HomeMy WebLinkAbout1999-012122 - tear off reroof � � PERMIT
� �CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 '„�r��,�;,:•�_�
Crystal Bay, Minnesota 55323 Permit Number: __ _
(612) 249-4600 Date Issued: :
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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AP PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ Date Received:
Entered By: Pernut#: �B�,�,b
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 ONTRACTOR_/
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JOB SITE ADDRESS: I � -� �} (�i �l�-.2 �`�'� ZIP: �-� -� � �� I
NAME OF OWNER: �f C� � c� i,J PHONE: (home) �}�5= �'�� ��
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MAILING ADDRESS: j � � t� �-�.'���`�j� CITY: �����GZ[,� ZIP:�� _:���
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CONTRACTOR: I ' �o PHONE: (�I �) �l�G Co L��1 �
CONTACT PERSON: 1 � ER .� Z- , ���-" �
MAILING ADDRESS: +-j`�1? ��� �3 v<<� CITY: � ZIP: � ��-f� �
STATE LICENSE: # C.Q��-t'�--
ARCHITECT/ENGINEER: PHONE:
MAII,ING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPQ SED WORK(describe in detai�:-j � l ��� � � �'`5��.c..� ` ��C
�l�l Gti--�2�.'S � 'v'1 �� �� �,--�•-� .
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ / �� � �J � � �
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 thi 's not a permit and work is not to start without a
permit; and that the work will b2 in ccorda ce w' h the approved plan.
APPLICANT'S SIGNATURE• � DATE; � Z'" C
NOTE! Parade 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 RIGHTS OF SUBJECTS OF DaT<1
Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secoon.
Subd.�. Information reqirired to be given individual. An individual asked to suppiy private or confidenrial data concerning himself shall
be informed of: (a) the purpose aod iatended use of the requested data within the coilecting'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any laiown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the identity of other penons or enaaes authorized by sta[e or federal law to receive the data. This requiremen[shall
not apply when an individual is asked to supply invesrigadve data, pursuant to secuon 13.82, subdivision�, to a law enforcemeat ofFicer.
The commissioner of re�enue mav place the noace reauired under ehis subdivision in the individuai income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data b�individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject
of s[ored data on individuals,and whe�her it is classiFied as public, private or confidendal. Upon tus funher request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be uuormed of the conten[
and meaning of that data. After an individual has been shown[he private data and informed of its meaning,the dara need no[be disclosed to him for
six mon[hs thereafrer unless a dispute or acaon pursuan[to this secaon is pending or addiaonal data on the individual has been coilected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry
may require the requesting person to pay the accual cosu of makine, certifying, and compiling[he copies.
The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot compiy with the request
within that time,he shatl so inform the individual,and may have an additional five days wichin which to comply with[he request,zxcluding 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 pm�are
data conceming himsetf. To exercise chis right,an individual shall nodfy in writing che responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccunte or incomplete and attempt to norify past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes the dara to be correct. Data
in dispute shall be disclosed only if the individual's sta[ement of disagreement is included with[he disclosed data.
The determination of the responsible au[horiry may be appealed pursuan[to the provisions of the adaunistradve procedure act relating to
contested 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 permit or license from the City of Orono or any of its departments may require you to fumish 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 pernut or license requires Council action to approve, some information may become
public.
5. 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature