HomeMy WebLinkAbout1998-010335 - tearoff/reroof PERMIT
CI�+Y OF ORONO PERMIT TYPE:
'' 2750 Kelley Parkway- P.O. Box 66 r��_?��L_Lf��`��.�
Crystal Bay, Minnesota 55323 Permit Number: ;��, :_;_;��;.�
(612)473-7357 Date Issued: �}��•t-j�;,;_ _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE `�
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Total Fee: $ Date Received: ,
-Entered By: Permit#: /U,33 S
CITY OF ORONO - BUII�DING PERNIIT APPLICATION
A.11 information must be svbmitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
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JOB SITE ADDRESS: `�,- �.� %r r��''�� � � ���� ZIP: ���� �� `�
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� NAME OF OWNER: ,��`�t�i/ ��I��� ���1�"� PHO�tE: (home)
(work)
MAII.ING ADDRESS: ����S � ������'��1 �1 CTTY: �'1 i"'►��i�� ZIP: S�
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COti'TRACTOR: ��'�����Et��✓�► CF��1�� _ PHONE: S�f� �_�����
CON'TACT PERSON: `�f'' �' , C��r� -. MOBILE/P R: ,
MAILI�i TG A.DDRESS: �' . �� � � CITY: �� ��R�l�� ZIP: �.l`�%�
STAT'E LICENSE: # at��( `{ �a��—
A.RCHIT'ECT/ENGINEER: PHO��TE:
;VIAII.,LYG ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF tiVORIi: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED`VORK(describe in detain: I�� �c-�,,� ���.�
STORIES: SQ. FEET OF EACH FLOOR: �
NO. OF BEDROOMS: GARA.GE STALLS: ATT. DET.
ESTiI�i IATED CONSTRUCTION VALUATION (excluding land): $ ���(����1
I hereby apply for a building pemnit and I aclrnowledge 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 BuildinJ 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.
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APPLICANT'S SIGNATURE: l', `.�"���-/'!/—'J�� DATE: �
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permiited events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF D�T?,
Subd. 1. Type of daea. The riehcs of individua!on whom the data is stored or to be s�ored shall be as sec forth in this secaon.
Subd.2. Information reqirired to be given indiridual. An individual asked to suppiy privace or confidzaaal dara coacerniag himself shall
be informed of: (a)the purpose and inrended use of the requesud dara within the collecdng�tace a,eacy,polidca!subdivision,or sratewide rystem;
(b)whecher he may refuse or is legaily requird to supply che r:quested dara:(c)any lrnown coasequeace arising from his supplying or refusing to supply
privace or confidendal dara;and(d)the idendry of ocher persoas or enddes auchorized by stat�or federal law to receive tha data. This requiremeac shall
no[appiy when an individual is asked to suppiy invesrigarive dam, pursuan�to secaon 13.82,subdivision 5, to a law enforcemeat ofFccer. -
The commissioner of revenue mav place che noace rauird und�r this subdivision in [he individual ir.come nx or prooem tax refund
inscrucdons instead of on�hose forms.
Subd. 3. Access to data by iadividual. Upon requesc to a responsibie auchoriry,an iadividual shall be informed whether he is the subject
of scnred dan on individuals,and whecher it is classified as pubiic, privace or co�denrial. Upon his furrber request, an individual who is the subjecc
of stored privace or public daca on individuals shall bo shown[he dati wichout any charge to him and;if he des'ues, shall be informed of the contenc
and meazung of chat data. Aher an individual has been shown che privace data and informed of ies meaaing,[he data need noc be disclosed to him for
six monchs[hereaiter uriless a dispute or acdon pursuanc to chis secaon is ptnding or addidonal daca on the individual has beea collecc�d or creared.
The responsible authoriry shall provide copies of the privace or public data upon reques�by the individuai subjecc of the data. Tiie responsible authoriry
may require the requesring person to pay the accual coscs of making,cerdfying, and compIling the copies.
The responsible au[horiry shall compiy immediacely, if possible,wich any request made pursuant to this subdivision, or wi�hin five days of
the dace of che requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply wich rhe requesc
within�hac time,he shall so inform ehe individual,and may have an addinonal Five days within which to comply wi�h�he requesc,excluding Saturdays,
Sundays and Legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or pri�•ate
data concerning himself. To exercise this ri¢hc,an individual shall nori"ry in wriang che responsibia authoriry describing the nacure of che disagrecmeac.
The responsible authoriry shall within.i0 days ei�her: (a)comct the data found to be inaccurate or incomplete and aaempc to nodfy past recipien�s of
inaccurdte or incomplete data, induding recipien�s named by �he individual; or(b)nodfy [he individual thac he believes�he data to be correcc. Data
in dispute shali be disclosed only if the individual's sc3tzmenc of disagr:emen�is included with[he disclosed da�a.
The de�zrminarion of the responsible au�horiry may be appealzd pursuant to che provisions of the admirustrarive procedure act relaring to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts 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 deparcments may require you to fumish certain private or
confidential information.
You are notified that:�
1. The information you furnish wiil be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, buc refusal may require that the City deny the permic or license.
3. The information may be shared wich ocher local, state or federal agencies to the excent necessary to process
the permi[ or license.
4. If your reques[eci pernut or license requires Council ac[ion to approve, some 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 application or permit.
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I understand my ri;hts as stated above. �
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