HomeMy WebLinkAbout1995-007389 - tearoff/reroof "�� PERMIT
(�TY 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:
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FEE SUMMARY:
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CONTRACT41�;_ . : . ,: . ���.-,::_ �: �, �_.. : . OWNER _ .
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE� �.
� Total Fee: S ,���,,'� -� ��� DateReceived:
f Date:�aproved:
Entered Bv: %�l
Pe:mit„`: l'=> �'':�
CITY OF ORO�O - BU7ZDING PERIVIIT APPLICATION
�I.L I�"F'ORtiI�TIO�T�ILST BE SL��iTTTED �i FL"LL BEFORE PL�v REVIEtiV`�"II.L
BE ST:�RTED ___
----------------- _�__------ -=----.--�---'��---------------------
THE �,PPLIC:��1'I' IS: (circ:e one) O�V�ER CONTR�CTOR �
JOB SITE �DDRESS: /?-� �= ��'�y «��Sc /,7/Z z�: 5 S 3% �
N�'�TE OF O�VYER: �� r�� Q�c w�N �-� �� � pxo`�: (home) y�� -y� �'�
(w�or�>
I�IAILL�iG�DDRESS: � ) (, Gr�v/ G�/tS �lU'�ITY: �/�C)1v�� ZIP: S� `�'/�
CONTR�CTOR: j��Ll� ����/(�� PHOiVE: ;'�'� ���0� �
� ��IOBLLE PHO.NE/PAGER:
�IAILING�DDRESS: �/00 �x C���o�'' /`1,/�ITY: S j C�v i S �KLIP: --5 S /�
ST:�TE LICENSE: �
:�.RCHI'I'ECT/ENG��ER: PHOi��E:
�IAILL\G�iDDRESS: CITY: Z�:
N�tiLE: REGISTR.-�TIO�t n
TYPE OF WORK: New Addition Accessory Structure
�1ove ��.��� �/A1 r ri�n Lan�Alteration
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PROPOSED�VORK(describe indetail): �a�t � -� r�;—,
STORIES: SQ. F�EET OF EACH FLOOR:
v0. OF BEDR001�LS: G�R�GE ST.�I.LS: ATT. DET.
ESTLI�IATEDCONSTRtiCTIOtiV�LU�TION(eYcludingland): � /, /� ��
I hereby apply for a building permit and I acknowledae that the information above is complece
and accurate; that the work will be in conformance with the ordinances and codes of the C;cy�
and with the State Buildin� 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.
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�PPLIC�ti�'T'S SIG�IAT'URE: - ..'��� DATE: � Z
NOTE.' ParjHomes events �equire separate permit approval by Police Department and
City Council 60 days prior to the event. Non-permuted events will not be allowed.
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Sec.13.04 RIGHTS OF SLB.TECTS OF D�T�
Subd. 1. Type of data. The nehts oi individual on whom che data is scored or[o be stored shall be as sec forth in this secdon.
Subd.�. Information required to be�ven indi�idual. �n individual asked to supply private or confidenaal daci conceming himself shall
be inYormed of: (a) the purpose and in[ended use of the requested da[a wi[hin the collecdng'state aeency, pollrical subdivision, or sta[ewide system;
(b)whether he ma}•refuse or is legally required to supply che c�quested data;(c)any Irnown consequence arising from his supplying or refusing to supply
priva�e or confidenaal data:and(d)the idendty of o�her persoos or enndes au[horized by state or federal law ro receive the data. This requirement shall
no[apply when an individual is asked to supply invesngadve data, pursuant to secnon 13.82, subdivisioa�, to a law enforcement ofitcer.
The com.missioner of reverue �nav olac� �� odce ��ouired under this �ubdivision in the individual income raz or propem tat reiund
instructions inscead ot on[hose forms.
Subd. 3. Access to data by indi��dual. [Ioon reques[to a responsible auehonry,an individuai shall be informed whether he is the subjecc
of stored data on individuals, and whether ic is classined as public, pnvace or contidennal. lipon his fur[her request, an individual who is the subjec[
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desites, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for
six months[herearrer unless a dispute or acdon pursuane[o this secdon is pending or addi[iooal data on[he individual has been collecced or crea[ed.
The responsible aucnoriry shall provide copies of the pn�ace or public data upon request by the individual subject oi the data. T'he responsible authoriry
may require [he reauesting pecson ro pay [he acrual cosu of making, certifyine, and compiling the copies.
The responsible authori[y shall comply imm�iacely, if possible, wi[h any requesc made pursuant to this subdivision, or wi[hin five days of
the date of the reques[,excluding Sa[urdays.Sundays and leeal holidays, if immediate compliance is no[possible. If he cannoc comply with the request
within that time,he shall so intorm[he individual,and may have an addidonal five days wi�hin which ro comply with the request,exciuding Sacurdays,
Sundays and (eeal holidays.
Subd. 4. Procedure when data is not accurate or complete. An individual may concest che accuracy or completeness of public or priva[e
data concerning himself. To exercise�his right,an individual shall notify in wricing the responsible au�horicy describing the na[ure of the disagreemen[.
The responsible auchority shail wichin 30 days ei[her: (a)correct the data found ro be inaccura[e or incomplete and attemot to nodfy past recipients of
inaccurate or incomplete data, inciudine recipients named by the individual; or(b) nodfy ehe individual tha�he believes the data to be correc[. Data
in dispu[e shall be disclosed only if the individual's stacemen[of disaereement is included wich the disclosed data.
Thz decermina[ion of[he responsible au[honcy may be appealed pursuan[ro [he provisions of the admuustradve procedure ac[ rela[ing to
contested cases.
DAT:� PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Righcs of subjects of data", we would like to inTorm you that your request
for a permit or license from che City of Orono or any of its departments may require you to fumish certain private or
� confidential intorma[ion.
`i ou are aotified tha[:
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 da[a, but refusal may require [hat the City deny the permit or license.
3. The informacion may be shared wi�h o�her local, state or federal asencies 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 cercain rights under �1.S. 13.04 (available uoon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
�/J��E. �' U�K-%� �C/C��C�t �
First ��d'�� Last
�,� c� c: ��(r` f=G S�u/� �/ U �� -
Address
�r'� �U i S �l� �C7,C/ 53��/� ;�L � �'��
Ciry Sta�e Z:p Phone
I unde d my rights as stated above.�_
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