HomeMy WebLinkAbout1999-011463 - tearoff/reroof PERMIT
CITY OF ORONO PERMIT TYPE:
2750?(elley Parkway- P.O. Box 66 � �=-'-'��v��
Grystal Bay, Minnesota 55323 Permit Number: �:jt;;;,:_,:;
i612) 473-7357 Date Issued: _ _ _
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT PE T IGNATURE ISSUED BY:SIGNATURE ,
Total i:ee: $ Date Received:
�tered By: � Permit#: // '`f�
CITY OF ORONO - BLTII..DING PERMIT A.PPLICATION
All information must be submitted in full before plan review w�ill be started.
(please print all information)
THE APPLICANT IS: (circle one) OtiVNER OR CONTRACTOR
JOB SIT'E ADDRESS: 2`�;3� �'�v�£� �'/V ZIP:
NA1��E OF Otii��R: ��,�r � + 1 � r o n., � ��-,-� __ PHONE: (home)
(work)
��u_,�G C�n�ss: aq3s f R��� �-w ��. crrY: o�;:vo z�:
CO�ACTOR: C���'-cs I�c7o�� v� PHONE: SSO--OO�,S
COI�t'TACT PERSON: T,.,�, NIOBILE/PAGER: �3�a�t - G� /
MALLl�'G ADDRESS: �v�l� X"c.��n� �-N CITY: ��y:r,,,�• ZIP: Ssy�
STATE LICENSE: # ��g 3
ARCHITECT/EI\TGI�i TEER: PHONE:
1�xA.II�1NG ADDRESS: CITY: ZIP:
�T�ME: REGISTRA.TION#
TYPE OF �VORK: New Addition Accessory Structure _
Move Remodel/Alteration�_ Land Alteration
PROPOSED`�ORK(describe in detain: �r �����`'!' �--e-��-� �{� �f���'e �=7 �
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIi�iAT'ED CONSTRUCTION VALUATION (excludi.ng land): $ /� 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 Ciry and with
the State Build�n� Code; that I understand this is not a pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICAl�'T''S SIGNAT'URE: �-� D`�TE: �� a�� ��
NOTE! Parade of Homes eve require sep te permit approval by Police Depariment and
City Counci160 days prior to tke event. Non permitted events will not be allowed. �
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. 1
Sec.13.04 RIGHTS OF SLTBJECTS OF DATA '
Subd. 1. Type of daca. The righct of individual on whom the data is srored or to be srnrcd shall be as sec for�h in this secaon.
Subd.2. IntormaGon required to be given iadiridual. An individual uked to supply private or coafidearial data concerning himself shall
be informcd o,`: (a) �he purpose and incended use of the requesced dara wichin the coIIecdng 3nce ageary,poliacal subdivisioa,ar sramwide rysc:m;
(b)whe4te:he may refuse or is.lcgally requir_d co suppty the r_quesud data;(c)any faiown coosequcace arising from his supplyiag or refusing to supply
private or con.Zder.dal dara;and(d)the ideadry of other persons or enrides au�orized by sc�te or federdl law to receive che data. This requiremenc sha!I
not apply when an ir.dividua!is asked to supply invesdgarive dae,pursuant ro secdoa 13.82,subdivision 5, to a law enforzemeat officer.
'Ihe eer.imissioner of revenue mav D13C� CIl� nodc- r�uird under chis subdivision in the individual income mx or orooectv e�z refund
inscrucaons insuzd of on�hose forms.
Subd. 3. ?.ecess to data by iadividuai. Upon requese to a responsible authoriry,an iadividual shall be informed whechec he u ehe subject
of stor:d dan on individu3ls,and whecher ic is c(assifi:d as public, private or conF.dendal. Upon his funher requesc,an individual who is che subje:c
of stor.d private or pub(ic dam on individuais shall be shown the dac�wi��out any charge to him and;if he desires, shall be informed of the coatenc
and m:aning of that dara. Afcer an individual h�s been shown the priva�e dan and inFormed of ics meaning,[he data ne:d not be disclosed to him for
six months thereafter unless a dispute or acaon pursuanc to [his secdon is pending or addidooal dara on the individual has been collecced or erear�d.
'Ihe responsible au�t:oriry shall pcovidz copies of the privatr or pubtic data upon request by[he individual subjecc of the data. 'I1ze responsible authoriry
may requir the requadng person to pay the accual coscs ot making,cerafying,and compiling the copies.
The responsible auchoriry shall eomply immediacely, if possib(e,wieh any request made pursuant to this subdivision,or wichin five days of
the date of the reques�,excluding Satutdays,Sundays and lega]holidays,if immediate compliance is not possible. If he cannot comply with the requesc
wichin[hat dme,he shall so inform the individual,and may have an addidoaa!Five days wichin which to compty wich the request,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accurdcy or eompleteness of public or private
data conceming himself. To ezercise this right,an individual shaIl noafy in wridng ehe responsible authoriry dascribing the nature of the disagreemenc.
The responsibie authoriry shall within 30 days eitt:er: (a)correct�he data found to be inaccurdce or incomplete aad aaempc to nodfy pasc recipiencs of
inaccurate or incomptece data, including recipien�s named by che individual; or(b)r.odfy the individual thac he believes che daca to be correcc. Data
in dispuce shall be disclosed only if the individual's stacemenc of disagreemenc is included with the disclosed data.
The decerminaaon of the responsibla au�horiry may be appealed pursuan[to the provisions of tha adminiscrarive procedure act relaang to
cont:sced eases. •
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request
for a pernut or license from the Ciry of Orono or any of its depar[ments may require you to furnish ceRain private or
confidential information.
You are notified that:
1. The inforcnation you furnish will be used to detecmine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or licease.
3. The information may be shared wich other local, stace or federal a�encies 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 application or permi�.
First �fiddle I.asc
Address
Ciry Sace Zip Ptione
I understand my ri�hts as s[ated above.
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