HomeMy WebLinkAbout1997-009312 - tearoff/reroof�r PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number. - �- -�-
Crystal Bay, Minnesota 55323 -
(612)473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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APPUCANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE -��C�
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Total Fee: $ ��,. � = Date Received:
Entered By: � �; Permit#: -� % i,�
CITY OF ORONO - BUII,DING 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�OR CONTRACTOR�
JOB SITE ADDRESS: ( � �� n��rvc=:>�„r�. ,y .S/ ZIP: S.f � �, l
NAME OF OWNER• ��b m tt S �C� r�+ � PHONE: (home)
(work)
MAII.,ING ADDRESS: ( `� �-� ���-,a-� CITY: t�7� y�_ZIP:
CONTRACTOR: � � �� � 1'l r � �'--i �-�li i�'�i PHONE: ��� -6 5 -� C�
CONTACT PERSON: � �� � MOBILE/PAGER:_�� ��7 - 3 � r �
MAILING ADDRESS: �'� `� s- �Y,�.ti, ,,,-, CITY:jl�c��v D ZIP: �
STATE LICENSE: # 5����
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteratiotf�_ Land Alteration
PROPOSED WORK(describe in detai�: ��-,� �� V�� � �
VL�, s r+, � c--e
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $_ ��Z `_' �'
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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 nce w" the approved plan.
APPLICANT'S SIGNATURE: v�i. DATE: � — � Z���
NOTE! Parade of Homes events require separate permit approval by Police Deparlment 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 SLJBJECTS OF D�TA
Subd. 1. Type of data. 'Ihe righa of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqtrired to be givea individual. An individual azked to supply private or confidenrial data concerning himself shall
be informed of: (a) the purpose and inunded use of the requested dara wichin the collecang'statE agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is tegally required to supply che requested data;(c)any l�own coasequence arising from his supplying or refusing to supply
private or confidential data;and(d)the idenriry of other penons or enddes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the notice rewired under this subdivision in the individual income tax or propem tax refund
instrucrions inscead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of scored data on individuals,and whe[her it is classified as public,private or confidendal. Upoo his further request,an individual who is the subject
of stored private or public dara on individuals shall be shown the da[a without any charge to him and,�if he desires,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 thereafter unless a dispute or acdon pursuant to this secrion is pending or addidonal dara on the individual has been collected or created.
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 the requesting person to pay the actual cosu of making,cerrifying,and compiling the copies.
The responsible authoriry shall comply immediately, if possibte, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shail so inform the individual,and may have an addiriooal 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 pm�ate
data concerning himself. To exercise this right,an individual shall norify in wriang the responsible authoriry describing the nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incompiece and attempt to nodfy past recipienu of
inaccurate or incomplete data, inciuding recipien�s named by the individual; or(b)noafy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinadon of the responsible authority may be appealed punuant to the provisions of the adarinis�ative procedure act relaring to
contested cases.
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a pemut or license from the Ciry of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. 1fie information you furnish will be used to determine your qualification for the permit 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 a;encies to the eztent necessary to process
the permit or license.
4. If your requested permit or license requires Council ac[ion 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.
6. Your full name is required to process this application or permit.
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City Sta[e G�p rnuuc
I understand my ri;hts as state bove.
Signamre �