HomeMy WebLinkAbout1998-010841 - tearoff/reroof , PERMIT
= C'ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �����=�����'���`
Crystal Bay, Minnesota 55323 Permit Number: t_;3;_;;;;,�_
(612) 473-7357 Date Issued: ; {�;;�;;w;;=;�_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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ICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE S
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Total Fee: $ Date Received:
Entered By: ,�� Permit#: ;�D �1/
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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TIiE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SIT`E ADDRESS: ��,5��� L��N�,�Air-'F .���1� ZIP:
NAME OF OWNER: L,��n���� PHONE: (home) ���� --")�}S�
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: /-�-�,� ,C�c��`-�l>119 PHONE: ��j�(�, -S� 3`�
CONTACT PERSON: MOBILE/PAGER:
MAILmTG ADDRESS: �2� i �n;�;q �NO. ����CITY:�;N� ZIP: SS�3�
STATE LICENSE: # �o� ��v S�,
ARCHITECT/ENGINEER: PHONE:
MAILIl\'G ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: �"��� �,�F � (ZC Sl���+����
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $�.�, r;-�,��,�'�+�. `���'
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 accqrdance with e approved plan.
APPLICANT'S SIGNATURE: yl.�- DATE: �' ys
,
NOTE! Parade of Homes events �quire separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SiJB.TECTS OF DATA
Subd. 1. Type oE data. The rights of individual on whom the data is stored or to be stored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data conceming himself shall
be informed of: (a)the purpose and intended use of the requesced data within the collecting'state agency,political subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any irnown consequence arising from his supplying or refusing to supply
private or co�dendal data;and(d)the idenary of o[her persons or entides authorized by state or fedecal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieative dara,pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or propertV tax refund
instructions instead of on chose forms.
Subd. 3. Access to data by individual. Upoa request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidenaal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shail be shown che data without any charge to him and,-if he desires, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to hun for
six months thereafter unless a dispute or acrion pursuanc to chis secrion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual cosrs of making,cerrifying, and compiling the copies.
The responsible authority shall comply immediately, if possibie, with any request made pursuant to this subdivision,or within five days of
the date of the request,exctuding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Sarurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, inciuding recipients named by the individual; or(b)nocify the individual thac he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the pcovisions of the administrarive procedure act reladng [o
contested 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 City of Orono or any of its departments may require you to fumish certain private or
confidential 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, but refusal may require that the Ciry deny the permit or license.
3, The information may be shared with other local, state or federal agencies 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 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 permit.
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First M�ddle Last
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Address
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Ci � State Zip Phone
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I understand my g as tated above � ,�
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Signamre � �
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