HomeMy WebLinkAbout1997-008885 (Re-roof) PERMIT
� CITY 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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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: - � -� - _ :_ � . 4 . OWNER:
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APPLICANUPERMITEE SIGNATURE ISSUED BY:SIGNATURE ���"�.
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Total Fee: $ Date Received:
Entered By: ,,��i, 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: �� ()� � ✓ h � r �l`�' ZIP: �� � � �
NAME OF OWNER: � �-. � ,' .� �-e L�� �<: -� �; � � PHONE: (home)
(work)
MAILING ADDRESS: j �c� � d � � h�� �� CITY: e}:-� ,-. a ZIP: �� � 1�
3 � `i .57 � �
corrrxacTox: � ; �_ ,� ,__� �=� _�- _rxorrE: � ��_- s-7 ! C�
CONTACT PERSON: ��� � MOBILE/PAGER:
MAILING ADDRESS: �7 C�v (�.�.��-� � ��- CITY: � �_ZIP:
STATE LICENSE: # �C3 0�i �S
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: \�� �G' -� �
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
permit; and that the work will be in accordance with the approved plan.
l -�DATE: �-�� J� - ��
APPLICANT'S SIGNATURE: �C --TC-- _�=� �
NOTE! Parade o,�Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
. �
Sec.13.04 RIGHT'S OF SiJB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the 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 supply private or confidential data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, potitical subdivisio�,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)the iden�iry of other persons or enriries auchorized by sta[e or federal law to receive the data. This requirement shall
not appty when an individual is asked to supply investigarive dara, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the norice reauired under this subdivision in the individual income tax or propercv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whether ic is c(assified as public, private or confidendal. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hirn for
six months thereafter unless a dispute or acrion pursuant to this section is pending or addidona;data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon tequest by the individual subject of the data. The responsible authority
may require the requestine person to pay the acrual costs of making, certifying, and compIling the copies.
The responsible authoriry shall compiy immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sa[urdays,Sundays and leeal 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 addidonal five days within which to comply with Ihe request,excluding Saturdays,
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[his ri¢ht,an individual shall norify in wri[ing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be correc[. 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 to the provisions of the administradve procedure act relacing to
contes[ed cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request
for a pemut 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 fumish 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 pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
$. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
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First Middle Last
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Address � 2
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Ciry State Zip Phone
I understand my rights as stated above.
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Signature
DATE TIME
CITY OF ORONO CALLED IN V a
INSPECTION NOTI SCHEDULED
PERMIT NO. oMPLETED �
ADDRESS 2��F
OWNER � K 'e-- CONTR. i
TELEPHONE NO.
� DESCRIPTION � � � �
t� 01 FOOTING
11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
� 1p WATER HOOK-UP 17 SITE INSPECTION
Z 04 WALL BD.
/� 14 SEWER HOOK-UP O6 PROGRESS
Q p5�FINAL p� COMPLAINT
� 07 DEMO-SITE 27 SEPTIC MAINT.
J 15 SEPTIC INSTALL. 22 FOLLOW-UP
07 DEMO-FINAL
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
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