HomeMy WebLinkAbout1999-011970 - tearoff/reroof � PERMIT
� � 'L`ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 - � � -
Permit Number: : ;..__�_' :�°�.:•:
Crystal Bay, Minnesota 55323
(612) 249-4600 Date Issued: :.E_. �r`�;«t_,�
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SITE ADDRESS:
DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: _ _
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��
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iotal Fee: $ Date Received:
Entered By: ,�, Permit�: �i ��7 U .
CITY OF ORONO - BUILDING PERMIT A1'PLICA.TION � �
All, information must be submitted in.full before plan revies� R-ill be started. . �
. (please prini ail information) . , . � i
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T'�3E APPLICA2�'�T` IS: � � � (circle one) . O�YNER OR CONTRACTOR _ � � �
JOB SITE ADDRESS: Z�: �
NAI1��E OF Oti��R: .��/ % /.s V' �S '��> � PHONE: (home) ��l� r-/C�j._",� ���� I
. � (work) � �
I�L4IL�G ADDF.ESS• �'��J�`��;/ ��r�;s l c�c�� CITY: �/� � �T�D•'� ��-s:7G=/�
CONTRACTOR: � PFiO�tE: �
CO�'TACT PERSO�►: � MOBILEfPAGER: �
MAILLIti'G ADDRESS: CI'I'Y: ZIP:
STATE LICE�'SE: � � � �
. . �
ARCHITECT�E�TGINEER:� . . . PHO��:.� �
11�AILT�i TG ADDkZESS: CITY: ZIP:
. ��; RECrISfiRATION#
7�ypE pF '4YORb'.: New Addition Accessory Structure
Move � Remodel/Alteration _ _ Land Alteration
PROPOSED'SYORK(describe in detain: - ='"
STORIES: SQ.F'EET OF EACH F'LOOR: _
i\70. OF BEDROOI�IS: GAR.A.GE STALLS: :ATT. _ DET. . . -
EST .Il-i IA.TED CONSTRUCTXON VALUATION (excluding lanc�: $ 3�r�a .
I hereby apply for a building permit and I acknowled�e that the information above is complete and
accurate; that the work will-be in conformance with the ordinances and codes of the Ciry and with
the State Build�*�� Code; that I understand this is not a peraut and work is not to start without a
permit; and thac the wcrk will be in accordance with the approved plan.
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APPLICA�.�"T'S SIG\ATU�E: �%�'�-vt�,-r=� � DATE: � �'
NOTE! �arade of Homes events require separate permit approvai by Police Department and
� City Counci160 days prior to tke event. Non permitted events wi11 not be allowed.
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Sec.13.Q4 RIGXTS OF SUBJECTS OF DaTA - - - • �
Sutd. i. Tpp•of daca. The ri3hcc of iadividual cn wham rhe data is scaced or ro be smc:d shall be u sec fonh in[his sccrian,
Su�d.2. Iatorma�an rtqcrired tc be given iadiridual. �+J;-�ividual uk:d to supQiy privae ar coaFdccdaI daa conceming hiisseif shatl
tti iaforu::d o`: (a) th=Purpose aad iac:aded use oE the roqua-,�dati wichia the eal2eceag S��a3eary.polidcaI sabdivision,ar samvr.de sis;-�;
(b}whe�`.e:he r._�y r_�se oris.legally r_quir:d to suppty_the r_quer�d dati:(c)aey Ic�own eaasequcace arisia3 froci his suppiyia3 or reFi:siag co sugQt�
privam or ca::�e,::al dae;a,^.d(�c�e idendry aC o�erpecsors or ead3a auc�oriz:d by snte ar f:�c_':_::;o r_ceive c�o d3�. 'Ihis r_quiremeac s��
r.ot a�pty w�ea an i:dividuaI is ask:d co suppiy invudgadve daa,purn:aac w secdon 13.82,subdivisioa 5,oo a law enfaccementafncec. . . - �
'Che ee::tmissioner of rcver.ue mav iac; the nadce r_auir_d under this su�division in the individual ir.come uz or orooem t;z teFur.d
instruedans ias:esd of on those forms.
Sutd.3. Access to daca by iadi,ndual, Upon requesc ro a cespaasible auchariry,an'tndividual shall be inforzaed whe�her he is che subjecc
ef r.or.d daa on individaaI.s,aad wheche�it is et�ssified u pubtie,privac�or eanF.dena�l. Upan his fur�her r_ques�aa iadividuaI who is tha subjecc
o!stor.d priva�or pubiic dam on individuaIs shall be shawn the daa wia4aut a.ny ch3rge w hia and;if he daires,shall be infocmed o[the eoamat
aad m:aning of�at data. Ahcr an individaal his beea shawn the priva�:dati u.d iaformed of ia meaniag,the dan aeed not be d'uclosed m him far
siz mandu�I:er_afcer unless a d'upuce oc acaon pursuant to this se:don is p<¢dL�sg or addidoaal dac�on rhe individuai has beca eolIec�d or eccac:d.
Tae cespoeuible nuc2:odry shallprovide eopies ot�he privac_or pc�btie daa upan request by the iadividual subjcct of che daca. The responsibte aachedry
may cequir_ �':e c:quesdng per�on ro pay[he acacal eosts ai making,ecrrifying,u.d eomp�ling the eoQies. �
The cesgaRsib(e auehoriry shaIl eampiy imrnediatety,if possbfe,wich aay requat aLade pursuant co thu suhdivisioa,ac wichin five days oF
the dar�of the reqaat,ezcluding Saturdays,Sundays and legal ha�days,if ir,imedia�e compliaace is notpouble. If he eaaaot eomply wirh the tequesc
wichin that acr.e,he shall so inform che individuaI,ar.d may have aa addidoaaI five days within which to comply wich t�e cequest,ezcIudiag Sacurdays,
Sundays attd Ie3a2 holidays. . . �
Subd.4. Pzocedure whea data is not aecurate or eamplete. An icdividual may eonmst d�ce acc�raty oc eompleteneu of pablic orprivace
dam eonceming himself. To ezercise this righc,an individual shaIl noafy ia wridag the respoasible auchoriry desenbing the naa,ire o(the d'uagreemenc
The respoasibie au�horiry shall within 30 days ei��:er: (a)eorrece�he data found to be inaccuram or incampiem aad acc:mpc to nadCy past recipien�s of
ina:cucate or incamplece daca, including �ecipieacs nuned by che individual;or(b)cadfy the iadividual thac he believes the dati to be correcc Da�
in dispuc:shail be discIosed onIy if the individuaI's scacemenc o!disagrcemea[is induded wi�h th�disciosed daa.
The decerminadon ot�he responsibte auchoriry tnay be appeaIed pursuanc to the provisions of tha adminiscradve procedum act teladng m
eont�swd cases. � . . .
DATA PRTVACY ADYISORY
In accordance wich M.S. 13.04,Subd.2, "Ri�u of subjec�s of data",we would like to inform you that your request
for a pennit or Iicerue from the Ciry oE Orono or aay of its departments may require you to furnish certain private or
conf dencial information.
You 2re notified thar.
I. The information you furnish will be used to determine your quatiFicacion for[he pecmit or license requested.
2. You may refuse to suppiy data, but refusaI may require that the Ciry deny the permit or license. � �
3. The information may be sh2red wich o�her IocaI,state or federal a�encies to the extent necessary to process
the permit or license. �
4. If your requested permit or license requires Council action to approve, some information may become
. public. � � - - - - . . . . �
�5. You have certai.n ri�hts under M.S. I3.04�(available upon reqaesc) to review privace data on.yourself. . .
6. Your full narae is required to process this applicacion or permic.
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Ciry Snte Zip .P�oae j�!z — L% ?/ 7l S/�
I understand my ri�cs as stated above.
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