HomeMy WebLinkAbout1999-011647 - tearoff/reroof PERMIT
' C'irfY �F ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: _.;;,.;;: „-,F,:�;;
(612)473-7357 Date Issued: i:� ;;�;��;
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARYi i
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CONTRACTOR: , OWNER:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ v� 7 3. �,� Date Received: � / C _
Entered By: �a�L __ Permit#: `
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CITY OF ORONO - BUILDING PERMIT APPLICATION ,
All information must be submitted in full before plan revie�v «-ill be started. .
(please print all information) :
_M �' . � ���------�----
THE APPLICAI�'T IS: � (circle one) OSVNER O CONTRACTOR -
JOB SITE A.DDRESS: I C: S (-{� r� -E- ►.� - :�, �/� ZIP: S S�`� 1
� � PHOivE: (home) �r_� Z--�� �� �� ��
r�ra�� oF o���x: ��a� �� ���� � 1 ?
� - (work) �
Nzaa,�rG�Dr.Ess: � �� s -+-I�� r �-d���2crrY: �.�-��� c z�:�.�
CO�ACTOR: ��c� C�C.�= c- Z.�, -� PHONE: � �l � �-E �3` ��r 7 7
CON7'ACT PERSON: ��r � {-(�.��1,�-,� MOBILE/PAGER: �______
IVIAILI�'G ADDRESS• �--Q�4 � �<<s ���CITY:(,�x��� s� .�-� ZIP: �`� l�
STATE LICE�'SE: #. ' c c,c� � _
ARCHIT'ECT�E�'GT�i TEER: P330NE: -
�Itii'G ADDRESS: CITI': ZIP:
tiAME: REGISTRATION#
TYPE OF tiVORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED�YORK(describe in detai�: ��ti C��-� `� ���� ��'�" �- ���'c�`'ti' S�`����
STORIES: SQ.F'EET OF EACl3 FLOOR:
NO. OF BEDROOiVIS: GARAGE STALLS: ATT. DET. �
� � �.
EST .Il-i IA,TED CONSTRUCTION VALUATION (excluding land): $ 1(� crT� .
I hereby apply for a buildina permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance wich the ordinances and codes of the City and with
the State Build�n� Code; that I understand this is not a pennit and work is not to start without a
permit; and that the work will be ' �ac ce with the approved plan.
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APTLICA��'T S SIGNATURE: i - _ -�-�--
NOTE! Parade of Homes events require separate permit approval by Police Department and
� City Council 60 days prior to tke event. Non permitted events wilt not be allowed. �
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Sec.13.OS RIGFiTS OF SiJB,TECTS OF DaTA •
Sabd. 1. Type of data. The righ�s of individual on wham che data is scored or to be scar.d shall be as set forth in this section.
Subd.2. Information reqiured to be given indiv�dual. An individuaI asYed ta supply privam or confideadal dara concerning himself shalI
be infors.ed af: (a)the purpose acd inceaded use oF the tequesced dara wichin the coIIecang�tate ageacy,polidcal subdivision,ar scacewide rys::m;
(b)whe�e:he;..ay r.Fuse or u.le3ally tequir.d ro suppiy the r:quesud data:(c)aay laiown coasequeace arisiag from his supplying or refusing co suppty
privace or con:;Cer.c3.1 dats;and(d)che ideadry af o�herpenoas or enades auc�orized by suce or federal law to rnuivz t�o da3. This requircmenc shalI
not apply when an ir:dividuaI is uked to supply invcsdgadve daa,pursuaac ro secdon 13.82,subdivision S,w a law enfaccement ofncer. . �
'I�c_cer.unissioner of revenue mav niacr �he nodc- rauird und-r this subdivision in the individual income t+z or orooem taz refund
instrucaocu insuzd of on chose forsns.
Subd.3. Access to data by indiridual. Upon roquesc to a responsibie auchoriry,an individual shall be informed whechen c�is[he subjecc
of stor.d dan on individuais,aad whe�her it is c[assiFied as public,private or conF.denaal. Upon his fur�her requesc,aa iedividual who is ttie subjcu
of stored private or public dam on individuaIs shall be shown the dara wichout any charge to him and;if he desues,shall be infocmed of the eon�anc
ar.d meaniag a[�4at dara. Afcer an individual has been shown the priva�e daa and informed of ic�meaaiag.[he daca ne:d not be d'uclosed to him for
six monchs ehereafur unless a dupute or acaon pursuanc co this secdon is pendLlg o�addidoaal daa on che individual has been collecc:d or ereac.d.
The cesponsibie auck:ariry shall�provida eopies of che priva�o�public data upon mquest by che individual subject of che data. The responsiblo auchoriry
may requir_the r_quesdng person to pay�he accual coscs af rn3king,eerrifying,and eampiling che copies.
The rspansible auchoriry shaIl comply immedia�aty,if possible,wi�h any requac madc pursuanc to�his subdivision,or wicfun five days oF
the da�e of rhe cequesc,ezcluding Sacurdays,Sundays and legal hotidays,if immediate compliance is noc possibie. If he canaat comply wich the requesc
wichin tt�ac dme,he shall so inform rhe individual,and may have an addidonal fiv:days within which to comply wich the requesc,exciuding Satucdays,
Sandays and legal holidays.
Subd.4. Procedure when d�ta Ls not accurate or eomplete. An individual may eonc:sc ehe accuracy or comple�eness oFpublic or private
dara concerning tiimself. To ezeccise chis righ�,an individuaI shall nodfy in wridng che respoasible auchoriry describing the nature of the diugreemeac.
'Ihe responsible au�horiry shall wichin 30 days ei�;er: (a)correcc eha data found to be inaccurdc�or incomple�e and aaemp�to nodfy past racipiencs af
inaccurace or incamplece data, including recipicncs named by che individual;or(b}noaFy the individual thac he believos�he data to be correc�. Data
in dispu�e shall be disclosed anty if the individuai's statement oE disagreement is included wich the disclosed data.
The decerminadon of the responsibta auchoriry may be appealed pursuanc to the provisions of che adminisaarive procedum act relating to
eontesxd eases. •
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Rights of subjeccs of data", we would like to inform you tha[your request
for a pemut or license from the Ciry of Orono or any of its departments may require you to furnish certain private or
confidential information.
You ue notified thar.
I. The information you furnish will be used to decermine your qualification for the permit or license requested.
2. You may reEuse to suppty data, but refusal may require that the City deny the permit or license.
3. The information may be shared wich o�her local, stace or federal a�encies to the excenc necessary to process
the permit or license.
4. If your requested permit or license requires Couacil action to approve, soaie information may become
public.
5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on.yourself.
6. Your full name is required to process this applica�ion or perm.ic.
Firsc ,Ltiddle Last
Addreu
Ciry �, Sate Zip Phone
I unde st y ri ts s ted above.
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