HomeMy WebLinkAbout1995-007263 re-roof PE�NAIT `
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:
FEE SUMMARY:
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APPLICANTiP RMITEE SIGNATURE ISSUED BY:SIGNATURE �
� � • CITY OF ORONO - BU'�LDZNG PERMIT APPLICATION
Total Fee: $ �� �. `5 _ Date Received:
Date P.pproved:
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Entered By: � .�--�' Permit tt: ������ -��
AI�L INFORMAT30N M�ST BE SIIBMITTED IN FIIL.L BEFORE PLAN REVIEW WILL Bg STARTED
( See Check-off List Enclosed)
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THE A.PPLICANT IS: (circle one) OWNE� or CONTRACTOR
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N� OF OWNER: �%-�C�c�'-ll� L`�- �.�l��c �-�- PHONE: (home) Y7��"-�d�
MATLING ADDRESS:1 �I .��f�;(„�< f-� CLcc6 ��c� CITY: �0 1r5 lt �ti-..r _ ZIP: 5 S �,,f �
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CONTRACTOR: � C< <��-�- PHONE:
MAILING ADDRESS: CIZ7: ZIP:
STATS LIGENSE: �
ARCHITECT/ENGINEER: _.---- _ PHONE:
MATLING ADDRBSS: CITY: ZIP:
N��: R.BGISTR.ATION n
TYPE OF WORR: New Addition Accessory 5tructure Move _
Demo Remodel./Alteration enova�e� Land A1J�e� ration
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PROPOSED WORR (describe in detail) : �.�.� ��� Gi-«y � ���.� +-�-- �i����I���- ``� �`'�
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L G�L J L(;`�L.. '/.f' .� �n c.v 'G' • -+Gr�r� �"' � (t(• � � - --�r-,��'�'��� ��!�- `-�°` .
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STURIES: SQ. FEBT OF EACH FLOOR:
NO. OF B$DROOMS: GARAGE STAI.LS: ATT. DET.
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FSTIMATED CONSTRIICTION VALIIATION (eacluding land) : ��, G`��
I hereby apply for a buil.ding 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 wil 1 be in accordance with the approved plan. �
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APPLIC�7T'S SIGNATDRE- . � '�Y�.- "� ..%' 2:�L�_E'�rv' DATE: � - •2�
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'� A: �. � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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.u.. DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish wil.I be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other Iocal , state or
federal agencies to the extent necessary to grocess the permit or
license.
4. If your requested permit or license requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
E. Y�ur full name is requirect to process this applica�icn or
permit.
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First Middle Last
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C-'ef ��r � � �� L � � �,
Address
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City State Zip
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I understand my rights as stated above.
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Signat
BUILDING&ZONING—473-7357 • ADMINISTRATION& FINAtiCE —�373-7358 • PUBLIC WORKS—473-7354
ASSESS[N G
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�,04 RIGHTS OF SIIBJECTS �F DATA
Subdivision L T9Pe of data- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Information required
to be given in�vi�ual. An.individual asked to
su ly private or confidential data concernina tam 1 hin the collecti g state agencY,
PP
purpose and intended use of the requeste �b� Whether he ma� refuse or is legally
political subdivision, or statewide system;
required to supply the requested data.; (c) anY known consequence arising from his
su 1 ing or refusing to supply private or confidential data; and (d) the identity of
PP Y stete or federal law to receive the date.. This_
other persons or entities authorized by investi ative data,
reguirement shall not apply when an individual is asked to supply g
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma olertV tgX re°und lnstr�uctionsunsteadhos
subdivision in the individual income tax •r r ►
on those orms. -- .
����L Upon request to a responsible
Subd. 3. A�� tO �� by
authority, an individual shall be informed�hetbh�ec'hp �g eeor confidential.e UPon h�s
individuaLs, and whether it is classified p ublic data on
further request, an individual who is the subject of Se to himriand if he desires, shall
individuals shall be shown the data withouo anh ��g. After an individual hes been
�e informed of the content and meaning the data need not be disclosed to
shown the private data and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
� ending or additional data on the individu e h� 8teeor p bl c datarupon request by
p require the
responsible authority shall provide copies o t P ilin the
the individusl subject oftrie actual�cos h of mak ng,l cert fyingyand comp g
requesting person to pay -
copies. immediately, if possible, with any request
The responsible authority shall comply
macie pursuant to this subdivision, or wit olida e �f Simmediateat ompliance eisu not
excluding Saturdays, Sundays end legel h �' with the
ossible. If he cannot comply with the request �thi�i��nt�ch toh omplynform the
p heve en additional five ys
individuel, and Tn$Y �d le al holidays.
request, excluding Saturdays, Sur►daYs g
Subd. 4. Proce�u'e �+hen data is not accurate or complete. An individual may
himself. To
contest the accuracy or completeness of public or private �tthe�responsible authority
exercise this right, an individual shall notify in writing
describing the nature of the disagreement. Tng�C�P$e or in omplete and att pt to
days either: (a) cocrect the data found to be
notify past recipients of inaccurate or incomp�t he believesdthe datalto be correct
the individual; or (b) notify the individual eement is
Data in dispute shall be discl tg d only if the individual's statement of disagr
• included with the �isclosed da � g�pe�1ed pursuant to the
� The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases•