HomeMy WebLinkAbout1996-007960 (re-roof) . � �'ERMI�
�;ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: ��`j`i-�-�� ���
Crystal Bay, Minnesota 55323 ;��}i'��=<i-;
(612) 473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT PERMITEE SIGNATURE ISSUED BV:SIGNATURE '��
Total Fee: � DateReceived:
Date Approved:
Entered By: ���; Permit#: '7��C�
CTTY OF ORONO - BUILDING PERi�IIT APPLICATION
AI,L P�'OF21�I�,TION�NST BE SLB�IITTED IN F`�ZL BEFORE PL��REVIEtiV tiYII..L
BESTARTED
---------------- -----
THE APPLIC��'T IS: (circle one) OWi�tER OR CONTRACTOR
Jos srrE An�xEss: � 7 `� � �'/�S �� �� /� z�: } S � � /
�/�� �� S PHO��: (home) � 7�— :�/;��
NANIE OF O`V�ER: � -_
(w�ork)
I�IAILINGADDRESS: 3 '� '�l 7 C/�S�' r� C�'//z_ CITY: '�'��;L,�- T.9 ZIP: �--5- ��',T
CON'TRACTOR � PHO�TE: -�-_
. MOBILE PHOivE/PAGER:
MAILINGADDRESS: - CITY: �--- ZIP: ---�_
STATE LICENSE: # ---
ARCHITECT/ENGINEER: PHO�tE:
vIAILI�i tGADDRESS• CITY: Z1P:
NAlvIE: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move RemodellAlteration Land Alteration
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PROPOSED WORK(describe indetail):�e�-
STORIES. ______— SQ• �ET OF EACH FLOOR:
NO. OF BEDROO�IS: GARAGE STALLS: ATT. DET.
EST11�i IATED CONSTRUCTION VALUATION(escluding land): $ /�'�� ��
I hereby apply for a buildin� permit and I acknowled;e that the information above is complete
and accurate; that the work will be in conform.ance with the ordinances and codes of the City
and with the State Buildin� 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.
/ �2 DATE: �/� - �'l-�
APPLICANT'S SIGNATURE' � �C%\
NOTE! Par�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.
Sec.13.04 RIGHTS OF SUB.TECTS OF D�T,�
Subd. 1. Type of data. 'Ihe rights of individual on whom the data is stored or to be stored shall be as sec forrh in this secdon.
Subd.2. Information reqirired to be�ven individual. An individual asked to supply private or confidenaal data concerning himself shall
be informed of: (a) the purpose and in[ended use of the requested data wichin[he collecdng'stace agency, polirical subdivision,or stacewide system;
(b)whether he may refuse or is legally required co supply the requested data;(c)any fmown consequence arising from lus supplying or refusing to supply
privace or confidendal data;and(d)tbe idendry of ocher persons or enddes authorized by state or federal law to receive the data. T'his requirement shall
no[appiy when an individual is asked [o supply invesdgadve data, pursuan�[o secaon 13.82, subdivision 5, to a law enforcemenc o�cer.
Tlte commissioner of revenue mav place the notice required under this subdivision in [he individual income tax or prooertv taz tefund
instrucrions inscead of on�hose 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 whecher i[is ctassified as public, private or confidenoal. Upon his fur�her request, an individual who is the subjecc
of scored private or public data on individuals shall be shown che data wichout any charge co him and, if hz desires, shall be informed of the concent
and meaning of that data. Aher an individual has been shown che priva[e dara and informed of its meaning, the data need no[be disclosed to him for
six mon[hs [hereafter unless a dispuu or acaon pursuant to this secrion is pending or addiaonal data on the individual has been collected or crea[ed.
The responsible authoriry shall provide copies of the private or pubtic data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay [he aceual coses of making, cerrifying, and compiling che copies.
The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to[his subdivision, or within five days of
the date of the request,excluding Sanirdays,Sundays and legal holidays,if immediate compliance is not possib(e. If he cannot comply with the request
wi[hin that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himseff. To exercise chis right,an individual shall norify in wriang the responsible authoriry describing[he nature of the disagreemenc.
The responsible auchoriry shatl wichin 30 days either: (a)correcc the data found to be inaccurace or incomp(ece and attempt to norify past recipients of
inaccurate or incomplete dara, including recipients named by [he individual; or(b)notify the individual that he believes[he data to be correct. Data
in dispute shali be disclosed only if che individual's sta�ement of disagreement is inctuded with the disclosed data.
The determination of che responsibl� auchoriry may be appealed pursuan[to the provisions of the admirustradve procedure aCt relating to
concested 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 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 Ciry deny the permit or license.
3. The information may be shared 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 [his application or perm.it.
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First Middle Last
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Address
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Ciry State Zip Phone
I understand my rights as stated above.
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Signature