HomeMy WebLinkAbout1998-010868 - tear-off/re-roof PERMIT
CITX OF ORONO PERMIT TYPE:
+6750 Kelley Parkway- P.O. Box 66 �`;'���-�'�'v'�'
Crystal Bay, Minnesota 55323 Permit Number: ;_��i_;::��:�:
(612) 473-7357 Date Issued: �i 7; �_;;°�_:_:
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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A�PLICAN ERMITEE SIGNATURE ISSUED BY:SIGNATURE
, To'tal 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)
------------------------------------------------------- -------------------------------------------------
THE APPLICANT IS: (circle one 'OW E O CONTRACTOR
-- �
JOB SITE ADDRESS: >���� � T�� �' C�%f ZIP: .�.���l�
' OF OWNER:,.-' ,� '���� s� �—�f�/�j��'PHONE: (home) ���— ���
IVAME L ,
/ (work)
MAII.ING ADDRESS: ,���..� �-� ��-�`' _ ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z�:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
�
PROPOSED WORK(describe in detain: 1�� �,;:�>� �?/>v� � _
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�,
ESTIMATED CONSTRUCTION VALUATION (excluding land): $,�S 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 pernut and work is not to start without a
permit; and that the work w�l corZ�nce with the approved plan.
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APPLICANT'S SIGNA �� � DATE: � "�� '�
NOTE! Parade of Homes eve ts re are 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 SLTB.JECTS OF DaTA
Subd. 1. Type of data. The rights of individual on whom che 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 supply priva[e or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requesud data wichin the collecang'stace agency,polirical subdivision,or starewide rystem;
(b)whecher he may refuse or is legally required to supply the requested data:(c)any imown consequence arising from his supplying or refusing to supply
private or confidenoal data;and(d)the idendry of other persons or enriaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigadve dara, pursuant to secaon 13.82, subdivision 5, [n a law enforcement officer.
The commissioner of revenue mav D1ace the nodce reouired under this subdivision in the individual income rax or propem tax refund
instruccions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,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 confidenaal. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown the dara wi�hout any charge to hicn and, if he desires, shall be informed of the content
and meaning of chat data. Aher an individual has been shown che private data and informed of i[s meaning,the data need not be disclosed to him for
six monrhs[hereaher unless a dispute or acdon pursuanc to this secaon is p�nding or addiaonal data on the individual has been collected or created.
The responsibie authoriry shall provide copies of the private or public data upon request by the individual subjecc of�he data. The responsible authoriry
may require the cequesdng person to pay the acnial cos[s of makine,certifying, and compiling the copies.
The responsible au[horiry shall compiy immediately, if possible,wich any request made pursuant to chis subdivision,or within five days of
the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
wi�hin chat time,he shail 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 pubiic or private
data conceming himself. To exercise this right,an individual shail nodfy in wridng the rosponsible authoriry describing the nacure of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct[he data found to be inaccurate or incomplece and aaempc to noafy past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual thac he betieves the data to be correcc. Data
in dispu[e shall be disclosed only if the individual's statement of disagreement is included wirh the disclosed data.
The determinarion of the responsible authoriry may be appealed pursuanc to the provisions of the administrarive procedure act relating 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 Ciry 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 detemune 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 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
pubiic.
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.
First �Siddle Last
Address
Ciry Sate Zip Phone
I unde t 3 my hts as state ye
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Signamre