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Home My WebLink About1997-009806 - tearoff/reroof PERMIT - � "�ITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 = Crystal Bay, Minnesota 55323 Permit Number: _ �± � (612) 473-7357 Date Issued: SITE ADDRESS: .:,- , , ., _ . .. ��.F � �..; � DESCRIPTION: Y.: . _. . ._ ^.:.-_.i�,j_ f� � i� .. . „_ _, . _ � . , _: ., .:�E�l. _ _. � ..___ I�•;t:l. _; t':__Yi�_t i�;�s„'�'t'4:; '�;r:+t"; s:..,�._..;tzs��i,t- — — -� •E .�:t.:sW' i;-. '� � .. �11`'�}�';'a ._ ._:f,i1=� G�.;i.!s f--�,.. � . . ._._�L�.::._':'� �i"9v... REMARKS: FEE SUMMARY: =�.:��;- _. _ . . -_ ��;�_�,�;�,;��;.'�'��: .....__..._____ - `r�.� � '"�_vi:._._ t='�::�:_ ~{`. _ . �L CONTRACTOR: - - . . _ . OWNER: : , ,. _ ._. . _ _ _ _ —i . . . . . :��s.' �- _ ' �' . . , , . . . . . . ��-� -... _� . s.,x� :� '�'� � . �.�, .. . ;:- ��y �, .... .� . .. .. ,.. , ._ .. �.. .. . . � � . . _ _, .. ,�. _ .: .�.i ;. . � . k. =-? a f „ _ „ . � . :, . . _� , ,,. . . <,��r_. . � . : . � .,, _ . ,-, �� ., . _ .. . � .. � 'S y:= .� .r , . . �. � . . ,.. �...,d,.i . . �� - . .. _ . .__ �...._ . e.. .. ..__. .�.^ .. � �� ..e. / APPUCANT;PERMITEE SIGNATURE ISSUED BY:SIGNATURE i Total Fee: $ Date Received: Entered By: ,�,! . Permit#: �j�;C; r CITY OF ORONO - BUILDING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) • ---------------------------------------------------------------------------------------------------------------------- ____ THE APPLICANT IS: (circle one) OWNER O CONTRACTOR� JOB SITE ADDRESS: ��'�� 1 f� �j� �� ZIP: ��' S %I NAME OF OWNER• ��;►�� ts�S PHONE: (home) T�-��/� /� (work) MAILING ADDRESS: �c��S ��1�� !'� � CITY: C>�L ZIP: :s � �I � � CONTRACTOR: ��LSI�'-- PHONE:�y� - � �z 5 CONTACT PERSON: 7 v,� I2; �i` M�B�E/PAGER: MAILING ADDRESS: ,s�/S /l.>" �-�Y l c c CITY: it.{,�'� S ZIP: 5-5- �.� STATE LICENSE: # ��z�7 ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME; REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration 5� Land Alteration PROPOSED WORK(describe in detai�: �C�✓ ' lr � �e,'L� -��-b-�- �nl STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ^'� p u ESTIMATED 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 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: ��''� `%� �. DATE: ��-/S-�y_7 NOTE! Parade Qf 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. Sec.13.04 RIGHTS OF SLJBJECTS OF D�T�1 Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set fonh in this secaon. Subd.2. Information reqirired to be given individual. �t individual asked to supply private or confidendal data concerning himself shall be informed of: (a) the purpose and intended use of the requested dara within the collecting'state agency,political subdivisio�,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply • private or confidendal data;and(d)the idenriry of other perso�s or enaries authorized by state or federal law to receive the data. This requirement shall not appiy when an individual is asked to supply invesueaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or proaertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject of stored private or pubtic data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the conten[ and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,tbe data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this section is pending or addidonal data on[he individual has been collected or created. The responsiblz authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of makin¢, certifying, and compiling the copies. The responsib(e authoriry shall comply immediately, if possib(e, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sarurdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request within that ticne,he shall so inform the individual,and may have an addirional five days within which to comply with the request,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 right,an individual shall noafy in wridng the responsible authoriry dzscribing the nature of the disagreement. The responsible authoriry shall wi[hin 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correce. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. The determinacion of the responsible authoriry may be appealed pursuant to the provisions of the adminiscrative procedure act relating to contested 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 permit or license from the City of Orono or any of its departments may require you to fumish 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 permit or license. 3. The information may be shared with other local, state or federal agencies to the extent 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 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. �E�J-fs�/'i /��P-TI��S � /l �L S/�� l.-e�11.5�� 1�� - irst yiiddle Last ��/� �� /D v Addres�s�� 1 " �� --�� Z�— Ciry State Zip Phone I understand my rig as stated above ��'G � Signature A. REOUESTER COMPIETE flt�ms 1-3) HENNEPtN COUNTY _ZZ_ � �1 OATEOFRECUEST INFORMATION DISCLOSURE RE�UEST 3u�nC �5� ��ti' Minnesota Government Data Practices Aci 2. aEGUESTE NAM �wc rs�•M.� RECUEETE*MOTE: �AGK �• �l�('�� A. Requnt fnqu�nry—Pnwte Dan on indiv�tluals.Ah�r you naw be�n y m�tlau and inform�d of ia m�amnq.tM data nHa not D�Oiu�os�a to y� AODFESS�rl n«ow� � ��s iifOflth�thft��ftN Y�It3i�O��A��O►iRiO�ii pMtl�nq Ot�CCtdOnil O�t� ZG�Q g �amq�uc� 1 r _ anf,lo�z. «,,��o..,,�o�,.��a. � _ -_ s. MONE r��nMo�c� -y B. You may b�rpu�r�C to pay t��acfual cosb Of m�kinp,C�rti}y�nq andor l�I�tu�� /�'Irnn�� J-�J" 71�� !l�L� � f L� 7C•J� eomo��np m�CaO�es of informaUon r�0uest�C. a pESCR�PT�ON OF TME iNfORW.7ION NEOUES�ED If�+��c-c� � n� �� ,�1�a� o�l c.�.��. � ,,� � - �3� �'��co �C� G�T`�--� �e�r,-.{� /<7 v�"� u ��l7 h�t�� S. NEO STE��'+++�TUR „ _ x .. _. _ .-–'--- _ . 8. DEPARTMENT/O1VIS10N COMPLETE 7. fiE0uE5t ruHOLE r � •. DET�QTwENTiDiviSiON N�wE � + r'i�� ''� �` f. REouESTED sr: {, REOUEST TYP£ � ❑ In-p�rson ❑ Mait ❑Phon� ❑SuDj.ot eM oaea ❑ hlot m�suoi.ot tn•ana 10. TME iNFORwA710N REOUESTED IS GV.SSiFiED: 17. REOUEST - ❑PUBUG ` ❑ NON-?UBUC ,�AD��b ❑D�n��d ��D��n D�n t�:01am m 13) � pRIVA7E ❑ PRGTECTED NON-AUBLtC t2�u�.+OAi S�GNwTUpE ❑ CDNFIDENTIAL x �� '� ,��'� 11 RfIJARKS/CAYMENTS fll nO�inO O�I N Gu�d»O i0 u ro O�nr�Ccrs ro�M r�Owttp Gn�utnOnfl'o�nat A40 MI�I Nr OtM��Y�i.COTrMnA IOG��W��NI. y(�Z..� ��.J�rt`-J`�(�-rC c�i��`� C. DEPARTMENT/DIVISiON COMPl.ETE WHEN FEES ARE ASSESSED (A rscsipisd caAY o1 thrs lorm is to bs provided ro tM rsqussrer eic tim�mon�y is r�csive0). ��' �FEES:FLAT RATE � �� ❑FE£S:SPECIAL RATE(Compi�t��4�tucn torn+MC 1310 r'�1M O[AK x tAan tM fi.A7 RATF or STANOARD Fff SCNEDULE ia us�O•1 INO.OF P�GESI ♦Sw�Gnrn.Wnuv fa FLAT 11ATE Nno�nc I htv�ncnvW from tn�acw�namW.tM amount ina�qtW oPP��t� my��pnatur��n paym�nt for providmp tM mtormauon nquested. 7oDwrs D�TE t6. � RECEIVED 9Y TOTAL ANOUNT DUE S � TOCwrS OwTE 17A. AMOUNT TO OE�EP�IO � iiECE1VED SY � - � rso�o��rr.raN d o.w ts0.00/ S � TODwr'S OwTE i78. �W'�CE DUE � PIECfIVED S� 1 �uoo�con�a«�on a eoor�o� S D. RECUESTER PLEASE NOTE ITEMS CHECXED " " '1. p Make check�money order payable to: 2. 0 If mailed. retum entiro form and any fees to: • MC 1506IZ-8 REQUESTEA COPY/RECElP7 •