HomeMy WebLinkAbout1998-010546 - tear off reroof PERMIT
�- CI,�;.Y OF ORONO PERMIT TYPE: . ._
275 Kelley Parkway- P.O. Box 66 �:��_?�_�'I f•���
Crystal Bay, Minnesota 55323 Permit Number: ;;�t_;_,;��.,
(612) 473-7357 Date Issued: i,�;;J sY'_;:i 4�;w=
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
,; • .�il'otal Fee: $ ��,�j, �fo DateReceived: �—e� �'��
Date Approved:
Entered By: Permit#: �Q �'�
CITY OF ORONO - BUII.DING PERMIT APPLICATION
ALL I�Ii FORMATION MT1ST BE SUBi�IITTED IN FULI.BEFORE PLAN REVIEW WILL �
BE STA.RTED
TI3E AppLICANT IS: W (circle one) OWNER O CONTRACTOR M
JOB SITE ADDRESS: 3S�D v l� �e� Z�: 5.5�3�
� PHONE: (home) ��j- 6l��
NAME OF OWiYER: ��r.� �h r�s ���s��
(work) ����- d 5 7(�
MAILINGADDRESS: ���D �U � G CITY: (',j"vA/J Z���.3 ar
CONTRACTOR: � ��{T/ f `I/�� PHONE: %� 3 -3�53 6
viOBILE PHONE/PAGER: � 6l6 `3 3 3
�aa,�rGaDnxEss: !(�0 �t�' s7`- 5aut�. _crrY: l��yX�:,.3 z�:�-s3�
STATE LICENSE: # Q 3 S� ('o
ARCHITECT/ENGINEER: PHONE:
MA►II.INGADDRESS: CITY: ` Z�:
N�ME: REGISTRATION #
TYPE OF WORK' New Addition Accessory Structure
Move RemodeUAlteration Land Alt�ation
PROPOSED WORK(describe indetail):�/¢lr (J�� /�n/�t �E����
STORIES: _ SQ• �T OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTNi IATEDCONSTRUCTIONVALUATION(escludingland): $ �2 2 �
I hereby apply for a building permit and I acknowled�e 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.
APPLICANT'S SIGNATURE: ��N.P�( l %��i'�d�'��r` DATE: � " z —
NOTE! parade of Homes events require separafe permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
. � _- `�
Sea 13.04 RIGHTS OF SiJBdECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stoced shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data conceraing himself shall
be infotmed of: (a)the purpose and inunded use of the requested data within the collecting'state agency,polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the idenriry of other penons or endties authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesugative data, pursuant to secdon 13.82, subdivision 5,to a law enforcement officer.
The commissioner of revenue mav alace the nodce required under this subdivision in the individual income tax or proDerty taz refund
instnicrions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whethec it is classified as public, private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the dara without any charge to him and, if he desires, shall be informed of the content
and meaning of that data. Afrez an individual has been shown the private dan and informed of its meaning, the data need not be disclosed to him for
siz months thereaher unless a dispute or acuon pursuant to dvs secdon is pending or additional dan on the individual has been coilected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting penon to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authority shall comp(y 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 legat holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shail so inform the individual,and may have an addidona!five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy oc compieteness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in writing the rosponsible authority describing the nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and atiempt to notify past recipien[s of
inaccurate or incomplete data, including recipienu named by the individual;or(b)notify the individuai that he believes the data to be correct. Data
in dispute shall be disciosed only if the individual's statement of disagreement is inctuded with the disclosed data.
The deterrnination of the responsible authority may be appealed pursuant to the provisions of the adminisaadve 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 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 permit or license.
3. The information may be shared with other local, state or federal agencies to the 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.
5. You have certain rights 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 permit.
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First ddle Last
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Address c �� � �C 3 � 6 .
Ci� State Zip Phone
I understand my rights as stated above.
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