HomeMy WebLinkAbout1996-008178 - tearoff/reroof �
•� �ERMIT
� CITY O� ORONO PERMIT TYPE:
� 2750 Kelley Parkway- P.O. Box 66 ��;_1'L_�.=;t•k�=
Crystal Bay, Minnesota 55323
Permit Number: ;:;i�;^;�?;�;
(612) 473-7357 Date Issued: f,y�r!�'��'��,
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: �— ��_���1 i����t. — =�T . L��= OWNER:
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APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE �1
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, � Total Fee: $ DateReceived: ;'/,��';>�.
DateApproved: �
Entered By: ,,�.i; , Permit#: ,�'i7?
CITY OF ORONO - BUILDING PERMIT APPLICATION
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL
BE STARTED
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
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JOB SITE ADDRESS: ,�' � %,;>�- ! - i`� `=� / ��� ZIP: - � - `-� �'
NAME OF OWNER: � ���y�� � -� <�� f� - , PHONE: (home)
(work)
MAILINGADDRESS. G`1::� - � �. ,1�-�; c�<; fi�i CITY•����%j1'✓ �'�i�'�-;=, ZIP• -��,�s' � i
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CONTRACTOR: �� , ��, � �/%,� , _ � , � � ;_�� —, _, �� ,_' <;, �-
PHONE• `
MOBILE PHONE/PAGER:
MAILINGADDRESS• --,i ��' - � , /�. ;., , � ,''�',�%�ITY: I ;' _ ' ZIP• �!; �
STATE LICENSE: # � - ' � �r
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration �� Land Alteration
PROPOSED WORK(describe indetail): I r����,�, �� -t a ( `� '-=; '� ', - r __'=
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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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 w rk will e in accqrda�ce with the approved plan.
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APPLICANT'S SIGNATURE: ` � �'�����` � � � � � DATE: � � � � ��
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.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting"state agency, political subdivision, or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to suppty investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the notice required 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 authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whether it is classified as public, private or confidential. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown the data without 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 him for
six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created.
The responsible 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 making, certifying, and compiling the copies.
The responsible authority 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 not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and lega(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 individuai shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data, inc(uding recipients named by the individuai; or(b)notify the individual that he believes the data to be correcL Data
in dispute shall be disclosed only if the individuaPs statement of disagreement is induded with the disclosed data.
The detercnination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRNACY 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 pernut 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.
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I understand my rights as stated above. ,
Signamre � �
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DATE TIME
CtTY OF ORONO CALLED IN '��`�./'r�
INSPECTION NQJIC,F� �; scHE�u�Eo i�'%-= ������� � ��
PERMIT N0. � coMP�ETE� _.�_ �
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ADDRESS =�� _t• ' �' f
OWNER � =�'� CONTR. -�`��%=- ��`�
TELEPHONE NO. ���.-�- �^J 3 i
� DESCRIPTION __ ' c_� r�;b''
� 07 FOOTINCi 11 MECHANICAL RI 18IXCAV/(iRADING/FIWNO
� p2___ MQ- 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 031NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= 05 FINAL 14 SEWER HOOK-UO O6 PROGRESS
F` 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMO—FINAI 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOFi TO MEET YOU:_YES_NO
� COMMENTS:
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d WORK SATISFACTORY:PROCEED � PROJECT COMPLETE
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� ❑ CORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONOITION WITHIN HOURS. r- pHOTO TAKEN
INSPECTOR WILL RETURN `
❑STOP ORDER POSTED.CALL INSPECTOR
�,CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call fo xt i s ction 24 hours in advance.473-7357
OwnerlContr c on site
Inspector. �
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