HomeMy WebLinkAbout1997-008963 - tear-off/re-roof �. PERMIT
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�,�TY 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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REMARKS:
FEE SUMMARY:
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APPLICANT�PERMITEE SIGNA RE ISSUED BY:SIGNATURE
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' Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT 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
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JOB SITE ADDRESS: � �� �: � /�� �t (/�f��.' ZIP: 1 � � �c
;_� r,Ch ��it � �-��h eC ���.:�
NAME OF OWNER: � �>� �'-� �� t��y- G �� PHONE: (home) C� �( �' ��C Q 9
J' (work) 'L% � � C� J l� �'
��' (� �S,- �'� � CITY: ����� �' ` ZIP: � � S
MAILING ADDRESS: ,. L� .S r� `✓ y� L' > � �
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration.�_ Land Alteration
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PROPOSED WORK(describe in detai�: �C� C;Y (�� � ���' ��� ���� `��';� ��=� ` '
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;�-��� �' � '�� �"` �� ' �--�
STORIES: �_ SQ. FEET OF EACH FLOOR �x > �,
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � ( �' i
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.
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APPLICANT'S SIGNATURE: ��� a'��� �-�-' ��'~��""�` DATE: j - ,
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 RIGHTS OF SLJB.TECTS OF DATA
Subd. 1. Type of data. The ri¢hts of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidendal data conceming himself shall
be informed of: (a)the purpose and intended use of the requesced data within the collecting'state agency,poliacal subdivision,or sratewide system;
(b)whether he may refuse ot is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the identiry of ocher persons or enddes authorized by state or federal law to receive the data. This requiremen[shall
not apply when an individual is asked to supply invesrieadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or proper[v tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsibie authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wi[hout any charge to hicn and, if he desires, shall be informed of the content
and meaning of chat 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 thereaher unless a dispute or acdon pursuant to chis secdon is pending or addidonal data 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 subjec[of the data. The responsible authoriry
may require the requesang person to pay the acrual cosu of making, certifying, and compiling the copies.
The responsible authoriry 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 addiaonal 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 concerning himself. To exercise this right,an individual shall nodfy in wriang 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 norify past recipients of
inaccurate or incomplete data, including recipiencs named by the individual; or(b)noUfy 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 disdosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of ihe administrarive 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 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 agencies to the ex[ent necessary to process
the pemut 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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First �, � Middlz Last
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C�� State Zip Phone
I understand my rights as stated above.
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Signature
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTIxCE scHEou�E� �� •�
PERMIT NO. =� � �� � � cornP�E1E� �� ��j
ADDRESS �'�x�'� L'S�U���
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION l�C}� C�� �Y��C�"C�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL � 19 LAKESHORE/WETIANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 TE INSPECTION
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Z OS FINAL 14 SEWER HOOK-UP 06 PROCaRESS
F' 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTFtACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d ,�WORK SATISFACTORY:PROCEED PROJECT COMPLETE
� : CORRECT WORK 8 PROCEED ISSUE CERTIFICATE OF OCCUPANCY
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� �' CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. – pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR (- CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73rJ7
OwnerlCoMractur�n s" �
Inspector. , �
White Copyllnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTI � SCHEDULED���
PERMIT NO COMPLE �
ADDRESS 'e-� /���
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION � `E= �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP E INSPEC
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ❑WORK SATISFACTORY:PROCEED �OJECT COMPLETE
W �CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY
��� CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. _ PHOTOTAKEN
INSPECTOR WILL RETURN
- CITATION ISSUED
❑STOP ORDER POSTED.CAIL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i 'on 24 hours in advance.473-7357
OwnerlCont ac r s' .
inspector.
White Copyllnspector's File Canary CopylSite Notice