HomeMy WebLinkAbout1998-010295 - roof/siding repair PERMIT
� 4',lTY OF ORONO PERMIT TYPE:
2750 Kelle Parkwa P.O. Box 66 �-,i i? �,T�si;
y y Permit Number: �
Crystal Bay, Minnesota 55323 `-��t-`���=�'`
(612) 473-7357 Date Issued: f_:�.,f�f�� ;;,�;_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — �;���,� �_t.�;�t. —
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��1—�-,.�'-�C,
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}otal Fee: $ Date Received:
Entered By: Permit#: _�G �2�S�
CITY OF ORONO - BITII�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�( R CONTRACTOR
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JOB SITE ADDRESS: ���� (/G����J�%�.:�'�/ y� ZIP:
NAME OF OWNER: �r��'�°�-�'� '`' f ��Gr���j � PHO�tE: (home) � �f -�j�/C/v
��� (work)
MAILIl�'G ADDRESS: z�/C>�� !�C�L�e�.-�:������ CITY: �;;����yz � ZIP: `��' ��/
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C0�ITRACTOR: � PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAII.,ING A.DDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHIT'ECT/ENGINEER: PH0�1E:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF `i�ORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED`VORK(describe in detai�: .Sjj�yr..�- � ��y�� � _ j����} ��rh]�� /'�'`,��t��'
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STORIES: � .� SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: � GARAGE STALLS: ATT. � DET.
csx'.% �
ESTIVi IAT`ED CONSTRUCTION VALUATION (excluding land): $ ���'�� � �
I hereby apply for a buildin�permit and I acknowledge that the information above is complete and
accurate; tha� the work will be in conformance with the ordinances and codes of the City and with
the State Buildin� Code; that I understand this is not a permit and work is not to start without a
pernut; and that the work will be in acc ance with the approved plan.
APPLICANT'S SIGNATLTRE: ' '� DATE: G" l �' S
r
NOTE! Parade Qf Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non perntitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLBJECTS OF D�TA
Subd. 1. Type of daca. The ri¢hts of individual on whom�he data is scored or co be stored shall be as se�forth in this secdon.
Subd.2. Information reqirired to be given individual. An individuai asked to supply privatt or confidea¢al dara coacerning himself shall
ba informed of: (a)the purpose and in[ended use of the requested daca within the collecang'state ageacy, polidcal subdivisioa, or sra[ewide rysum;
(b)whether he may refuse or is legally required to supply the rquested dara:(c)any Irnown coasequence arising fmm his supplying or refusing[o supply
• priva�e or confidendal dara;and(d)the idenary of other pzrsoas or enria:s auchorized by state or fedecal law to receive rhe data. 'Ihis requiremenc sfiall
not apply when an individua]is asked to supply invesd�adve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. -
Thz commissioner of revenu� mav place the nodc� r�ouir�+ und�r this subdivision in the individual income tax or oroperrv tax refund
instrucrions insczad of on chose forms
Subd. 3. Access to data by indi�-idual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject
of scored dara on individuals,and whe�her ic is class�ed as public, privac�or conFidenrial. Upon his funher request, an individual who is the subjecc
of stored private or public dara on individuals shall be s�own the data wichout any charge to him and,'if he desires, shall be infocmed of the content
and meaning of chat data. After an individuai has been shown the privac�data and informed of ics meaning, the data need no[be disclosed to him for
six monchs thereafter unless a dispute or acaon pursuanc to [his secaon is pznding or addidooal daca on rhe individual has been collected or crearPd.
Thz responsible authoriry shall provide copies of the private or public data upon requesc by the individual subjecc of che daca. The responsible authoriry
may require the requesdng person to pay thz accual cos�s of making,cerrifying, and compiling the copies.
The responsible authoriry shall comply immediacely,if possible, wich any request made pursuant to[his subdivision, or wi[hin five days of
the date of the requesc,excluding Sacurdays.Sundays and legal holidays,if immzdia[e compliance is not possible. If he cannot comply with the reques�
within thac time,he shalt so inform the individual,and may have an addiaonal Fivt days wirhin wtuch to comply with che request,excluding Sacurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest che accuracy or completeness of public or pri�•ate
data concerning himself. To exercise[his ri¢ht,an individual shall noa"ry in wriang[he responsible authoriry describing the nantre of the disagreement.
The responsible auehoriry shall wichin 30 days ei[her: (a)correct�he data found to be inaccurate or incomplece and attempc to nodfy past recipienu of
inaccunte or incomplete data, including recipiencs named by �e individual; or(b)nocify the individual thac he believes[he data to be correct. Data
in dispute shall be discloszd ocily if the individual's statemenc of disagreement is included with[he disclosed data.
The dzcerminaaon of the responsibte au�horiry may be appzalzd pursuanc[o the provisions of[he adminisaarive procedure act reladng to
contesced cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts 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 informacion.
You are notified that:
1. The informa[ion you furnish will be used to de[ermine your qualification for the permit or license requested.
2 You may refuse [o supply data, but refusal may require that the City deny the permit or license.
3. The informa[ion may be shared with other local, sta[e or federal agencies to the extent necessary to process
the permit or license.
4. If your requested perrnit or license requires Council action to approve, some information may become
public.
5. You have certain riahts 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.
�v,�° �" �'S ����. ;>�
First �fiddl� Last
Address .
Ciry Smte Zip Phone �
I unders my ri�hts as staced above.
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