HomeMy WebLinkAbout1999-011474 - tearoff/reroof . PERMIT
��TY OF ORONO PERMIT TYPE: - - -
2750 Kelley Parkway- P.O. Box 66 �°-��"v��
Crystal Bay, Minnesota 55323 Permit Number: _ ,. ����;.;�.
(612) 473-7357 Date Issued: _ _ .= -
SITE ADDRESS:
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REMARKS:
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APPLICANT-PER ITEE SIGNATURE ISSUED BY:SIGNATURE . t"�
� Total Fee: $ Date Received:
Entered By: ,,�`� _ Permit#: �'/��`�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review w�ill be started.
(please print all information)
THE A.PPLICAi`'T IS: (circle one) OtiVNER OR CONTRACTOR
JOB SITE ADDRESS: � Z �� � ��`L��-�c ��%::J �+7F. ZIP: '�� �(I /
' �r�'�'S�,'^�'HONE: (home) �7 6 �y�'��
NAl�iE OF Oti�TER: i c�IL °f� N�L � ,
(work) �'/`%-���-Z `�
MAIL.L\'G ADDRESS: �`'`��' � CI'I'Y: ZIP:
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CO�ACTOR: -- P����
COi�1TACTPERSO`: i�;<1G �' �'n'-✓ NiOBILE/PAGER:
MAILI�i TG ADDRESS: /a�x'✓ '-� CITY: ZIP:
STATE LICENSE: # r---
ARCHITECT/E\TGItii TEER: — PHO�'E:
NIAILI�i TG ADDRESS: CIT'Y: ZIP:
NAME: REGISTR.ATION#
TYPE OF tiVORIi: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED`VORK(describe in detai�: I�i�- �l,C; �' � ��---�
STORIES: Z SQ.FEET OF EACH FLOOR: ����'�
NO. OF BEDROOMS: `� GARAGE STALLS: ATT. DET. z-
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.-� �. � ���i���O
EST .Jl�i IATED CONSTRUCTION VALUATION (excludi.ng land): $ � �
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 Build�-+� Code; that I understand this is not a pernut and work is not to start without a
permit; and tha� the work will be in accord ce with the approved plan.
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APPLICAi�'T'S SIGNATUKE: �%' �� DATE: :�' �- � f
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
. . .
Sec.13.Q4 RIGFiTS OF SLJB,TECTS OF DaTA '
Sutd. 1. Type of data, The righcs of individual on whom the data is storcd or ro be scnced shall be as set forch in this secaon.
Subd.2. Information reqirired to be given indiridual. �1n iadividual asked to supply private oc confidenrial dara concerning himself shall
be inforu:ed o,`: (a)the purpose aad intendcd use of the requesud dara withia the colIecdng State ageacy, polidcal subdivision,or sca�ewide rystem;
(b)whechcr he may refuse or is.legalIy requir_d to suppiy the rquesc�d data;(c)any]mown coasequence arisiag from his supptyiag or refusing w supply
privace or connder.riai data;and(d)the idendry of o�her pecsoas or er.rides au�orized by s[ace or fedecal law to rrceive the daca. 'Ihis requiremeuc zhali
noc apply when an individual is asked to supply invesdgarive dam,pursuanc ro secdon 13.82,subdivision S, [o a!aw enforsement o�cer.
'L�e eer.imissioner of revenue mav olace [he nodc- r�uird und-r this subdivision in the individual income taz or orovem raz refund
inscrucdons inscead of on those forms.
Subd. 3. ?.ecess to data by individuaI. Upon requesc to a rtsponsible auchoriry,an individual shall be informed whethe�he is the subjecc
of scor:d da�a on individuals,and whecher it is c(assified as public, privace or conF.denrial. Upoa his funher cequesc,aa individual who is che subjecc
of stored pcivace or public dam on individuals shall be shown ehe dam wichouc any charge to him and;if he des'ues, shall be informed of the eontan�
and meaning of that dara. Aher an individual has becn shown che privare dan and informed of ics meaaiag,[he daca need not be disclosed ro him for
six monchs thectafrer uriless a dispute or acaon pursuane to tfus secdon is pending or addidoaal data on the individual has been eollecc.d or erea[�d.
The responsible aucY:ariry shall pcovide eapies of the privam or public data upon request by the individual subjcct o[[he dara. The responsible authoriry
may rcquire the cequesang person to pay the acntal cosu oi na.king,certifying,and eompiling the eopies.
'Ihe responsible authoriry shall comply immediacely,if possib(e,wich any cequest made pursuanc to this subdivision,ar wichin five days of
the dam of the tequtst,excluding Saturdays,Sundays and legal holidays,if immediate compliaace is not possible. If he cannot comply wich the requesc
wichin chat dme,he shall so inform[he individual,and may have an addidooal five days wirhin which to comply wich the request,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or eomplete. An individual may contest tha accuracy or completeness of public or pri�•ate
data concerning himsetf. To ezercise this right,an individual shall nodfy in wridng the responsble auchoriry describing the nature of the disagreemeac.
The responsible authoriry shall within 30 days eict:er: (a)correct cha data found to ba inaccurate or incomptece and attempc to nodfy past recipien�s of
inaccurace or incomplece data, including recipien�s named by [ha individual; or(b)nodfy the individual that he believes the data to be correcc. Dati
in dispu�e shall be disclosed only if the individual's sta�er,.en�of disagreement is includzd with the disclosed data.
The deterrninaaon of the responsible auchoriry may be appealed pursuanc to the provisions of the ad¢unisaarive procedure act relacing to
contesud cases. •
DAT�, PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Righcs of subjects of data", we would like to inform you tha[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
confidencial information.
You are notified that:
1. The information you furnish wiil be used to de�emune your qualification for the permi[or license requested.
2. You may refuse to supply data, but refusal may require that the Cicy deny the permit or license.
3. The information may be shared wich o�her local, stace or federal a�encies to the ettenc necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain ri�hts under M.S. I3.04 (available upon request) to review private data on yourself.
6. Your full name is required to process chis application or permit.
Firsc ,Lfiddle I.asc
Address
Ciry Sate Zip Phon�
I und�rstand ' ri;hts as state,¢ above.
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