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Home My WebLink About1995-007513 - chimney repair , � PERMIT � �ITY OF ORONO • :='50 Kelley Parkway- P.O. Box 66 PERMIT TYPE: _ :-«,.L. Crystal Bay, Minnesota 55323 Permit Number: ;:i�`i:_�-,��=: �� (612) 473-7357 Date Issued: SITE ADDRESS: _ _ __ _ _: ,; ,;:.: ,,.:_ r ;-�;.� -. .: -. :,-� - - - - - .._- . :�.: :.. ,..... 3 !-:_.:':' DESCRIPTION: ,-. . , : . - - _ _ _ _. .. ::: , : ..._ :,.. . _.._ . . .;-� � = �_- __�.�1 _ ---• . _. _ . ,' =E� _� . _. .'4z:t��i; it,E___ �'�.,�, 1,��;;,.l.:;� �:�:�:-.. I Y�� F:i��'i t`;:�t--: �=z;, :�"(�:F�f� � I ��r��: ��E. �C��`?��`: I '.:,i_�'t? € i��."-� _ . � •:� I I � CONTRACTOR: :` � �_:i i:,<�.:.,._ ._ °;, � . � �' OWNER: . . _ . ._ . .. - - - _ . : : :: . -: : ; ; .:: : : ,.:;�. ; . � :, . :•,::: �: . f�! �..: .. . . .. . . . . .::.. . .•i �:i. ... ... . _.. ... ._ _.... '. ' "_...... _ _ .. ...... . . .._ . . � .::. ... ! S � ' • '_' '�. � � :t i t ..r�_:_ ..i .• .1'ri i S :�J '_ ._ + : _--< �: . :-.'. . 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En�ered Bv: ��,�, Permit7: �l'��-� CITY OF ORONO - BIJILDING PER�IIT APPLICATION �LL L��ORtiI�TION�tI.�ST BE SLB�tIT'I�ED �i F'UZL BEFORE PL��t REVIE�ti ti�II.,L BE ST:�RT'ED THE �PPLIC:�ti'I' IS: M (circ.e one) O`tiNER OR CO�TR�CTOR JOB SI'I�E �.DDRESS: � _ \'\� � { , , \ ;`� , { ZIP: ��. j N�I�LE OF OtiVNER: �� '� _� ��. � '�� _� PHO�tE: (home)�� t �"_, �_� � � � � («�ork) 1IAILL\'G:�DDRESS: ` r�.� ��',��`��'I� � CITY:� `'\, \� �_ \ ZIP: �� _ _ \ ,^ CONTR�CTOR:�� `\� ` ` � � � C�� , PHO\�: `� �1-� - � . g>�� .1�10BILE PHO�IE/P:�GER: 1�IAILL�G�DDRESS:�� ,�' �� CITY: `�� ,_:� � ZIP: ; � ` �i � �� STATE LICENSE: � �� 1 1 - �RCHTI`ECT/E�GLv"EER: PHO��E: l�1AILL\G�DDRESS: CITY: z�= ��,:vIE: REGISTR��TIO�t fi TYPE OF `�ORK: New Addition A essory Structure Move Rer�ode��Alte:ation � TT �ndAlteranon `VORIi describe indetail): �� ' �,�11 ' 1 �" —� ii� PROP�SED � � ! �, �, A � \ � � t ,� � � � .� � �� 4 STORIES: _____ SQ• �ET OF EACH FLOOR: NO. OF BEDROOI�IS: G�,I2�iGE ST_-�LLS: �TT. DET. ESTI:ti�1�TED COrSTRti CTION V:�LUaTION(escludingland): � �-� ,�� '�� T hereby apply for a buildin� permit and I ac!cnowledQe that the information above is complete and accurate; that the work will be in coniormance wirh the ordinances and codes oi the Ciry and with the State Buildin� 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 �vith the approved plan. APPLIC�'VT'S SIGNAT'LJRE- �—:�_ _� � � `�� DATE• �� i� � ,�. 1 � NOTE! Parade of Homes events require separate permit a�proval by Police Department and City Council 60 days prior to the event. Norz-permirted events wi11 not be allowed. . ' Sec.13.0�1 RIGHTS OF SLBJECTS OF D,�T�1 Subd. 1. Type of data. "Ihe nghrs oi individual on whom che data is scored or to be stored shall be as se�for[h in this secrion. Subd.2. Information required to be�ven indi�idual. .�n individual asked to supp(y private or confidendal data concerning himself shall be informed of: (a) the purpose and in[ended use ot the requested daca wi[hin[he collecting"stace agency, polidcal subdivisioo, or statewide system; (b)whecher he may reiuse or is legally required to suoply the ctquested data;(c)any lmown consequence arising from his supplying or refusing to supply priva[e or confidendal data;and(d)the idenn[y of o[her persons or er.tioes au�horized by state or federal law to receive the data. This requirement shall no[apply when an individual is asked to supply invesagaave dara, pursuan[to secdon 13.82, subdivision�, co a law enforcement o�cer. The commissioner of revenu r�av olac� cnA rodc� r�auired under �his subdivision in the individual income raz or oropem [ax refund inscructions inscead of on :hose forms. Subd. 3. �ccess to data by individual. lioon request to a responsible authonry,an individual shall be inYormed whether he is[he subject ot stored data on individuals, and whecher it is classifled as puolic, pnvate or conndential. Upon his furcher request, an individual who is the subject of stored private or public data on individuals shall be snown the data wi�hou[any charge to hun and, ii he desires, shall be inYormed of[he content and meaning of thac data. .�fter an individual has been shown che private data and informed of iu meaning, the data�eed not be disciosed to him for six mon[hs [hereafter unless a dispu[e or acdon pursuant co [his section is pending or addidonal data on the individual has been collected or crea[ed. The responsible auchonry shall provide copies ot the pncaa:or puolic data upon request by the individual subject of the data. The responsible au[hori[y may require the requesting person to pay [he actual coscs of making, cerdfying, and compiling the copies. The responsible authority shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or wirhin five days of [he date of the request,excluding Sanirdays,Sundays and legal holidays,if immediaee compliance is no[possible. If he cannot comply with the request wi[hin tha[time,he shall so iniorm the individual,and may have an addidonai five days wichin which to comply with che request,excluding Sa[urdays, 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 priva[e data concerning himself. To exercise[his nght,an individual shall noafy in wriang the responsible authoriry descnbing the nature of the disagreement. The responsibie authoriry shall within 30 days either. (a)correct the data found[o be inaccurace or incomplete and attempt to nodfy past recipients of inaccurate or incomplece data, inciudine recipients named by [he individual; or(b) notity the individual tha[he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's sra[emen[of disaereement is included wi[h the disclosed data. The de[ermina[ion of the responsiole au�horiry may be appealed pursuanc ro the provisions of the admuusaanve procedure ac[ relating to contes[ed cases. DAT� PRIVaCY �,DVISORY In accordance wi[h M.S. 13.04, Subd. �, "Rights of subjects oi data", we would like to inform you that your request for a permit or license from che City of Orono or any of its departrnents may require you to furnish certain private or confidential information. Iou are r.o�ified tha�: 1. The information you furnish will be used to determine}�our qualification for the permit or license requested. 2. You may refuse [o supply data, but refusal may require that the Ciry deny the permit or license. 3. The information may be shared with other local, state or federal agencies to�he extent 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 cenain rights under �1.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. � . � � -� �� . �� . First_ �� f�ddle� � Last �� j��i � � � ��' �� 1 � _ �ddress (� r . � - I ' � ��'`� V�V �\ �\ �( � �(�!, � V ' - � � � � � 1t � � � City � Stare Zip Phone I understand my rights as stated above. / �._� , � , • , � ; '�� , �: ;" : � � , . � \ ,, � _ �� r� I � ;� � A � �� _ ` _ Signature ____�,