HomeMy WebLinkAbout1999-011794 - tearoff/reroof/cedar PERMIT
� �i TY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��=�2=-=���`���
Permit Number: .-
Crystal Bay, Minneso 55323 -'� i��"_�
(612)47`9=�3�7���'_ �F,aa Date Issued: TM,� :__
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT PERMITEE SIGN URE ISSUED BY:SIGNATURE � .l�y
Total Fee: $�;1�S' -1 �� Date Received:
Entered By: �'.l, . Permit#: ii `7�`-� �
. CITY OF ORONO - BUI�,DING PERMIT APPLICATION � �
All in�orma�ion must be submitted in full before plan reviejv �-ill be started. . �
� (please prinl all information) . . '
. . � � -- -- I
_ --- . . . . ,
'l�'HE APPLICA.IrTT IS: � � (circle one) . O�NER OR N � ;
� ZIP: �� S,6 _ � I,
JOE SITE AUDRESS: _�=75 M�r^ �- ,
NA.N�E OF Oti'Y��R: Lcc.d���- �//'c.s� PHONE: (home) y 7 3��3�a
. work
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IYiAILI�'G AJDDRFSS: 175 -„�i�-t��'� �i_ CITY: c�o-ro ZIP:yz;i��-
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CO�ACTOR: �r/�STic-rr� . J I PFiONE: � /-v 3c��� �I
CONT'AC3'PERSON: � M ILE/PAGER:
MA�II.'�i'G ADDRESS: '17c� /3'``� i9,.P �v_ _CITY: l � o�, ZIP: -y;�� �
STATE LICEi�TSE: # �o/,�s'��� �
. . . . �
ARCHI'TECT/E\TG .l�i TEER: PHOti'E:. � i
N1A.II, .I�i'G ADDRESS:
CITY: ZIP: '
� ���: REGISTRATIOv�
�
TYPE OF '4YORK: New Addition Accessory Structure �
Move Remodel/Aiteration�_ Land Alteration ;
�
PROPOSED ti'YOR�(describe in detai�: /cs�'6��/r��� '
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STORIES: SQ.FEET OF EACS FLOOR: �
NO. O� BEDROOiVSS: GARAGE STALLS: ATT. DET. � - . . �
ESTIitiTATED CONSTRUCTXON VALUATION (excludina land): $ 6� �/�- �
I hereb a ly for a building permit and I acknowledge that the information above is complete and �
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accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Buildin� Code; that I understand this is not a permit and work is not to start without a
pernuc; and thac the work will be in acc ce with the approved plan.
APPLICAi�TT''S SIGNATURE: �r� - DATE: 8 o2S�"T�y
NOTE! Parade o,f Homes events require sepa ate permit approval by Police Department and
� City Counci160 days prior to tke event. Non permitted events will nof be allowed.
. . . . � ..
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Sec.13.Q4 RIGFiTS OF S'ttB,TECTS OF DATAi - - • �
Sabd. i. Type oC data. The righcs of iadividual on whom the data is sroced or m be smred sbalI be u sec focth ia this scction.
� Subd.2. InformatIon nquired to be givm individual. ,+.n individuaI uked w suP4lY Pri'��or eoafideadal daa caaceraing himself shaIl
be infoc�ed oF (a)the purgase and tacended use of the requesced dara wichia the eoilecdng 3tate agenry.polidal subdivision.or sa�ewide rysem•
' � (b)whet�erha:..ay r.Fust or u_IegalIy requ'u:d to supply.che r.quesctd ds�:(c)aay latowa eaasequeacs arisiag fi+om his suppiying or;efuting to supply : .
. privaca or coti.der.caI dam;ar.d(cn c�e ideaary o[o�her persoas o�eadda aucsorizcd by scsce or fe�e�'!�w;�r.c:ive t�e d3c�. This r.quiremeac shatl`
net appiy w::ea an ir.dividuaI is uked to supply invuagidve data,pursuaat ro secdoa 13.82,subdivisioa 5,oo a Iaw en[ec�emeatotneer. •• . - �
The eer.unissioner of revenue mav otaca the nodc�t-auir-d und-r this subdivision in the'individual tncocrte az or oroaem raz refund
inmucdons�nscezd of on those foessLs. - . •
Subd.3. Aecess to datz br individual. Upon requesc to a cespoasible auchodry.an'mdividuaI shall be informed wheche�he u the subjecc
o[stoc:d dan on indtviduaLt.aad whechet ic is eIassifi:d u public,privat�or coaF.deadal. Upea his ttuther rquest,aa iedividual who is the subj:ec
of stocai priva::or publfc daa on iadividuaIs shall be showtt�he daa wic}saut u�y charge to him usd;il he duires.shatl be infocmed of the eoateac
and meaning o[dut dsa. Afur aa individual has beea shown the peivatB daci ar.d Informed ot ics meaaiag.ehe daa ne:d not be diselosed oo hun far
siz mondu themfur anlas a dispuce or aedon pursuanc w this secdon is pending oc aQdidonal daca on the iadividual has beea eaUec�d or ereac:d.
The tespotisibte audsoriry shallp�ovide eopies of ehe pcivaru or pubtic daa upon tequest by die individual subject o[the daa. The cesponsibte auchoriry
may mquire�he requadng person ro pay the accual eosu of making,eecdfying,aud eomp�ing the eoQies. '
The tesponsible authoriry shall eomply immedistety.if possible,wich aay request made pursuant co this subdivision,ar wichin five days of
the da�e of die teqaac.ezciuding Saturdays.Sundays usd legal hotidays,if irsuaediate eompliaace is not pouibTe. If he eanaot eompty wich the request
wi[hin that dme.he shall so inform the individual.and may have an addidooai five days wi[hia which to compty wich the cequest,exciudia'g Satutdays,
Sundays and le3aI holidays. . , . . .
Su�d.4. Procedure whea data is not aeeurate or fomplete. An individual may eon`st the accuracy or,eompleteneu af public orpdvate
dara eoneerning h�.:nsetf. To ezecche this righ�an[ndivtduai thall nadfy fa wridag the respomtble audtociry desen'biag the aaeuee of the disagreemene .
The nspoasib;o .�.:::oriry shall wi�hia 30 days either. (a)correct che dan found to be inaccunte or iacomplete�ed ac�empt to aoufy past recipiencs of
inaccucace or ince.—,.plece daca.inctuding�eeipiencs named by tbe individual;or(b)aoafy the iadivlduaI thai he believes the data to be eo�reet Daa
in dispuce shall be disciosed only it che individual's statemenc o!disagreem:at is taduded wi�h the d'udosed data.
, Zhe decemtinadon oi the cesponsble authoriry tnay be appealed pursuanc oo the provi;ions of the adminisQadve procedure ut relatiag to
eontes�d eases. ' . • � . �
� DATA PRIVACY ADYISORY �
In accordance with M.S. 13.04�Subd.2, "Ri�r.hts of subjeccs of data",we wouId like to inform you that your request
for a pernut or license from the City of Orono or any of its departments may require you to furaish certaia private or
confidential information.
You aze notified that:
1. The information you furaish will be used to deternaine your qualificacion for the permit or license requested.
2. You may refiue to supply data, but refusal may require that the Ciry deny the permit or license. � �
3. The information may be shazed with other local,state or federat agencies to the extent aecessary to process
the permit or license. �
4. If your requested permit or licease requires Council action to approve, some iaformation may become
. public, ' . � � • � : . � . . . �
�3. . You.have certai.n rights under M.S. 13.04�(availabie upon request) to review private data on.yourself. ` . . .
6. Your full na.tae is requi�ed to process this application or permic.
F�� � �r�a�� �� •
Addcess _ _ _ _
Ciry Sam Zip P�oae
I underscan ted above.
. � � . '
Signamre •