HomeMy WebLinkAbout1996-008544 - replace living room wind PEIRMIT
� . �;iTY OF ORONO PERMIT TYPE: . . . _.
2750 Kelley Parkway- P.O. Box 66 `���j 1� i..�! «�:�
Crystal Bay, Minnesota 55323 Permit Number: �':�t;i��€�.�,r
(612)473-7357 Date Issued: i ; i:;t_-,;��=:�.
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/ ERM E SIGNATURE 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
JOB SITE ADDRESS: �`�/5 �i9 S� �i`J1�� S f ZIP:
NAME OF OWNER: C_��L ,�`t ,��I�� / �: PHONE: (home) �/ � ���G S S�
(work) c��—o C� � 1
MAILING ADDRESS:�?y�c� _1,t,�ff��CJC �l�..0 CITY: y"�/,�J G /�� ZIP: � �c�
CONTRACTOR: S�L� 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
PROPOSED WORK(describe in detai�: /�'f i°/,�/ f /.��U�1� C.J ltit�C�'
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ jC�oo "`�`'
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.
� :� � J/— �—
APPLICANT'S SIGNATURE:,/C �� DATE: l — 9 �
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NOTE! Parade of Homes events require separate pernz approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
�
Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The righa of individual on whom the data is stored or to be stored shall be as set forth in[his secdon.
Subd.2. Information required to be given individual. An individual asked to suppiy private or confidenaal data concerning himself shall
be informed of: (a) the purpose and intended use of the requested dara wichin the coliecang'state agency, poliacal subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplyin�or refusing to supply
priva[e or confidencial data;and(d)the idenriry of other penons or enoaes au[horized by state or federal law to receive the data. This requiremenc shall
not apply when an individual is asked to supply invesrieadve dara, pursuant[o secdon 13.82, subdivision�, ro a law enforcement o�cer.
The commissioner of re�enue mav pface the nodce reauired under this subdivision in the individual income tax or propem tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individuai. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of s�ored data on individuals, and wherher it is ctassified as public, priva[e or confidendal. Upon his funher request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the conten[
and meaning of that data. After an individual has been shown the privace data and informed of its meaning,che data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant[o this secaon 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 subject of the data. The responsible authoriry
may require the requesring person to pay the actual costs of makine, certifying, and compiling the copies.
The responsibie authoriry shal(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[he individual,and may have an addicional five days within which to comply with the request,excluding Saturdays,
Sundays and leeal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this ri¢ht,an individual shall nodfy in wri[ing the responsible authori[y describing the nacure of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of
inaccurate or incomplete data, including recipients named by [he individual; or(b)notify the individual tha[he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagteement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relaang 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 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 extent necessary to process
the permit or license.
4. If your requested permic 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.
6. Your full name is required to process this application or permit.
First Middle Lasc
Address
Ciry State Zip Phone
I understand my rights as stated abov .
G��ti.��� — ,
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Signa[ure
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ATE TIME
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CITY OF ORONO CALLED IN /� . J �'
INSPECTION NOTI E SCHEDULED tr1 �`� _'3-.-�0
PERMIT NO. `� COMPLETED ���H ''�
ADDRESS � � / �� -v- '
OWNER CONTR. .�,��
TELEPHONENO. _ �_'�i -/�7c�c� ,�4<.�
� DESCRIPTION _ �a rz.n�'�� �
� 01 FOOTINO 11 MECHANICAL RI 18 D(CAV/GRADINQJFIWNO
�Q 02 FRAMING 13 MECHANICAL FINAL 19 LAf�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 W BD. 12 WATER HOOK-UP 17 SITE INSPECTION
� FINAL 14 SEWER HOOK-UO 06 PROGRESS
�
J 07 DEM4�ITE 27 SEPTIC MAINT. 21 COMPIAINT
Q 07 DEMO—FINAL 15 SEPTiC INSTALL. 22 FOLLOWUP
= 09 PLUMBIN(i RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
v BIN�FINAL 36 FOUNDATION REMOVAL
� OWNER/ ONTFiACTOR TO MEET YOU: YES_NO
� MENTS: ��=��� �. �L�./
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d WORK SATISFACTORY:PROCEED �(PROJECT COMPLETE
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� CORRECT WORK&PROCEED � �
W ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION W�THIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN `
❑STOP ORDER POSTED.CALL INSPECTOR
�-.CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for t e inspection 24 hours in advance.473-7357
OwnerlCon a or o it •
Inspector.
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