HomeMy WebLinkAbout1999-011946 - re-roof � = PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 _
Crystal Bay, Minnesota 55323 Permit Number: - ' '` -
(612) 249-4600 Date Issued: _
SITE ADDRESS:
__. _ _ :�, . . . _. ��.�; . �
�<<:,_
' _ . . . . _. . "� t µ __.' ::itz—�...'. . ,
DESCRIPTION:
�:1_,{7 i i�s}}:� ��='''��'s:�'� -,'r�� `-'•i.���'/��':;."I°����I��t��__
Y''C.�(� _' i:1 i"j'= ����i'�•: . . .- t-t;�,—•�':_,il_i!- -
_=1l'•:s#�� _.iw'-��`?_' 4_<<'r f-:�_ i . �:?_'�+iL��'kR i �i�-i�._
REMARKS:
FEE SUMMARY:
_ _ S:u _
_. .=?� _ '_
_ r.." ----._.._..___ .- -
CONTRACTOR: OWNER: - - _ _ - . -
_ ._. . . �.._,,�;�
_ ��_�- �:;;',�,�;:r� �',._
-�; .._ :_,� _:_.- _ _ _
_ , . , _ � >
t i—f .1:'.� _f i•`_• x!.'I�`��._t � ��":�' .._. : �u".� ... .. . ..� __. . _ - — _ _F'�` '•W� �°�si� :"�.
�i.= . —. .r �_
• - -� � _ . .i_ . . ... . ...... ..._ ,.,. r .... , ,_. ..._. . . _.
.- .__.. ;._'__.._. . .
. _, . . ; y . .. _ "
. .�.
.—�`�`� ..y r . � i i F {`,;+7 �- .�: . `_ �}:; = i r".� s..
_ . _. _ . _ _.._. . ._. .__ ..�._._. . .. .. �,__ .�:...'__ _�. :., i .. `_ . . .._ _ ,
, �, .
, _ : • t . ��;�:
. . _ . � . :, . . . .. v 1,r - • ,� i. . .
;,,,t'-i4�t;'���� '•_!ti{~',��'•si-i����_ __ .�+� i_� _. - � . . t� -; - �� 2 , _ .
,y�� �.. ,
, < < . ; € .._ _ �.
_ � .. ,
_ ..1 _ .. . . . . _ , � . ,;_
.. . _�... _ . .. ....... �, _, ,,_ . _ ;; .": . �
�
.� � i
/� � /� .�
APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ •� Date Received: `d � r
Entered By: � Pernut#: (�q.�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
---------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: -v� 3 �':� ��/��'U"/ �'-�v ��-fj�- � ZIP: >5�-�1`
NAME OF OWNER: � �'� � �L v G�PHONE: (home) �'`7�- �� �T�
(work) �------___..�_.
,�.3� ,� , !�✓ �r.v ���<<'CITY: W/�.�'"ZATi� ZIP: �s �
MAILING ADDRESS: �y `3'�
CONTRACTOR: �� �-��--f= PHONE: �7/— �� ��
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: �'� �;'�= CITY: Z�:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z��
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration - Land Alteration
PROPOSED WORK(describe in detai�� ��. �%� f'.9/T�� �—t'->`'L'9�-�'`� � `'��'�
�}� �j ,� /1J c',�- S j d-c,.i N�
:,
`� SQ.FEET OF EACH FLOOR:
STORIES: �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ c�.'��='�'�
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.
� � DATE: ,,�:�I'` t_.< %�
APPLICANT'S SIGNATURE: , ��ti ,���L�-�
NOTE! Parade of H� 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 S[IBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or co be stored shall be as set forth in this secaon.
Subd.2. Informadon reqirired to be given individual. An individual asked to supply private or confidenrial dara concerning himself shall
be informed of: (a)the puipose and in[ended use of the requested data within the collecting"state agency, political subdivision,or sratewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply
privace or confidenaal data;and(d)the idennry of other persons or enaties authorized by state or federal!aw to receive the data. This requirement shall
not apply when an individual is asked to supply invesdeadve dara, purntant ro section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav ptace the noace reauired under this subdivision in the individual income tax or propem tax refund
instructions instead of on[hose forms.
Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, privace or confidenrial. Upon his funher cequest, an individual who is the subjecc
of stored private or public data on individuals shall be shown the dara wi[hout any charge to hirn and, if he desires, shall be infotmed 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 monrhs thereafter unless a dispute or acaon pursuan�to this seccion is pending or addidonal data on the individual has been collected or creaced.
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[he requesring person to pay the actual costs of making, certifying, and compiling the copies.
The responsible au[horiry 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 addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data�s not accurate or complete. An individuat may contest the accuracy or comple�eness of public or private
data concerning himself. To exercise this ri¢ht,an individual shall nodfy in wridng the responsible au[hority describing the nature of[he disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccunte or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the dan to be correct. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
The detertninadon of the responsible authoriry may be appealed pursuant[o the provisions of the adaunistiadve procedure act reladng to
contested cases.
DATA PRIVACY 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 deternune 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.
(. Your full name is required to process this application or permit.
First �tiddle Last
• Address
Ciry State Zip Phone
I understand my rights as stated above.
1, i
� , .� , "
Signature