HomeMy WebLinkAbout1999-011494 - tearoff / reroof r
PERMIT
CIT� OF ORONO PERMIT TYPE: .
�2750 Kelley Parkway- P.O. Box 66 ``:���: �.��iv`:;
Crystal Bay, Minnesota 55323 Permit Number: :�;���;�;,��
(612) 473-7357 Date Issued: i;�,,�t_;;�,���;-,;
SITE ADDRESS:
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REMARKS:
FEE SUMMARY: [ (
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APPLIGANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE �`
Total Fee: $ �7� � Date Received:
Entered By: r('1! Perm.it#: //
CITY OF ORONO - BLTILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started. .
(please print all information)
THE APPLICA.NT IS: (circle one) O�NER ONTRACTOR
JOB SITE ADDRESS: o�`� 6 �7 �.RS�o ��- � ZIP: s-��� �
NAlbIE OF Oti�7ER: �e� �z ��'''� PHONE: (home)
(work)
IVIAII.ING ADDF.ESS: s�'� CTTY: ZIP:
. I�v, �: S n� ��'�� �=�-�s'� Pxo�-�_ ���--- ls~-�
CONTRACTOR. /
CONTACT PERSON: C� v� I�iOBILE/PAGER: 6� -3 t � '
MAILTtii'G ADDRESS: 5�i� S L�w rva�o p IT'Y: �� ZIP:
STATE LICE�'SE: # 5 3��
A.RCHITECT/ENGItii'EER: PHO�'E:
i1�IA.ILTi�'G ADDRESS: CIT'Y: ZIP:
NAME: REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED'��ORK(describe in detain:
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: . GAR.AGE STALLS: ATT. DET.
ESTI�i IATED CONSTRUCTION VALUATION (excludin.g land): $ 7�, �iD'7>• �
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 wi[h the ordinances and codes of the City and with
the State Buildin� Code; that I understand this is not a pernut and work is not to start without a
permit; and tha� the work will be in accordance with the approved plan.
APPLICA��TT'S SIGNAZ'URE:�J`�'� D�TE: � �7
NOTE! Parade o Homes events require separate permit approval by Police Department and
City Council 60 days prior to tke event. Non permitted events will not be allowed. �
. '
Sec.13.04 RIGFiTS OF SUBJECTS OF DaTA '
Sutd. 1. Type of data, 'Ihe rights of individual on whom[he data is sroced or to be s�ored shalI be as sec forch ia this secaon.
Subd.2. Iatormation reqirired to be given indiridual. An individual askcd to supply privam or confidendal dara concerniag himself shaIl
be informed o;: (a)[he purpose aad iatcnded use oE the requesced dara wi[hia the collecdng�tate ageaty,polidcai subdivision,or smccwide rysum;
(b)whetfier he taay refuse or is_legally requir_d co supply[he r:quesud data:(cj any icnown coasequeace arisiag from his supplying or tefusing to supply
privsce or conitdendal dara;and(d)the idendry af ocher pecsoas or eaddes au[horized by sc�te ar federal law to rec:ive che data. This requiremenc shall
noc apply w;en an ir.dividual is asked to supply invesagadve daa,pur�anc ro secaon 13.82,subdivision 5, co a Iaw enfoccement officer.
"I�e eenmissioner of revenue mav olace che nodce r�uir_d under this subdivision in [he individual income tax or orovem taz refund
instrucaons inscead of on[hose forms.
Subd. 3. Access to data by iadividual. Upon requcsc to a responsible au[hority,an individual shall be informed whether he is the subjeu
of stor:d daa on individuals,and whecher it is classifi:d as public, privace or conFdenaal. Upon his fucther request,aa iadividual who is the subje:c
of stor.d private ar public dam on individuals shall be shovm the dara wichouc any charge to him and;if h�des'ues, shall be infomied of the concanc
and meaning of chat dara. After an individual has been shown[he private daci and informcd of ics meaaiag,the dara ne�d not be d'uclosed to him for
siz monrhs theroafter uriless a dispute oc acaon Pursuane to this secaon is pending oc addidoaal daca on the individual has been collecc�d or creaced.
'Ihe rtsporuibie authoriry shall p�ovide copias of che privat.:or public data upon request by the individual subject of the data. The responsible autfioriry
may cequir the tequesdng person to pay the accual cosu o[makin¢, cetvfying,and compi�ing the copies.
'Ihe responsible auchoriry shall comply immcdiattty, if possible, wieh any request made pursuanc to this subdivision,ar wichin five days of
the dace of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request
wi�hin that ome,ht shall so inform the individual,and may have an addidonal five days within which to compiy with the request,ezcluding Saturdays,
Sundays and Icgal holidays.
Subd.4. Pracedure when data is not accurate or eomplete. An individual may contest the accuracy or compteteness of public or pri�•ate
dara conceming himself. To ezercise this right,an individuai shall noafy in wridng ehe respo�sible auchoriry describing the naatre of the disagrtemea�
The responsible authoriry shall within 30 days eitt:er: (a)correct[he data found co be inaccurat�or incompiete and aaemp[to nodfy past recipien�c of
inaccurate or incomple[e data, including recipienes named by the individuat; or(b)nodfy[he individual that he believes the data to be correcc. Data
in dispuce shall be dis:losed only if the individ�al's sta�emene of disagrcement is includtd wirh[he disclosed data.
The de�erminadon of the responsible auchoriry may be appzaled pursuant to the provisions of tha adminis�arive procedure act telaang to
contesud cases. •
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hcs 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 decermine your qualification for the permit or license requested.
2. You may refuse to suppty data, but refusal may require that the City deny the permit or license.
3. The information may be shared wich other local, state or federal agencies to the e�tent necessary io process
the permit or license.
4. If your requested permit or license requires Council action to approve, some informa[ion may become
public.
5. You have certain ri�hts under M.S. 13.04 (availabie upon request) to review private data on yourself.
6. Your full name is required [o process this application or permic.
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Firsc �fiddle Last
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Addreu
Yl�a v�N � YYv�r� �5.3 � t� �
Ciry Sate Zip Phone
I understand my � hts as sta ed above.
� .
Sign�are
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED 7 9 •�
PERMIT NO.�/5�`�1'SG COMP TED G� k
,
ADDRESS_ �fG� �� � �-c��
OWNER CONTR. n�m,,�
TELEPHONE NO. �7� � Cr_+�S 3�
� DESCRIPTION �/�C��rs�
� 01 FOOTING 11 CHANICAL RI 18 EXCAV/GRADING/FILLING
Q RfS1�IT1Q� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y ION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAI 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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d �ORK SATISFACTORY:PROCEED C PROJECT COMPLETE
� ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. n pHOTOTAKEN
�NSPECTOR WILL RETURN `-
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTIONREQU�RED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contractor o
Inspector.
White Copyllnspector's File Canary Copy/Site Notice