HomeMy WebLinkAbout1999-011839 - reroof/reside PERMIT
��17'�'i( OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 - � - - �-.
Crystal Bay, Minnesota 55323 Permit Number: _:i�:i_w�.;_;��::
(612) 249-4600 Date Issued: �_t� ��_ �`�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ ��:;:� ; _.i�;�_ _ _ . _ OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
` � !�- � Date Received: � y-��'�� /
Total�ee: $ � G' �
Entered By: � Permit#: /f `���`� �
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CITY OF�ORONO — BZTII�DING PERMIT Al'PLICATION �
A.11 informa�ion must be submitted in full before plan revie�v���ill be started. . �
. (please print all information) . : .
_� - . � . CONTRACTO' . -
'I�i-iE AP?LTCAN'I` IS: (circie one) . �SVNER O ' .
J�s
SITE A.DARESS: 1 '� . , �r LK� ��, z�: S���l J _ ;
1, 1 _, -��
NA11�SE OF Oti'Yi�►TER: ��fl MG�� .� (,�1��C'(,�E!'\ PHO��: (home) �� i � C
. � (work)
IYLAILI�i G A�DF'•ESS: SiR r�� CTTY: ZIP:�_
� c�cox: ,S��� �� i�'�. � ��-�M.S 1 J�. PHo�: �17-07�'�
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CON'TACTPERSON: �) �/ ''�` v�' MOBILE/PAGER �� ._ 7C� S�`�
MA.L�L,ItiGA.DDREss: 1 � ��� �Gl A ' C�' �1��'���v ����� �� S�-. 3rJ7—
STATE LICENSE: # D �
ARCHITECZ'�ENG .Itii TEER: . � PHONE:. ��
i1�II�'I�i'G ADDktESS: CTTY: ZIP:
� A�,�-�+ gEGISTRATIO�I#
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TYPE OF �'YORK: New ���� �'S''��'Addition Accessory Structure
Move Remodel/Alteration Land Alteration _
� � tG i ����Il l��hb�r �lo; �daf on h���se
PROPOSED ti�ORK(describe in detai�: ��
Va � '� � �i �,�- �- � hD s�� r�1�.�16��
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STORIES: SQ.F'EET OF EACS FLOOR:
i\O. OF BEDROOMS: GARAGE STALLS: ATT• _____ DET. . .
ESTIitiIA.TED CO
NSTRUCTxON VALUATION (excluding land): $ ��� �'�C _ �
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 a.nd codes of the Ciry and with
the State Build�n� Code; that I understand this is not a permit and work is noc to start without a
permit; and thac the work will be in �ccordance with the approved plan.
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APPLICA�\"T S SIGNATURE•
NOTE! Parade of Home� events require separate permit approvaI by Police �epartment and
� City Counci160 days prior to the event. Non permitted events will not be allowed.
. . . � � .
Sec.13.OS RIGHTS OF SUB,fEC'TS OF DATa • �
Satd. 1. Tyge o[data. �se righcc of individuai on wham the data u scomd or w be scor.d sbalI be as sec fo�ch in this section.
Subd.2. Iafarmation reqtrired to be givea iadiridvaI. an individual aske3 W suppIy privace or eoafidea¢al dam eocceming himsetf shaIl
be ia,°orm:d o`: (a)[he purpose aad ia4aded use oE che roqucscxi dan wichi3�he eollecdng E��:ageary,poliacaI sut�division,ar sa�wide rysmm•
Cb)u'h=�`.e:ho;.3y r_Fus:or is.legalIy requir:d to suPPtY.�e cequesud data:(c)asy I�ovra eoasequecce arisin3 froca�s supplyia3 or reEuiag to supp[y
privace or co:i:;dar.ca!dara;u:d(d)t�e ideadry af ocher�csoas or ecdces aucuoriz:3 by sc��or fe�c�'!_:;,a r.cei•+e�e da�. This r_quirc�eac 5�3!1
r.oc a�ply wcea an ir:dividual is asked to supply iavesagadve daa,pursuaac ta se.doa 13.82,subdivision 5, w a faw enfaccemeat ofncer. . -
The eenmisiiorser of revenue mav ptace [he nodc- r�uird und-r this subdivision in the individual ircome eix or orooem t�z refund
inscrucdoru L�suad of an those forms. .
Subd.3. Aecess to data bp iadiridual. Upon requesc to a respansible auchority,an individuaI shatl be informed whtcher he is che subjecc
of stor:d daa an individuaLs,aad whecher it is et�ss�ed u public,private or eonFdend�i. Upan his turcher r_quest,an iedividaal who is the subjccc
ef sior,d priva:e or public dam on individuals shali be shown the daa wirhout any eharge co hua and;if he desira,shalI be informed of the contenc
ar.d m:aning af chat dara. Aher an individual his been shown the privac:daa ar.d infa�d of ic�meaaing,cfie dam ne:d no�be d'uclosed to him for
six monc�c chereafrer unl:ss a dispuce or accon purruane to ehis secdon is pending or addidooal da�on the iadividual has beea eollec�d or erea�:d.
The cespoasible authoriry shaIl�provide eopies of the priva�orpubtic dara uFon request by the iadividual subject oC che daa. The respoasible authoriry
may rcquir_ che r.quesdng peaon to pay[he aceual eosu af makinz,eerdfying,ar.d compiling the eopia.
The resgonsible authoriry shaIl eomply imm:diacaly,if passibie,wich aay teqaest made pursuant to this subdivision,oc wichin five days of
the dac:of uke teques4 excluding Satuniays,Sundays and legal holidays,if immediate comp(iaace is not possibta. If he eanuot eomply wirh tha request
wirhin thac dme,ha shal!so inform ehe individuaI,and may have an addidona!five days wi[hin which to comply with the rcquest,ezduding Sacurdays,
Sundays and legal holidays. . .
Subd.4. Pzocedure when data is not accurate or compiete. An icdividual may eonc�st tha accuracy ar eompieceaess o[pablic orprivace
dara eoncerning tiimself. To ezercise�his right,an individuat shal!aodfy in wridng the respoasibte auchoriry descn'bing the nanire of the d'uagreemeae
The nspocuible auihoriry shall within 30 days ei�:er: (a)correcc che dara found to be inaccurat�oc ir.compia_aad acu.mpt to nodfy past recipienc�of
inaccu�ace or incamplete data, including recipicn�s narn:d by che individual;or(b)aoaFj the individual thac he believes the dati to be correcc Dat�
in dispu�e shall be disdosed only if the individ�al's scacemenc of disagreem:nt is included wich the d'udosed data.
The dacerminadon of the responsible au�horiry may be appaaled pursuanc to the provisions of cha adminisaadve proccdure act relaang to
cont�skd cases. � . .
DATA PRIVACY ADYISORY �
In accordance wich M.S. 13.04, Subd.2, "R.igh�s of subjeccs of data",we would like to inform you that your requesc
for a pemut or license from the Ciry of Orono or any of iu departments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to detemune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the perm.it or license.
3. The information may be shared wich other local, state or federal a�encies to the eztent necessary to process
the permit or license. �
4. If your requested permit or licease requires Council action to approve, some information may become
. public, . . . . .
��. You have certain ri�hts under bi.S. 13.04�(availabie upon request) to review private data on.yourself.
6. Your full name is required to process this applicacion or permic.
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C�ry Sate Zip ~ P�one
I understand my ri�hhts� ed above.
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