HomeMy WebLinkAbout1997-009479 - tear-off/re-roof � PERMIT
�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 '�..�..°� :�����;
Crystal Bay, Minnesota 55323 Permit Number. ;;_..�;:'�-�: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%PERMIT SIGNATURE ISSUED BY:SIGNATURE
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' Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII,DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTOR �
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JOB SITE ADDRESS: <<i'��i ��-5��' �� ' ZIP: ��g/
NAME OF OtiVNER:_ �+h1 (����- I� PIiONE: (home) � 7� ' �� 7 7
� (work)
MAILING ADDRESS: ��I�'"� �-5 r� /%� ;��CI'TY: C��^C) �--c}-- ZIP: S.��%�/
CONT'RACTOR: � I,�t a��er►- C�.; PHONE: �!'�� C''S' s�' '�
CONTACT PERSON: � f=� MOBILE/PAGER:
MAILING ADDRESS: � Ytt`/�-` �-� ar%`;,t� CITY: ;> %c�T(� ZIP: S�.�'�Y
STATE LICENSE: # �C�•��
ARCHITECT/ENGINEER: T PHONE:
MAII.ING A.DDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration Land Alteration
PROPOSED WORK(describe in detain: e�-e,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
EST .I�i IATED CONSTRUCTION VALUAT'ION(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 ' e approved plan.
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APPLICANT'S SIGNATURE: ,'�� ? �G " DATE: a / �'
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NOTE! Parade of Flomes even� require separate permit approval by Poliee 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 SLJB.TECTS OF DaTA
Subd. 1. Type of data. The righcs of individual on whom the daa is stored or to be stored shall be as set forrh in this secrion.
Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and intended use of the requesud data within the collecang state agency,poiiacal subdivision,or statewide system;
(b)whe[her he may refuse oY is legally requi�d to supply[he czquesud data;(c)any known coasequence arising from his supplying or refusiag to supply
private or confidendal data;and(d)rhe idenriry of other persoas or enrides authorized by state or federal!aw to receive the data. This requiremeat shall
noc apply when an individual is asi:ed to supply invesrigadve daca,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer.
llte commissioner of revenue mav olace the noace reouired under chis subdivision in the individual income taz or orooem taz refund
instrucdons ins�ead of on chose forms.
Subd.3. Access to data by individual. Upon request to a respoosible authoRry,an individual shall be informed whether he is the subject '
of scored data on individuals,and whether it is classified as public,priva�e or confidenaal. Upon his further request, an individual who is the subjecc
of storcd private or public data on individuals shall be shown the dard wi�houc aay charge to him and,'if he desires, shall be informed of the content
and meaning of that data. After an individual h�s been shown[he privace data aad informed of its meaning,the data need not be disclosed to him for
six monchs[hereafter unless a dispuce or acaon pursuant to this secdoa is pending or addiaoaal dara on the individual has been collect�d or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry
may require the requesdng Qerson to pay the accual cosu of making, certifying,and compiling the copies.
The responsible authoriry shall comply immediately, if possible,wich any request made pursuant to this subdivision,or wi�hin five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wirh the request
within that time,he shall so inform che individual,and may have an addiaooai five days wi[hin 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 orprivate
data concerning hirnself. To exercise this righc,an individual shall nodfy in wridng the responsible au[horiry describing the nature of the disagreemenc
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccucace or incomplete and aaempt to nodty past recipienu of
inaccurate or incomplete data, including recipiencs named by[he individual;or(b)aoafy the individua!thac he believes che dara to be correct Data
in dispuce shali be disclosed only if the individual's statemenc of disagreement is included wi[h[he disciosed data.
The determination of the responsible auchoriry may be appealed pursuant to the provisions of the admuvs�adve procedure act relaang 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 furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to de[ermine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the perm.it or license.
3. The information may be shared wich other local, state or federal a�encies 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 certai.n rights under M.S. 13.04 (available upon request) to review private da[a on yourself.
6. Your full name is required to process this application or permit.
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I understan rights as st�d ove.
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Signature