HomeMy WebLinkAbout1997-008967 - re-roof PERMIT
,, �ITY OF ORONO PERMIT TYPE: ; - ;:- :
�2750 Kelley Parkway- P.O. Box 66 �`��` '' �'`'
Permit Number: �.'�.�%�����'�'
Crystal Bay, Minnesota 55323 - - -�—
(612) 473-7357 Date Issued: =�::�i:s-:=�:3::
,TE ADDRESS:
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APPLICANTlPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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" � Total Fee: $ Date Received:
Entered By: Pernut#: �" /
CITY OF ORONO - BUILDING PERNIIT 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 ONTRACTOR\
JOB SITE ADDRESS: ��G� � �S � I �� - Z��
NAME OF OWNER n K n �r�c�.�,� PHONE: (home)
/ h � (work)
MAILING ADDRESS: %��� /Jo��ts ��`, I�'.CITY: �� Z�:
CONTRACTOR: i-��-L-S77ff�-- PHONE: ^��j 3 ��3zS�
CONTACT PERSON: �d ,.l ,�-�_K.-- MOBILE/PAGER:
MAILING ADDRESS: ��t� ;V }-h�r�{ I o v CITY: /��LS ZIP: �� z Z_
STATE LICENSE: # �L�t 7
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP'
NAME: REGISTRATION#
TYPE OF WORK: New Addition � Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detai�: �r /'' 2 ��� � 1�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ (,'��J L ^
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 accor �ce with t e proved plan.
APPLICANT'S SIGNATURE: % � � DATE: ������_
NOTE! p�rade 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 RIGH'TS OF SUB.TECTS OF DATA
Subd. I. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and in[ended use of the requested data wi�hin the collecting"state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse oY is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or refusing to supply
privace or confidential data;and(d)the identiry of o[her persons or endries authorized by state or federal law to receive the data. This requiremenc shall
not apply when an individual is asked to supply invesrieadve dara,pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav ptace the noace reauired under this subdivision in the individuai 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 thereafrer unless a dispute or acrion pursuant to �his secrion is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public dara upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual cosu 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 reques[
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 is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall notify in wridng the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreemen[is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relating to
contested cases.
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Riahts 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 pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut 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.
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Signature
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOT � SCHEDULED '� '
PERMIT NO. COMPLETED
ADDRESS - •
OWNER , CONTR.
TELEPHONE NO.
� DESCRIPTION , � "L � � �
� 01 FOOTING 11 MECHANICAL I 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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� 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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d ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE
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� [7 CORRECT WORK&PROCEED
W C ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the ne i 'on 24 hours in adva e.473-7357
Owner/Cont r o sit :
Inspecto
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