HomeMy WebLinkAbout1998-011005 - tearoff/reroof PERMIT
:�i�Y OF ORONO PERMIT TYPE: �;:_:��_�.;T:u=;
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: :t� �i��_���
(612) 473-7357 Date Issued: i � -': :=����s�=�
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE �.��ISSUED BY:SIGNATURE A~',",�` "C'�,
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Total Fee: $ Date Received:
Entered By: Pemut#: ,•',� ��
CITY OF ORONO - BUII.DING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE �iPPLICAI�'T IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: Z�- �J� C'�q Sc � 1�`�. �Z d ZIP: �S�'9 /
NA1�iE OF OWI\TER: �����- /���i1- PHONE: (home)
(work)
MAII.ING ADDRESS: Z��'o c�, S � --, CITY: ZIP:
C01�1'I'RACTOR: V�- t-. C���ti�;jTl4 C�-y�'� PHONE:�{`_�� - F.< � i.
CONTACT PERSO�': j�v�� 1�10BILE/PAGER: �'7—3 �� )
MAILING ADDRESS: �9�� C ,�; " ;,�,r� i?(ti� CITY:���„,��'} ZIP: �_s��_�
STATE LICENSE: # 5�-��� `�
ARCHIT'ECT/ENGI�YEER: PHOi�tE:
MAILING ADDRESS: CITY: ZIP:
N�y�; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�: 1�:/�v�-- ���� d- ?\�-i:����
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROO�ZS: GARAGE STALLS: ATT. DET.
ESTI�I�IATED CONSTRUCTION VALUATION (excluding land): $�� '�`� � O�-� _�`J
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 accordance wi e approved plan.
APPLICANT'S SIGNATURE: `���� ��. - -- DATE: � (__ ��i _ i�
NOTE! Parade o Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
. �
Sec.13.04 RIGHTS OF SUB.TECTS OF DaT?.
Subd. 1. Type of da[a. 'Ihe righcs of individual on whom che data is storcd or to be stor:d shall be as sec forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supp(y priva�e or confideadal daca concerning himself shall
be informed of: (a)the purpose and in[ended use of the rtquaied data wichin the collecaag'state ageacy, poliacal subdivision,or sracewide rystem;
(b)whecher he may refuse oi is legally required[o supply che requesced data;(c)any Imown consequence arising from his supplying or refusing to supply
privace or conndendal data;and(d)[he idendry of o�her persoas or enades au[horized by scate or federdl law to receive the data. This requ'uemenc shall
r.o�apply when an individual is asked to supply invcsdgadve dara, pursuanc to secuon 13.82, subdivuion 5, co a law enfoczement o�cer.
The commissioner of revenu mav plac� the nodce teauired under[his subdi�ision in the individual income rax or propem taz refund
instrucdons instead of on chose forms.
Subd. 3. Access to data by individual. Upon requesc to a cesponsible auchoriry,an individual shall be informed whether he is the subjecc
of stor.d data on individuals,and whe[her ic is classified as public, priva�e or confidendal. Upon his further requesc,aa individual who is the subjec�
of stored private or public data on individuals shall bo shown che dara wichout any charge to him and, if he dzsires, shall be informed of the contznc
and meaning of[f:at dam. Afrer an individual h�s becn shown che private data and informed of ics meaning,the data need no�be disclosed to him for
six monrhs chereafter unless a dispute or acdon pursuanc to [his secaon is pending or addiaoaal data on the individual has been collacced or created.
The responsible au[horiry shall provide copies of�he privam or public data upon request by che individual subject of the dara. The responsible authoriry
may require che requesdng person to pay the actuai coscs of making, cerrifying,and compiling[he copies.
The responsible auchoriry shall comply immediately, if possible, wi[h any request made punuant�o this subdivision,or wichin five days of
the dace of the request,exctuding Sacurdays,Sundays and legal holidays,if immedia�e compliance is noc possible. If he cannot comply with the requesc
wichin d�at dme,he shall so inform[he individual,and may have an addidonal five days within wtuch to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individua!may contest[hc accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in wriang the responsible auchoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days ei[her: (a)corr�ct the data found to be inaccurate or incomplece and aaemp�eo noafy past recipiencs of
inaccura�e or incomplete data, inciuding recipien�s named by �he individual; or(b)notify che individual thac ha believes che data to be correct. Data
in dispuc�shalt be disclosed orily if the individual's statemznc of disagreemenc is includad wi[h the disclosed data.
The decerminanon of[he responsible au�horiry may be appealed pursuanc to the provisions of the adminis�arivz procedure act reladng to
contesred cases.
DATA PRiVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request
for a pernut 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 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 wich ocher local, state or federal a;encies co the ettent necessary to process
the permit or license.
4. If your requested permi[ or license requires Council action to approve, some information may become
public.
j. You have certain tights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your fuil name is required to process this application or perm.it.
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Firsc �Siddl Last
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Address
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Ciry Srate Zip Phone
I understand my ri�hts as stated,�bove.
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signa�uco