HomeMy WebLinkAbout1999-011491 - tearoff/reroof PERMIT
CITY OF ORONO PERMIT TYPE: �
2750 Kelley Parkway- P.O. Box 66 -�� ��' '-�'! �`v`���
Crystal Bay, Minnesota 55323 Permit Number: ;�.���t�.�,�
: (b12) 473-7357 Date Issued: _ _;_,� ��
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMNiARY':
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CONTRACTOR: �- �-�!=��=°�F ?�=�=�;�?�� - `=��E � '-�'� �OWNER•
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PLICANT-PERM1 E SIGNATURE � ISSUED BY:SIGNATURE
Total Fee: $ , �J Date Received: ��`1 ��/
Entered By: Perm.it#: ,//��/
CITY OF ORONO - BUII,DING PERMIT APPLICATION
All information must be submitted in full before plan review w�ill be started.
(please print all infornzation)
Z'FiE A.PPLICA�'T IS: (circle one) OtiVNER OR ONTRACTO
JOB SITE ADDRESS: � � � 7 ��6`�SC� l�'a�,1� ���� ZIP:
NA�iE OF Otii�'ER: �n✓� V ✓��' PHONE: (home)
(work)
NIAILING A.DDF'.ESS: ��c�►��- CIT'Y: ZIP:
CONTRA
CTOR: � ��� � 17 �yv�l� PHOi�tE: ( �� ^'I 3 Z�
CON'TACT PERSON: MOBILE/PAGER:
MAII�I�'G ADDRESS• ?3` �9 '�� CITY: `��c� y�d• _ZIP: _SS�3 6 �
STATE LICENSE: # ��c� 5° lo
ARCHITECT/EI�GIl�TEER: PHOti�:
1�7AILI�i'G ADDRESS: CITY: ZIP:
�TAME; REGISTRATION#
TYPE OF tiVORK: New Addition Accessory Structure
Move RemodellAlteration Land Alteration
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PROPOSED`�ORK(describe in detain:
STORIES: SQ.FEET OF EACH FI.00R:
NO. OF BEDROO�SS: GARA.GE STALLS: ATT. DET.
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ESTIi�IA.TED CONSTRUCTION VALUATIO�t (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 Build:n� Code; that I understand this is not a ernut and work is not to start without a
permit; and that the work will be in accordance ith e approved plan. _ r��
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APPLICA��'T'S SIGNATURE: /G' , D�-�:
NOTE! Parade of 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.
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Sec.13.Q4 RIGEiTS OF SUB,TECTS OF D?.T?. '
Sutd. 1. Type of data. The righcs oF iadividual an whom che dam is scoccd or ro be scnRd shalI be as sec forch ia this secaon.
Subd.2. Information reqirired to be given indiridual. An individual asYed w supply private or confidcndal dara conccrning himself shall
be infor¢:cd o`: (a)the purpose and intendcd use oE the requused dam wichin the colIecang Sate ageacy,potidcal subdivision,or scamwide rysmm;
(b)whec�e:he rtsay refuse or is.legally requir.d to supply the r.quesud data;(c)any iacown caas:qu:ace arisiag from his supplyiag or refusing to supply
privace or conndendaI data;and(d)che idendry of o�her peaons or enddes auchorized by sc�ce or federal law to receive che dara. This requiremen�shail
no�apply when an ir:dividual is asked to supply invesdgarive daa,pursuanc co secaon 13.82,subdivision 5, co a Iaw enfoccemenr officer.
'Lhe ee^tmissioner of revenue mav olac- the nodc- rauird und-r chis subdivision in the individua! income tax or o�ooem taz refund
instcuctions instead of on thosc forms.
Subd.3. access to data by iadiriduaI. Upon rcques�to a cesponsible authoriry,an individual shall be inforraed whtcher he is the subject I
of stor:d daci on individuals,and whe�her it is classified as public,private oc confidendal. Upon his further r.quest,aa individual who is[he subjeu i
of stored private o�public dam on individuals shall be shown che dara wichout any charge to him and;if ha desues, shaIl be informed of che conten�
and meaning of[hat data. Ahu an individual has been shown the priva[e daa and informed of ia meaaing,[he data neod not be d'uclosed ro him for �
siz months thereaher unless a dispute or acdon pursuanc to this secdon is ptnding or addidoaal daca on the individual hu beea collecc:d or crea[�d.
The responsible auchoriry shall provida copies of che priva[�or public daca upon request by che individual subjecc of the dara. Tha responsible auchoriry
may requir the cequesdng person to pay the actual costs oi makin2,cerafying,and compiling the copies.
The responsible au[horiry shaIl comply imrncdiatcly, if possible,wi�h any request made pursuanc to this subdivision,or wi�hin five days of
the date of the rtqutst,excluding Sanlydays,Sundays and legal holidays,if immediace compliaace is noc possible. If he cannot comply with the requesc I
wi[hin that dme,he shall so inform the individual,and may have an addidoaat five days wichin wluch to compiy wich the request,ezcluding Sacurdays,
Sundays and legal holidays. i
Subd.4. Procedure whea data is not accurate or complete. An individual may cone�st the accuracy or eompteteness of public or privacc
data conceming himsetf. To exercise this right,an individual shaIl nocEy in wriang�he rosponsble auchoriry describing the nature of the disagreemenc. �
The responsible authoriry shall within 30 days ei@:er. (a)correce[ha data found ro be inaccurac�or incomplete and anempt to nodfy past recipiencc of ;
inaccucate or incomplece data, including �ecipien�s named by [he individual; or(b)nodfy the individual tha�he believes che data to be correct Dan
in dispuce shall be disclosed only if the individual's statemene of disagreemenc is included wi�h the disclosed data. �
The determinaaon of the responsiblz auchoriry may be appealed pursuant to the provisions of thz adminis�arive proceduro act relaang to
contesud cases. .
DATA PRIVACY ADVISORY h
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request ii
for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or �',
confidential information. i'
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You are notified that: �I
1. The information you furnish will be used to deternv.ne your qualification for the permit or license requested. '
2. You may refuse to supply data, but refusal may require that the City deny the permit or licease. �,
3. The information may be shared wich ocher local, state or federal agencies to the ettent 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 ri�hts under M.S. 13.04 (availabie upon request) to review private data onyourself. I
6. Your full name is required [o process this application or pe
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First ' � f �fiddle Lasc I
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Address ���� � '
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Ciry Sate Zip Phane
I understand my ri;hts as stated above.
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