HomeMy WebLinkAbout1999-011804 - tear-off/reroof � , PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 :_:��i;
Permit Number: =.`.-,.;� �
Crystal Bay, Minnesota 55323 - - - -
(612) 249-4600 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ -:: , `:. :. ;�: _ -: - . :.: OWNER:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
�iTY OF ORONO � 6122494616 OS/10/99 10:31 � :03/08 N0:210
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Tou�Fee: s c�'l�'. 7 � n��e t�ei�cd: g/ a� �7��•'�
Entered By: Pet�mft N: s � o�l # 2 3 3 y
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CITY UF ORONO - BUILDIl�IG PERNIIT APPLICA'TION
AU 3oiormation mu�t be eubmitted tn full betore plais rcvi�v v�lU he started.
{plsase print atl t�o,�notdon)
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'THE APPLICAI�T IS: (ctrcle on�) OWNER 0 NTR�►CI'4
Jos SI'1'E ADDRESS: Z850 a� ��d UJa.�.l ZIP:
NAME OF OWNER: �1,���5 C,�vcQcr����e.. PHONE: (hoa�e) ��3-�122
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rsAII.�tG Annx�s5: 28so L;�f� a��h��c crrY: �� z�•
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CVN7CRACrOR: �a n�e 2 2 00���a _ PSONE: �9�'�y910
cornc�c�r�nsoN: �.►,c���� ��.5� MOBII.E/PAGER:
MAII.II�'G ADDRB�S: oo c,�. A-✓. S • CTI'Y: l��s. T•�': 55 �
STA1'E LICENSE: � Z D 0/2 D � ,
ARCHITEC'I'lENG�TEER: PHONE:
MAILING ADDRESS: C1'�'�� �'�.—.—..
NAME: �GTSTRATIO��T+l
TYPE UF WORK: New Additioa,�,. Acxesaory Sttucam_
Move Remodet/Atteratioa � Land Alteration�,
._____
PI�OP05ED WORH(descrtbe tn detal�: ��n. aCL '�'✓t�2�-ot�t
ST�R�S: _�______ SQ.FF.ET OF EACH�'LOOR:
N0. OF BEDROQtii.S: GARAGE STALIS: A'T'I'• DET. �
EST�IATED CONSTRUCTICEN VALUATION(�ccIud[ng�and}: � 7 0�D 4�
I hereby apply far a buildiag germit and I acknowled�e thac the information tbove is compk�e and
uxurste; thut tha work wiU be in confocmance with the ordinances and codes of the Ciry u�d with
tbe State 8tsildin�Code; that I uaderstand this is twt�pernnit a�rd work is not to �tarc aitbaut a
permit; utd �at th+e work wilt be in accotdat�ce wtth the approved plan.
APPLICAN'T''S SIGNATC)RE: DATE: --=��---�..._
NOTE/ Par+a�Anm�s svtnls requlre sepanatt pernttt approval by Polics Dtparlmtat and
G'yty Council 60 days pr�a�to tht�Yent. Non-ptrn�ted svents w�1I�tot bs allowed.
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Sec.13.04 RIGi3TS OF SL'B.TECTS OF DaTa
Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be stored shall be a� set forrh in this secaon.
Subd.2. Information reqirired to be�ven individual- An individual asked to supply private or confidenrial data conceming himself shall
be informed of: (a)the purpose and in�ended use of the requested daca wichia the collecdng'state agency,poliacai subdivision,or sratewide rystem;
(b)whecher he may refuse oY is legally required to sunply[he requested data;(c)any Fmown consequeace arising from his supp..ir.;or refusing to supply
priva�e or conndenoal data;and(d)the ider.::cy o�ocher persoas or endaes auchoriz:d by sta�e or federal law to receive cne data. Ihis requiremen[shall
not apply when an individual is asked:o sspply in�esagadve data, putsuanc to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav ofa.� che nodce reauired under this subdivision in the individual income tax or ro em raz refur.d
insttucaons instzad of on those forms.
Subd. 3. Access to data by indi�ldual. lipon request to a responsible authority,an individual shall be informed whether he is ch:subjzct
of stored data on individuals,and whecher it is class�ed as public, priva�e or conndendal. lipon his further request,an individual who is the subject
of scored priva�e or public daca on individuals shall be shown the dac3 wi�hout any charge to him and, if he desires, shall be informed o:the cor.:��_
and meaning of�hat data. After an individual hu been shown the privac�data and�.iormed of iu meaning,the data need not be disclosed ro hirr: -
six months thereafrer unless a dispute or acdon pucsuanc to ehis secrion is pending or addidooal dara on the individual has been collected or creat�
The responsi`ie aurhoriry shall provida copies of�he priva�e or public data upon request by the iadividual subject of[he dara. The responsibie au[hori.
requir^ : requesrirt�person to pay the acnial cosu of makine. cerdfying, and compiling the copies.
i n� ;es�e^r.::.= �^'horiry shall comply immediac�ty, if possible,wich aay reGuest madz punuant to this subdivision, or within five days o;
_a�of�.- .;ses.,excluding Sacurdays,Sundays ana iegai hul:.:avs,ii ir,.^�~�°'-=���=�P�:�.�=:s rot possible. '.:;e :Zanot comply W'"'.'he requ:st
w,cnin[hat dr..a,he shall so inform rhe individual,and may have an addirional fi�e days wi�hin which to comYi; ve:.��he request,excluding�aturdays,
Sur.days and le3al holidays.
Su'-:j.4. Procedure when data is not accurate or complete. An individual may contest che accuracy or compte[eness of public or private
ds�concemu:�himself. To exercise 4his rieht,an individual shall nodfy in wricing rhe responsible authoriry describin;the nacure of the disagreemenc.
,.:� responsible authoriry shall within 30 days eid:er: (a)correct the data found to be inaccurace or incompiete and attempc to noafy past recipienu of
T ._curace or incomplete data, including recipiena named by che individual; or(b)nodfy the individual that he believes the data to be correcc Data
_: dispuce shall be disclosed only if the individual's sta[emen[of disagreemenc is included winc�he disclosed da�a.
The de�erminarion of the responsible au�horiry may be appealed punuant to che provisions of che administradve procedure act relacing to
centested cases.
DAT� PRIVACI' :�.DVISORY
i_:accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to ir.'��rm you that your request
for a permic or license from the City of Orono or any of its departments may require you to furnish certain private or
c�nfidential information.
You are notified that:
1, The information you furnish will be used to detemune your qualification for the permit or license :equested.
?. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3, The information may be shared with other local, stace or federal a�encies to the extent necessary to process
�he pemut or license. r �^�•
4. Ir your requested permit or license requires Co�cii action to appro��e, some i�_�..____ton may beco�e
public.
�, You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
(, Your full name is required to process this application or perm.it.
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First
Ac'.d ress
State Zip Phone
City
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