HomeMy WebLinkAbout1999-011498 - tearoff/reroof �'ERMIZ�
CITY OF ORONO PERMIT TYPE:
275� KelleyParkway- P.O. Box 66 "�;�:.:j i{:;;;�i=
Crystal Bay, Minnesota 55323 Permit Number: _:Y ��.�,_:
Date Issued: �
(612) 473-7357 i_?:=.:'i:f.:;;'°=;;�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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�.. PPLI A T%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee:� $ ;'� c`� Date Received: �"- � I�
Enteted By: /v/��.d� Permit#: `f
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CITY OF ORONO - BUII,DING PERMIT APPLICATION
All information must be submitted in full before plan revie�v �-ill be started.
(please print all information)
THE A.PPLICA2�'T IS: (circle one) OtiVNER O�CONTRACTOR
JOB SITE ADDRESS: !' �_i,..� ;�,/� -i c�����1`�S %�i� /.<�� ZIP: '��>�> > `i�'
i�'A11�SE OF Oti��R: � �G'Y1�i� �f rC�'�"� PHONE: (home) ���/" i %�G
(work)
MAII.,I�i'G ADDRESS: /Y>� ��'r��C/ i�`'S S :ktl CTI'Y:�C��;,f�;�� ZIP:
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co�cTox: y�/���� r ����:;s. -�- _Pxorr�: � I� ��-� � -
`� MOBILE/PAGER �l;� ��� ��� �� �' �
CO�PTACT PERS ON � �� -,- �; _ ' _
_, . . _ � r� ;;� CITY• � � - <� _ -
MAII,T�'G ADDRFSS: � I .� -; � �_ , r� , ZIP: � �.
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STATE LICENSE: # ;, � �I I
ARCHITECT�E�TGI`i TEER: PHONE:
�ZAII�Iiti'G ADDRESS: CITY: ZIP:
��ME: REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
I�Sove Remodel/Alteration Land Alteration
PROPOSED'��ORK(describe in detain: ���1'G'�� ,�������'� �/�`G� ` ' (�`����
STORIES: SQ.FEET OF EACIi FZOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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EST .Tl-i IA.TED CONSTRUCTION VALUATION (excluding land): $ �, -� '' (;
I hereby apply for a buildina 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 Buildi-�� Code; that I understand this is not a permit and work is not to starc without a
permit; and tha� the work will be in accordance with the approved plan.
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APPLICA��'T'S SIGNATURE: , � � -��.' - �;�>� �'�=- DATE: , ��� � � ���
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NOTE! Parade o Homes events require separate permit approval by Police Department and
City Council 60 days prior to tke event. Non permitted events will not be allowed.
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Sea13.04 RIGHTS OF SUB,TECTS OF DATA '
Satd. 1. Type oC data. The righcs of individual on whom�he dam is sto�cd or to be scnced shall be as sec forch in this secaon.
Subd.2. Iatormation reqiured to be given individual. �1n individual uked to supply private or confidenrial dara conccraiag himself shall
be informed of: (a)the purpose and intendcd use of the requested data wichin the eoIIecang Etatt ageacy,polidcal subdivision,or statewide rysum;
(b)wheef:er he may r:fuse or is_legaily requir_d to suppty che r.quesud data;(c)aay laiawn coasequence arising from tiis supplyiag or refusing to supp[y
privace or con:.der.aa.l data;and(d)the idendry of ocherpersoas orenodes au[horized by staee or federal law ro teceive t�e daca. 'Ihis requitemenc shali
not apply when an ir:dividual is asked to supply iavesrigacve daa,pursuanc ro secaon 13.82,subdivuion 5,to a law enforcemeat o�cer.
'[ha eeclmissioner of revenue mav oface �he nodc- rauird und-r chis subdivision in che individual income nz or orooem az refund
ins�ructions insuad of on chose forms.
Subd. 3. ?.ecess to data by individual. Upon requesc to a responsible aurhority,an individual shall be informed whether he is che subject
of stor:d daa on individuals,and whecher it is ctassified as public,Qrivace ar conF.dendal. Upon his furcher request,an individual who is th:subjecc
of scor_d privace or public data on individuats shall be shovm che dan wichouc any charge to him and;if he desues, shall be informed of che concanc
and meaning of[hat dara. Afrer an individual has been shown the privac.dan and informed of ics meaning,[he dam need not be d'uclosed ro him for
siz monchs thereafter uriless a dispute or acdon pursuant to this secdon is pending oc addidonal data on the individual has beea eollecc�d or creaced.
The responsible aud:oriry shall provide copies of�he privac:or public data upon request by che individual subject of the daca. Tha responsible auchoriry
may require the requ:sang pe�son to pay[he acntal coscs oi making, cerrifying,and compiling the capies.
The responsible au[ttoriry shail comply immediately, if possible,wieh aay tequest made pursuant to this subdivision,oc wichin five days of
the date of�he reques[,ezcluding 5aturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot comply with the request
within[hat dme,he shal!so inform che individual,and may have an addidoaal five days wi�hin which to comply with the request,excluding Sacurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accurdcy or completeness of public or private
dara conceming himself. To ezercise this right,an individual shall noufy in wriang[he responsible auchoriry dascribing the nature of the disagreemenc.
The responsible authoriry shall within 30 days eitt;er: (a)correcc c'�e data found to be inaccurac�or incomplete and aaempc to nodfy past recipien�s of
inaccurdte or incomplete data, inciuding recipien¢named by the individual; or(b)nodfy the individual thac he believes the dara to be correcG Data
in dispuce shall be disclosed only if the individual's sta[emenc of disagreem:nt is includcd with the disclosed data.
'I�e decerminaaon of[he responsible auchoriry may be appealed pursuanc to the provisions of the admirustrarive proc:dure act relaang to
contesud cases. �
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Ri�hcs of subjeccs 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 de�ermine your qualification for the permi[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 wich ocher local, sta�e or federal agencies to the ettent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
�. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this applicatioa or permit.
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I understand my ri�hts �s stated above.
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