HomeMy WebLinkAbout1999-011384 - reside/reroof �'ERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kel;�y Parkway- P.O. Box 66 - � '�= -�
Permit Number: -�'� '`u'=�
Gfystal Bay, Minnesota 55323 _ : �. �:�=,��
(612) 473-7357 Date Issued: �_',° ' � . _ _
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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� APPLICANT;PERMITEESIGNATURE ISSUEDBY:SIGNATURE
Total Fee: $ �'`j-Q � Date Received: �'=`� �f�
Entered�By: !�- Permit#: //���`f
CITY OF RONO - BLTII.DING PERNIIT APPLICATION
All information must be submitted in full before plan re�iew will be started.
(please print all information)
THE APPLICAI�"T IS: (circle one) �OWNER QR CONTRACTOR
JOB SIT'E ADDRESS: :���-�-'� �l� ���C� r 1 � ZIP: �� ��� �
C-.
NA1�IE OF OtiVi\'ER����v`�t��t'll'1� ��`�-��r��PHONE: ome) � ' ���
(work) � _. ,. .�--
�IAII..PtG ADDP�ESS:,-���-�-� �C�LSC v�-- CITY: �.—X� Z� IP: ���� I
CON'TR.ACTOR: �������-���`{' `����" �� � �-� PHONE:
COi�1'I'ACT PERSON: MOBILE/PAGER:
MAII�I�'G ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGItii TEER: PHO�tE:
i�ZAILING ADDRESS: CITY: ZIP:
�Jp,ME; REGISTRATION#
TYPE OF WORK: New �ddition Accessory Structure
Move �Remode Alteration ��< _ Land Alteration
�_.__�
PROPOSED`VORK(describe in detain: �e-����- `� ��`��C'� C��U`'r��-�
STORIES: SQ.FEE'���'EACH F�QQR:
NO. OF BEDROOMS: �AR.AGE STALLS: ATT. DET. �
�.__ __
_ ___
� L:'_"..�:\ � �J�,
ESTI1-i IATED 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 Buildin� Code; that I understand this is not a pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICAitiT'S SIGNATUREF�=�. ��_�:� �_�\�-`�.=��. DATE: `� '''F C" �
.
NOTE! Par d H m events re �re separate permit approval by Police Department and
S
City Counci160 days prior to the event. Non permiited events will not be allowed.
. Sec.13.Q4 RIGHTS OF SLlBJECTS OF DAT.+� '
Subd. 1. Type of data. 'Ihc righrs of individual on whom che data is scorcd or co be scoced shall be as sec forch ia this secaon.
Subd.2. Information reqirired to be given indiridual. An individual asked to supply privam or confidenaal dam concetning himself shall
be informed of: (a)[he purpose and iarended use of che requesud data wi�hin the coUecdng�tate ageacy,polirical subdivision,or sracewide ryscem;
(b)whecf:er he may refuse or is.legally requir.d to supply che c:quesud data;(c)any laiown coasequence arisiag from his supplying or tefusing W supply
privac:or confidenda!data;and(d)the idendry of o�her persoas or enrides au�horized by sc��e or federai law to receive t�e data. 'Ihis requiremenc shalt
not apply when an ir:dividual is asked to supply invesdgadve dara,pursuanc to secdon 13.82,subdivision 5, to a[aw enforccment o�cer.
Tha ce^lmissioner of revenu- mav pla-- the nodc- rauircd und•r this subdivision in che individual income raz or oropem taz refund
inscrucdons instezd of on those fornu.
Subd. 3. Access to data by individual. Upon requuc to a responsible auchoriry,an individual shall be informed whather he is the subjecc
of scored daea on individuais,and whecher it is classified as pubiic,private or confidenaal. Upon his further request,an individua!who is the subjecc
of stoced private or public data on individuals shall be shown[he dara wichout any chatge to hun and;if he desires,shall be infocmed of che coaten�
and meaning of[hat dara. Aher an individual has been shown�he private dara and informed of irs meaaing, the data need not be d"uclosed ro him for
six monchs theteafter unless a dispute or acaon pursuanc co [his secdon is pending or addidonal dara on the individua!has been collecced or created.
The responsible au[horiry shall provide copies of the privace or public data uFon requesc by the individual subject of[he daca. The responsible authoriry
may tequire che requesang person to pay the actual coscs o[making,cerrifying,and compiling che copies.
'Ihe responsible authoriry shall comply immedia[aly, if possible,wieh aay request made pursuanc to this subdivision,or wi[hin five days of
the darr of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
wichin chac ame,he shail so inform the individual,and may have an addidonal five days within wtuch to comply wich the request,excluding Sacurdays,
Sundays and legal holidays.
Subd.4. Ptocedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or privace
dan concerning himself. To exercise this right,an individual shall noafy in wridng�he responsible authoRry dascribing the nature of the disagreement.
The responsible auchoriry shall within 30 days eid:er: (a)correct the data found to be inaccurdte or incomplece and aaempc to nodfy past recipien[s of
inaccurate or incomplete data,including recipiencs named by tbe individual: or(b)nodfy the individua!thac he believes che dara to be correc� Data
in dispuce shall be disclosed only if the individual's stacemtnc of disagreemenc is includad with[he disclosed data.
'Ihe decerminaaon of the responsiblz auchoriry may be appealed pursuanc to the provisions of chz administrarive procedure act relating to
contesced 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 tha[your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You aze notified that:
1. The information you furnish will be used to detemune your qualification for the permit or license requested.
2. You may refuse to suppty data, but refusal may require that the City deny the permit or license.
3. The information may be shared wich ocher loeal, state or federal a;eneies to the ezcent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
S. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this applicatio❑ or permi[.
First �tiddle Last
Addcess .
Ciry State Zip Phone
I undecstand my ri;hts �s stated above.
Signature