia wh'ich to co��i;wic��r_quest,ezcludiag Saacrdays, '
Sundays ind(egal holidays. . , . ;
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Subd.4. Pzocedure when data ts not accurate or eomplete. An ir.dividaal may eonc:sc che ar�ry or eo�ple�eaeu of public orpri��ace
dara eonceming Iiimself. To ezeccise chis right,an individaaI shaIl nadfy ia wridn,�he tespoas�ble auchodry�acnbiag the n�n�re of the disagreemeat
The tesponsible auchoriry shall wichin 30 days ei��cr. (a)eocrecc dta da�fonad to be inaccuca��ar iccomp;e�ar.d a��pc to aarify pasc recipiencs of
inaccurate or incompiece data,including recipiea�s narned by che indivic�:aI;or(b)coafy the ir.dividual t�-:re betiev�the dati ro be correcc Da�
in dispute shall be discloscd only if the individual's sca�tmenc of d'uagrees.ent is iacluded wic�the d'u<los»cara.
The decerminadon o!the responsibte auchoriry may be appeale3 pursuaat ro the provisions of�adminisaadve procedum acc reladng co
eont�s.:d cases. . . .
DATA PRTVACY ADVISORY ;
In accordance with M.S. 13.04,Subd.2, "Ri�hcs of subjects of data", �•e wouId lise to inform you that your request
for a permit or Iicense from the Ciry oE Orono or any of iu depanments may require you to furnish certain private or I'�
confidential information. i
You are notified that:
1. The information you furnish will be used to dececmine your qualificacion fo:che permit or license re uested. f'�I
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2. You may refuse to supply data, but refusal r�ay require that the Ciry d�y the permit or license. � �
3. The information may be shared wich o�her loczl,stace or federal a�eacies to the e.ctent necessary to procas
the permit or license,
4. If your requested permit or lice¢se requires Couacil action to approve, some information may become ;
. public, ' . • . . . . . . � . ,
�5. You have certain ri�hts under M.S. I3.04�(available upon requat) to r�+iew p;ivace data on.yourseIf. . .
6. Your full narae is requiredy to process this application or pers�it. j
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I unders d my �hts as stat a ove.
Signacu e
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