HomeMy WebLinkAbout1999-011353 - tear off/reroof ERMIT
� OF ORONO PERMIT TYPE:
750 Kelley Parkway- P.O. Box 66 Permit Number: �:.€-i T F �::��jt�
Crystal Bay, Minnesota 55323 ;�;�, �,:-;�:=;
(612) 4�3-7357 Date Issued: � = J�
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPUCANT/PE ITEE SIGNATURE ISSUED BY:SIGNATURE
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. Total Fee: $ � . D Date Received: �w �.,��. '� "p'
Entered By: Permit#: 1 � 3 5`3 �-
CITY OF OR NO - BUII.DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started. .
(please print all information)
THE APPLICA�'T IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: � -� �-(�' ZIP:
NAME OF OWNER: � C�1 PHONE: (home) �-/7 �^����
(work)
1�IAII.I�i iG ADDRESS: — �_CTTY: �'jYO� C� ZIP:
CONTRACTOR: 6 � PHONE: ��{I 't�C� �
CONTACT PERSON: OBILE/PAGER:
MAII..L�'G ADDRFSS: CITY: L ZIP: c��/
STATE LICENSE: #�"�2c�� S S-(o b
ARCHITECT/El\'GINEER: PHOi�TE: �
iVIAII..ING ADDRFSS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition essory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: 2 12.Iap� -- -��c�'C �T � � $Q
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: _ATT. DET.
ESTII-i IATED CONSTRUCTION VALUATION(excluding land): $ �� �9�7• v� .
I hereby apply for a building permit and I acknowledge 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: _ DATE: ���Pr�
NOTE! Parade of Homes events require separate permit approval by Police Depariment and
City Council 60 days prior to the event. Non permitted events will not be atlowed. �
. �. ,
Sec.13.Q4 RIGHTS OF SLTBJECTS OF DAT.�i '
Subd. 1. Type of data. 'Ihe righcs of iadividual oa whom rhe dan is stoced or oo be swced shall be u sec forch in�his secdon.
Subd.2. Informaaon req�red to be givm indiridual. ?►rs iadividual asked to suppiy privace ar confidecdal data concerniag himtelf shall
be infocmed of: (a)the purpose aad inreaded use of che requured dan wid�ia the collecdag ttate agenry,poGrical subdivision,or sratewide system;
(b)whecher he may refuse oY is.legally requirzd to aupply the requesud data:{e)aay Imown coauquence uising from his supplying or refusing to suppty
privace or confidendal data;and(d)the idenary o[o�hu persaas or earides aurhorized by snte Or fedecai law ro receive che daa. This requiremenc s6a11
noc apply when an individuat is uked to supQly invadgadve dam,pursuanc ro secaon 13.82,subdivisioa S.w a Iaw entoc�ement officer.
The cec�missioner of rcvenue mav plac- the nodc- r-auired under chis subdivision in che individua! income tax or orooem taz cefund
inscrueaoas inscead of on diose foRns.
Subd.3. Aceess to data by indiv{dual. Upon requesc to a responsible authoriry,an individual shall be informed whaher he is the subject
o[stored daca on individuats,and wheeha ic is elasa�ed as public,private or confidendal. Upon tiis fucther cequest,aa iadividual who is the subjecc
of smred privace or public daa on individuals shall be shown ehe dara wirhouc any charge ro him and;if he desires.shall be informed of ehe contenc
and meaning o[that daa. Af�er an individual has been shown the private dan and informed of ict meaning,the dara need not be d'uclosed oo him for
siz monttu thereaher unleu a dispuu oc acdon pucsuanc w this secdon is pending oc addidonal data on the individual hu been collected or created.
The responsible authoriry shall provide copies of the privam or pubtic dara upon request by the individual subject of rhe data. 'Ihe responsible authoriry
may nquire�e nquesdng person to pay the accual cosu of makiag,eerdfying,and compiling d�e copia.
The responsible aurhoriry shall comply immediacely,if passible,wieh any requesc made pursuanc w chis subdivision,or wichin five days of
the date o[the request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is not possible. If he canaot comply with the requesc
wichin tbat ame,he shall w inform the individual,and may have an addidoeal five days within which to comply wich the request,excluding Saturdays,
Sundays u�d legal holidays.
Subd.4. Procedure whea data is not accurate or eomplcte. An individual may contest the accuracy or eompleteneu of public or private
dara eoncerning himsetf. To exercise this righG an individual shail noafy in wridng ehe respoasible aurhoriry describing the naare of�he disagceemeac
'Ihe nspoasible auehoriry shal(within 30 days either: (a)correcc rhe data found to be inaccunte or incomple[e and atumpt w nodty past recipienu of
inaccunte or incomplete data,inciuding recipienct named by the individual:oc(b)nodfy the individual that he believes[he dara ro be eocrect Data
ia dispute shall be disclosed only if the individual's statemenc of disagreeme�c is included with the discloud data.
The decermination of the responsible au�horiry may be appealed pucsuanc�the provisions of the adminisaarive procedure aet relating to
contesoed cases. •
DATA PRIVACY ADYISORY
In accordaace with M.S. 13.04,Subd.2, "Righcs of subjects of data",we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of its departments may require you to fumish certain private or
coafidencial 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 supply data, buc refusat may require that the Ciry deny the permit or license.
3. The information may be shazed with ocher local.state or federal agencies to the ettent necessary to process
the permit or license.
4. If your requested permit or license requires Couacil action to approve, some informatioa 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 permic.
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Finc �tiddle � � Lasc
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Ciry Sam Zip Phone
I understand my rights as stated above.
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