HomeMy WebLinkAbout1996-008000 - re-roof, re-side, repair � - - `y PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;�p-���;���{�
Crystal Bay, Minnesota 55323 Permit Number: s y{�,_�_�{}t?
(612)473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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APP�ICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: S �L' � DateReceived:
Date Approved:
Entered B��: �-�1-� Permit n: ��C� _
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CITY OF ORONO - BUII.DING PERIVIIT APPLICATION
:�LL I��OR1v1�TION l�ILJST BE SUBl�1TTTED IN FLJLL BEFORE PL��i REVIEW WII.L
BE ST�,RTED
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THE :�PPLIC:��iT IS: (circle onej O�VNER OR CONTRACTOR
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JOB SITE �DDRESS: 3�3� �;���.�,�,�� �`��'� z�: ;�1 1'
r1A:ti1E OF O�i�'�"ER: G. G�'�'J� ,�'6�/="���- PHOti�: (home)�— 7���
(work) '7 -�
�I�ILL�G:�,DDRESS: '`If� � L,� : �:'�'��1/, F�at' CITY: ��'C�'/��!",� IP: ,,� �f
CONTRACTOR: PHONE:
I�IOBILE PHOi�TE/PAGER:
I�I�ILING�DDRESS: CITY: Z�:
STATE LICENSE: ,#
�RCHTITECT/ENG�1rEER: PH0�1E:
��IAILL�G�DDRESS: CITY: Z��
��`�: REGISTR�,TION #
TYPE OF WORK: �Iew Addition Accessory Structure
iVlove Remodel/Alteration �,,,� Larxi Alterauon
PROPOSED`VORK(de �ribeindetail): .�rC�', '_' �.�°'�= ° � * ��'�a `���`'�'�/
a�' �. :''�^`� �,�°r� -.��r. /��"��,� �:�'►�F. � ��•; �, '� 'f , ,d
STORIES: ,� SQ. FEET OF EACH FLOOR: �l/��''�'�-X� �I C��
NO. OF BEDROONIS: _� GARAGE STALLS: ATT. DET.
ESTL�L-�TED CONSTRUCTION VAI.UATION(escludingland): �"��-- ���
I hereby apply for a buildin� permit and I acknowledQe that the information above is comple�e
and accurate; that the work will be in conformance with the ordinances and codes of the Ciry
and with the Sta�e Buildin� Code; that I understand this is not a permit and work is not to start
without a permit; and that �he work will be in accordance with the approved plan.
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3PPLIC�NT'S SIGNATURE: ; �_���__ /��;�.` `-� DATE: _- �"' /- : ��
NOTE! Parade of Homes events require separate permit approval by Police Department and
Citv Couneil 60 days prior to the event. �'�'on permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF D�TA �
Subd. 1. Type of data. "I�e righrs of individual on whom[he data is stored or to be scored shall be as set forth in[his secdon.
Subd.2. Iaformation reqirired to be given individual. .1n individual asked to supply private or confidendal data conceming himself ch�fi
be informed of: (a)the purpose and in[ended use of the requested dara wi[hin the collecdng'state agency, polidcal subdivision,or stacewide rymm;
(b)whether he may refuse or is leeally required to supply[he requested data;(c)any l�own consequence arising from his supplying or refusing to suppty
priva[e or contidendai data;and(d)the identiry of other persons or enddes authorized by state or fedetal law to receive the data. This cequirement shall
no[apply when an individual is asked to supply investigadve dara, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav �lace the norice required under this subdivision in the indiv_idual income tax or prooem raz reiur.d
instrucaons inscead of on �hose forms.
Subd. 3. Access to data by individual. Upon request ro a responsible au[horiry,an individual shall be informed whecher he is the subject
of stored data on individuals, and whether it is classified as public, priva[e or conYidendal. Upon his further request, an individual who is ehe subject
of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the conteac
and meaning of[hac data. After an individual has been shown rhe pnvace data and informed of its meaning, the data need no�be disclosed ro him ror
six months thereafter unless a dispu[e or action pursuant to this secnon is pending or addidonal data on the individual has been collected or creaced.
The responsible auchoriry shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible au[hor.n•
may require che requescing person to pay the actual costs of making. cemfying, and compiling the copies.
The responsible au[horiry shall compty immediarely, if possible, with any request made pursuant ro this subdivision,or wichin five days oi
the date of the request,excluding Saturdays,Sundays and legal hofidays,if immediate compliance is no[possible. If he cannot comply with[he requesc
wi[hin[hat tune,he shall so inform[he individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and leeal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest[he accuracy or completeness of pub(ic or privare
data concerning himself. To exercise this right,an individual shall no[ify in writing the responsibte au[horiry describing the nature of the disagreemen�.
The responsible au[horiry shall wi[hin 30 days eicher: (a)correct[he data found to be inaccurace or incomplete and attempc to nodfy past recipients of
inaccurate or incomplete data, including recipienu named by rhe individual; or(b)notify the individual tha[he believes the data to be correct. Dara
in dispute shall be disclosed only if the individual's statemen[of disagreemenc is included with the disclosed data.
The determinacion of[he responsible authority may be appealed pursuant to the provisions of the administrative procedure ac[relaang to
contes[ed cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a permit or license from the Ci.ry of Orono or any of its departments may require you to furnish cenain private or
confidential informa[ion.
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, but refusal may require that the Ciry deny the permit or license.
3. The infocmation may be shared with other local, state or federal agencies to [he extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourszlr.
6. Your full name is required to process this application or permit.
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First Vliddle Lasc
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I understand my rights as stated above.
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Signanire
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