HomeMy WebLinkAbout1997-009634 (tear off/re-roof) . PERMIT
, CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _ :���
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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APPUCANT/PERMITEE SIGN ISSUED BY:SIGNATURE
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' Total Fee: $ -"�� ��• � � Date Received: �
Entered By: � Pern-ut#: '>{- `%'> �/
CITY OF ORONO - BUILDING PERNIIT 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 QR CONTRACTOR-=
JOB SITE ADDRESS• ---,' -S G�% �i s���c, ���'�����' ZIP: ����5' �-� /
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NAME OF OWNER: �i'��5.�'-�� PHONE: (home) "� ' � ' � ,
; (work)
MAII.ING ADDRESS: .�-�z'-�' `", �1a ��cl`�; CITY: r��C��-f�� .�-� ZIP: i;-r ��� �i
CONTRACTOR: �l ���� /�<.�`M"^�� ��' .��i r-�- ��r�����i-����- - PHONE: --��� �_�/if ri�_
CONTACT PERSON: � � v��� ��: `r� MOBILE/PAGER: �':!� �� � _ �����
MAILING ADDRESS: �' � `� ir��� � � �✓, CITY: ` ��.-�_!� ZIP: �-�---��; �=
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STATE LICENSE: # �,�' _
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
�JAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration �— Land Alteration
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PROPOSED WORK(describe in detain:�F'- -��� ��` /�L�- ,f;e��-�- ����;���
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STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIlVIATED CONSTRUCTION VALUATION (excluding 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 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 accor�ance with the approved plan.
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APPLICANT'S SIGNATURE: ��G�%� c � ��� "-' DATE: �t� '��` �' �
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGH'TS OF SUB.TECTS OF D�TA
Subd. 1. Type of data. 'Ihe rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. r1n individual asked to supply private or confidenRal dara concerning himself shall
be informed of: (a)the purpose and intended use of the requesred data within the collecting'state agency, political subdivision,or statewide system;
(b)whether he may refuse oY is legaliy required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
� private or confidendal data;and(d)the idenriry of other persons or enaties authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked ro supply invesrigadve dara, pursuant to secdon 13.82, subdivision 5, ro a law enforcemenc o�cer.
The commissioner of re�enue mav place the nodce reouired under this subdivision in the individual income tax or propertV tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whecher he is the subject
of stored data on individuals,and whecher it is classified as pubiic, private or confidenaal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the contenc
and meaning of chat data. Afrer an individual has been shown che private data and informed of ics meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acaon pursuant to this secrion is pending or addidonal data on the individual has been coilected or created.
The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of che data. The responsible authoriry
may require the requesring person to pay the acrual costs of making, cerafying, and compiling the copies.
The responsible authoriry shali 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 leeal holidays,if immediace compliance is not possible. If he cannot comply with the requesc
within that time,he shall so inform the individual,and may have an addirional five days within which to comply wi[h the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individua(may contest the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days eicher: (a)correct the data found to be inaccurate or incomplete and attempc to norify past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes[he data to be correct. Data
in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Riahts of subjects of data", we would like to inform you that your request
for a permi[ or license from the City 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 determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut 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.
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 m}c-r}ghts as stated above. /,
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Signature ° �