HomeMy WebLinkAbout1997-008860 - tear-off/re-roof � PERMIT
G�t Y OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: -
(612) 473-7357 Date Issued: : -
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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, � Total Fee: $ Date Received: ��`�- � �
Entered By: ;; u Pernut#: �'�a
CITY OF ORONO - BUILDING PERIVIIT 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 O ON CTOR
JOB SITE ADDRESS: l��� G��J'�G,�'✓��� �� I�iD ZIP:
NAME OF OWNER: �, 1 V 1 G �e� PHONE: (home) y �� ' �g 2�j
�JI (work)
MAILING ADDRESS: � /`� /�/�l,a..i�SS' lT��ITY: ��n Q���IP:
CONTRACTOR �l 1�—��� PHONE: ���6 �Z� �
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: �!� b0 CITY: �' ZIP: 5 5�a'�2
STATE LICENSE: # ��/-7
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 detain: ��}�� 0�- ��Q.��r'- i�,•�� /t �:-�f,r��„�2_
��i C:'G z�'P�L1�-
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding 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 Building 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 ccorda e with the approved plan.
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APPLICANT'S SIGNATURE: U I \ DATE: � G` � ��
NOTE! P�rade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
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Sec.13.04 RIGH'I'S OF SUBJECTS OF D:�TA
Subd. 1. Type of data. The rieh[s of individual on whom[he data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to suppiy privace or confiden[ial data concerning himself shall
be informed of: (a)the purpose and intended use of the requesced data wichin the collecting'state agency,polidcal subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any 1�own consequence arising fmm his supplying or refusing to supply
private or co�denrial data;and(d)the identiry of other persons or enriaes au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
insteuctions instead of on those forms.
Subd. 3. Access to data by indicidual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether ic is classified as public, priva[e or confidential. Upon his further request,an individual who is the subjecc
of stored priva[e or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the content
and mea^ing of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acaon pursuant to this section is pending or addiUonal 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 authority
may require the requesting person to pay[he actual costs of making, cerrifying, 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 da[e 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 addicional five days within which to comply wi[h the request,excluding Sarurdays,
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 pri��ate
data conceming himself. To exercise this rieht,an individual shalt norify in wriang the responsible authoriry describing the narure of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipienu of
inaccurate or incomplete data, induding recipients named by the 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 disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant[o the provisions of the administradve procedure ac[relaang to
contested 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 pemut 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 extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some informa[ion may become
public.
g, 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.
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First �vfiddle Last
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Address �'� ��(7 y G, ri > j���
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C��� State Zip Phone
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I understand my rights as stated above.
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Signacure