HomeMy WebLinkAbout1997-009554 - 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:
DESCRIPTION:
_. .. . . :.�. �.__- . .:��.:.-
.,``.: :..; �t.F.„:.; 'i":,.';; :.-�'' ';'f y 7'i CV�y� - .._tj�. �'t��{'"��_'..L .
. ..».... ,,.. .... . .,. _ I .._ _RI� . _. i i.�°..... ... _r?.... ._
=,.,,�= ;.��j ��s�: ;�;:��;��.: T;, .. �.i:.�_.F°;�;,=�c'
i_:r?ti�a!r!µ ;_:s��;'�. . .- . �-?�_. ` . ii```.��Is�'•.'tv l�i-��='.._
�I
REMARKS:
FEE SUMMARY:
i.`�.._.._ i=_-__ $�;''�-+ . . _
_. _.. _�E i,�i,j'��.iF: �'1 '..
. .ij_._-i : T'r?F? �.r...���........_._'• rY'`...� ` �I .
CONTRACTOR: � -� -r W` OWNER:
_,; � ;.;-,�: :. _
.�: .._. : : �,._. . � =:.; _.3_ _ ._ . _ .... �
_ . = . . .._, . _ .. ={ � iai �:�.1
,"? �,. �.. � � � �: � r. �. f' e.i k"' '� � `' t -"- ' . � � .
. _
,., � � ;.� �•'- -
a. ,�r , . —, �i° s }
,
�
�_ _ ._._ . . t.. _ . . ._ .. .. -
!��� :: _``'� ;; i a ' �`-' . ,. . . .._..._ .}€.. .. . .. ._ _. _ . . ..f 4_._ t
-r_. . _, �_ ...
_. . � ... � . .._ ..__._ ' S ., . ._ t". i..
}.�, � . •� a ;� `: �� �— t� -� t �
'.. •;' r
��« � �, a �
R,
,
. , . . .. , , . ; < . :
� ._ _ . _.... . .. _ . . .. . ...,. _ ". ._. .`.. . _., , � . �
/_ �
AP ICAN /PERMiTEE SIGNATURE ISSUED BY:SIGNATU
�
� � '
Total Fee: $ Date Received:
Entered By: Pernut#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
' ----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ���C� C � � � U T � ��� ZIP:
,
NAME OF OWNER: �� �,,{ �����r{� PHONE: (home) ` , 1�
(work)
MAILING ADDRESS: ������ �c�_S�-c��1 �� CITY: ZIP•
c� c
CONTRACTOR �- �`� c;C�; •� c PHONE: ��\" I�� �.
CONTACT PERSON: C:,� �,� � ,�_ t<� MOBILE/PAGER:
MAILING ADDRESS: ��a1-� G � L.�, . CITY:e' � . ��\ ZIP: C.��`�
STATE LICENSE: # ���,>� ?�l{ �
ARCHITECT/ENGINEER: PHONE:
MAILTivG ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteratio Land Alteration
PROPOSED WORK(describe in detai�:���„S c���, � � � c�� ��-�
�..��\ �4^ ��c�� � .� e � O.c.Z �.�c,,a i S �.���..�G�-P�
� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTliVIATED CONSTRUCTION VALUATION (excluding land): $ a�L '""
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 with the approved plan.
APPLICANT'S SIGNATURE: �-o,� DAT`E: ��, , `�2 �`-��
.,
,
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 RIGHTS OF S[JB.TECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom the data is s[ored or to be scored shall be as set forth in this secrion.
Subd.2. Information req�rired to be given individual. An individual asked ro supply private or confidendal data concerning himseif shall
be informed of: (a)the purpose and intended use of the requested dara wirhin the collecang'state agency, potidcal subdivisioo,or sratewide system;
(b)whe[her he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply
� privace or confidenrial data;and(d)the idenaty of other persons or enaaes au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieauve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. .
The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals, and wherher it is classified as public, privace or confidendal. Upon his further request, an individual who is the subject
of stored private or public data on individuais shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for
six months thereafter unless a dispute or acdon pursuant to this secaon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shalt provide copies of the private or pubiic data upon requesc by the individual subjec[of the data. The responsible authoriry
may require the requesting person to pay the acrual cosu of makine, certifying,and compiling the copies.
The responsible authoriry shall 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 legal holidays,if immediate compliance is noc possible. ff he cannot comply with the request
within that time,he shall so inform the individual,and may have an addi[ional five days within which to comply with Ihe reque�t,exciuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this rieht,an individual shall norify in writing che responsible authoriry describing the nature of the disagreement.
The responsib(e authority shall within 30 days eicher: (a)correct the data found to be inaccurate or incomple[e and attempt to nodfy past recipients of
inaccurate or incomplete data, inciuding recipients named by che individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disc(osed data.
The determinarion of the responsible authoriry may be appealed pursuan[to the provisions of the administcarive procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that 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 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 City deny the pemut or license.
3. The information may be shared with other local, state or federal agencies to the excent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j, 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.
�C , ` ` ��
First � Middle Last
. v a��
Address �Gr.�\� � ' \�J �� ��� �/ �•� ��c` '
�� �
�,t�
�� �race �,� o�
Ciry T— .,...,
I understand my rig s as stated above.
� "� ��" -
Signature