HomeMy WebLinkAbout1998-010737 - re-roof PERMIT
CIT�( OF ORONO
,s PERMIT TYPE: -::�F`..;;�;,�;�;
2750 Kelley Parkway- P.O. Box 66 Permit Number: �_�; f,��;':;�;
Crystal Bay, Minnesota 55323 _ _ _ _ _
(612) 473-7357 Date Issued: _ ;f_��-:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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PLICANT�PERMITEE SIGNA E ISSUED BY:SIGNATURE
" Total Fee: $ �9�,j Date Received: 9��- 9 X
Entered By: � Permit#: /�1-�-�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforrrtation)
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: J�� � ZIl': .S/���
c
NAME OF OWNER• �r�- C�r� S �s�'�xor�: �no�e� y�/— ��.5�
CI � � �W���n.
MAILING ADDRESS: �.� � y CITY: d ZIP:
CONTRACTOR: �k��'�` PHONE: �'—��3 2
CONTACT PERSON: e f MOBILE/PAGER: �2 2 s
MAILING ADDRESS: �y�� r e i k� CITY: a r (C ZIP:
STATE LICENSE: # l (lJ�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: �
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�y ac/
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ / a��
I hereby apply for a building permit and I acknowledge that the information above is complete and
a�curate; 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 ' cordance wi the approved plan.
APPLICANT'S SIGNATURE: DATE: � � !��
NOTE! Parade o�Homes events require separ e permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGH'TS OF SUBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored s6all be as set forth in this secdon.
Subd.2. Information req�dred to be given iadividual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and inunded use of the requested data within the collecdng§tate agency,poliacal subdivision,or statewide sysum;
(b)whe[her he may refuse oY is kgally required to supply the requested dara:(c)any lrnown consequence arising from lus supplying or refusing to supply
private or confidenaal data;and(d)the idenriry of ocher persoas or eatities authorized by state or federal taw to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve dara,punvant to section 13.82,subdivision 5,to a taw enforcement officer.
The commissioner of revenue mav alace the notice rewired under this rubdivision in the individual income tax or nroaertv tax refund
insnvcdons instead of on those forms.
' Subd.3. Access to data by individual. Upon request to a respoosible aurhority,an individual shall be informed whether he is the subject
of stored data on individuals,and whecher it is classified as public,private or confidendal. Upon his further mquesG 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 coatent
and meaning of d►at data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for
six months thereafur uniess a dispute or acdon pursuanc to this secdon is pending or additional data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the iadividual subject of the data. The responsible authoriry
may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry sha(1 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 not possible. If he cannot comply with rhe request
within that time,he shail so inform the individual,and may have an addiaonal five days withia which to comply with the request,ezcluding Saturdays,
Sundays a�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 ehis right,an individual shall nodfy in wriring the responsible authoriry describing rhe nature of the disagreement.
Tt►e responsible au�horiry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data
in dispuce shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data.
The decerminadon.of the responsible authority may be appealed pursuant ro the provisions of the adminisacaave procedure act reladng to
contesud 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 furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to suppiy 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 n e is required o process this application or permit.
i�= �U� .�CItiO�Y'�^
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First nJ Middle �t
j 5zf� -�-_� //�/
Address
City
� ��r` State Zip Phone
I understand my rights sta d above.
Sig ro