HomeMy WebLinkAbout1999-011459 - tearoff/reroof PERMIT
�,,IT`: OF ORONO PERMIT TYPE: - -_ .
2750 Kelley Parkway- P.O. Box 66 _`:` '_``�;"
Crystal Bay, Minnesota 55323 Permit Number: _ _ s i
(612) 473-7357 Date Issued: _ _ _ _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT�PERMITEESIGNATURE ISSUEDBY:SIGNATURE �
A
T�ital Fee: $ Date Received:
Entered By: _T Permit#: // 'S/S�
CITY OF ORONO - BZTII..DING PERMIT APPLICATION
All information must be submitted in full before plan revie�v will be started.
(please print all informatiQn) _
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� _ _ _ .
______----- ----- --_ __ - --- ----------------------
THE APPLICAI\'T IS• (circle one) OtiVNER �CONTRACTOR �
--_____-------._—__,�
JOB SIT'E ADDRESS: �� ��S Cs� �o��cL.-� ZIP:
NAI�IE OF Oti�'ER: �1 �t�t-Cs ✓n PHONE: (home) �'� �^� 3�
—�-� (work)
NiAII..P�G ADDF'.ESS: �-�� �CD �`��I1'Y: �,��(t C7 ZIP: '
CONTRACTOR: �QC� PHONE: �{ ( —C�.� cr
COiv'TACT PERSON: ,e.� ` C_._l�' ILE/PAGER: .-2-S �
MA1LI\i'G ADDRESS: 8 1� CITY: ZIP: � �
STATE LICEI�'SE: #�-C�` ���5��,
ARCHITECT/E\'GItii'EER: PHO�'E:
1�IAILI�i TG ADDRESS: CITI': ZIP: _
NAIVIE: REGISTRATION#
TYPE OF tiVORK: New Addition Accessory Structure
Move Remodel/Alteration�---�nd Alteration
PROPOSED`VORK(describe in detain:�- ZZ�e (�od�� �°�r 1-' �
STORIES: SQ.FEET OF EACJ3 FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �
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EST�IAT'ED CONSTRUCTION VALUATION (excluding land): $ �J � 3�` �
I hereby apply for a building pernut 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 permit and work is not to start without a
permit; and tha� the work will be in accordance with the approved plan.
��?�--,�.�✓� � � _
A,PPLICA��TT'S SIGNATURE � D�TE' � �
NOTE! Parade of Homes events require separate permit approval by Police Deparfinent and
Cily Council 60 days prior to tke event. Non permitted events will not be allowed. �
' �
Sec.13.04 RIGHTS OF SUB,IECTS OF DATA '
Subd. 1. Type of da[a. The righcs of individuai on whom che data is srored or ro be snorod shall be as sec forth ia this secrion.
Subd.2. Information reqirired to be given indiridual. �1n individual asked W supply privare or confideaaal da�conccrning himself shaIl
be infora:ed a,`: (a)the purpose and intended use of the requuted daca wichia the colltcang State ageaty,paliacal subdivision,or sn[ewide rystm;
(b)whe4`e:he may refuse ar is_legally requir.d to supply the r.quesud daa;(c)any lasown caasequence arising frvm his supplying or refusing W supply
privace or conndeadal data;and(d)the ideadry af o�her per�ans or enodes authorized by sc�ce or federel law to receive t6e dara. 'lhis tequiremenc shall
noc apply when an ir:dividual is asked to supply invesdgadve daa,pursuanc ro secaan 13.83,subdivisian 5, co a!aw enfarcemeac officer.
'[he ce;�missioner of rcvenue mav ola:� the nodc- r�uird und-r this subdivision in the individual income taz or orovem taz refund
inscrucaons inscead oF on those forms.
Subd. 3. access to data by indiridual. Upon requesc to a responsible auchoriry,an individual shall be informed wha[her he is the subjecc
of stor.d daca an individuals,and whe�her ic is elauifi:d as public,priva�e ar confidendal. Upoa his fur�her r_quesc,aa individual who is ehe subjecc
of scored privace or public dara on individuals shall be shown�he daca wirhout any charge to him and;if he desues, shall be inforuied of the eone�nc
and meaning of chat dara. Aher an individual ha.s been shown the privace daa and informzd of iu meaaing,che daea ne:d not be disclosed to him for
six mondu ehereafter uriless a dispute or acaon pucsuanc to this secdon is pending oc addidonal,dara on the individua!has been collecc:d or creac:d.
The responsibia aud:oriry shall provide copies of the priva�:or public data upon tequest by the individual mbject of the dara. 'iht responsible auchoriry
may requir. the requesdng person to pay che acnial cos�s oi makinz,eerdfying,and compiling the copies.
The responsible authoriry shail comply immediatzty, if possible,wich any cequest made pursuanc co this subdivision,or within five days oF
the date of the requesc,excluding Satutdays,Sundays and legal hotidays,if immediate compliance is noc possible. If he cannot comply with the request
within th3t ame,he shall so inform the individual,and may have an addidonal five days wi[hin which to comply wich the raquest,excluding Saturdays,
Sundays and ltgal holidays.
Subd.4. Ptocedure when data is not accurate or complete. An individual may concest[he accuracy or completeness of public orprivate
data conceming himself. To ezercise chis righc,an individual shall nodfy in wriang chc responsible au�horiry describing the nature of the disagreemen�
'Ihe tesponsible authoriry shall within 30 days eict;er: (a)correct�hz data found co be inaccurdc:or incomplece and aaempc to nodfy past recipiencs of
inaccurate or incomple�e data, inciuding recipien�s named by the individual; or(b)noafy the individual thac he believes the data to be correct Data
in dispuce shall be disclosed only if the individual's statement of disagrecm:nt is included with th:disclosed data.
The decerminadon of the responsible auchoriry may be appealed pursuanc to the provisions of che adminis�arive procedure act reladng to
contesud cases. �
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�h�s of subjects of data", we would like to inform you tha[your request
for a pernut or license from the Ciry 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[o 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 licease.
3. The information may be shared wich o�her local, state or federal a;encies to the eztent necessary to process
the permit or license.
4. If your requested pecmit or licease requires Council action to approve, some information may become
public.
5. 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 application or perm.it.
First �fiddle Last
Address
Ciry Sate Zip Phoae
I understand my ri�hts as stated above.
Signscure