HomeMy WebLinkAbout1999-011951 - reroof PERMIT
�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number: - : ;;;;;;::.
Crystal Bay, Minnesota 55323 --�- - • �-
(612) 249-4600 Date Issued: = � =ry.;�,��
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SITE ADDRESS: � � � � � . � R
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER:
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APPL NT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��
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' Date Received: I
iotal �`ee: $ .
�ntered By: ,C�i, Permit#: //9-�� �
CIT`Y OF ORONO -BUILDING PERMIT AI'PLICA.Z`IOI� ` �
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_All information must be submitted in full before plan reFie� vtizll be started. . � '�
� (please print all information) . , .
:� APPLICA2��'I' IS: � - (circle one) .� O�YNER OR CONTRACT'OR � ' . . � ��� � �
JOB SITE ADDRE55: `� 5 I� I—� ~' vc�' ZIP: 5�3`�1� ! '
NAII�T.E OF Oti�+�R: ��r� � �Y-e�`ri C C�5 c��`1 PHO�'E: (home) �-�� �'�o�cJrj
_ � (work)
I1�I�II. .Itii'G A3JDRESS: ��cxv�-- CIfiY: C�J��n� ZIP: r'S'��_
CO��tACTOR: ��1� � PHONE: "
CO�TTACTPERSO�: � MOBILE/PAGER:
MAILlti'G ADDRESS: CITY: �-'�
STATE LiCE�'SE: # � •
ARCHIT'ECT/ENG .Itii TEER:� � . . � PHO�TE:.� ��
��Itii TG ADDRESS: CITY: ZIP:
. NAME: REGIS�RA.TiON�
TYPE OF ti'YORb: New Addition Accessory Structure
Move � Remodel/Alteration�C _ I-and Alteration _
describe in detai : ' � \ � `��' � �1``� `
?ROTOSED ti'��RK( �
STORIES: I SQ.FEET OF EACH FLOOR: '` .
NO. OF BEDROO�I�IS: � GARAGE STALIS: ATT• _ DET. . _ �
. . . . � . � � o�:
ESTII�i IATED CONSTRUCTIO�I VALUATION (excludi.ng lanc�: $ ��b� '
I hereby apply for a buildina permit and I aclrnowledge that the information above is complete and
accurate; that the work will be in conformance with the ordina.nces a.nd codes of the Ciry and with
the State Build:.n� Code; that I understand this is not a peraut and work is not to start without a
permit; and thac the work will be in accordance with the approved plan. -
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APPLICA.�.�"T'S SIGNATURE:�Y.��� �� 'l� �� DATE: �
N0�'E! �Parade of Home� events require separate permit approval by Police D p artment and
� City Counci160 days prior to t ke even t. N o n p e r m i t f e d e v e n t s �n l i n o t b e a l l o w
. � � � .
Sec.13.Q4 RIGFiTS OF SITSJECT'S OF DATa __ _ • '
Subd. i. Tppe oL data. The righct of icdividuai oa wham the data is scoced or ro be smr:d sha]I be u sec forch ia this scction,
Sutd.2. Inlormation nqtrired to be given ia3iridual. an iadividua2 uked tc�suPPtY Privac_ar eoafideeriaI data eoaceraing himself sha.n
be ia,°armed o`: (a)�e purpase acd ia�nded use aE�he requ:sc�i da�wichin�he eotIecdn3 3at�ageary.poliacaI subdivisioa,or snmvr.de rysc:�•
(b)whea`.e:ha e3�r.:u.se ai u.le3ally requir:d to supply.the r_queszd dati:(cj acy l�ewa eaas:queece arisia3 fro�a his supplyiag or reh:si:g[o y�ppiy
privam oreoa::dx:=l daa;a:.d(�t�e ideariry a(acherpe�soas ace�rides au�ori.zed by sace arfe�e=':_:.•:�r_ceive che da� This r_quue�ea�s��
not a,�pty w:.ea an i.dividuaI is uked to suppiy iavesagadvt dae,pursuanc co secdon I3.82.suL+division 5.oo a[aw enfocee�ant o�cer. .� . -
T�e ce:-�nsiszioner of rever.ua mav tace �he nodr_ r_auir_d under this subdivision in the individual ir.come ez or ocooem t;z refur.d
inmucaoas inste_d oCon chose forms.
Subd.3. aceess to data by iadividual. Upon tequesc to a�zspocuibie authociry,an individual shall be inforzaed whacher he is che subjecc
of stor_d daa on individuaLs,aad whecher ic is elaszified u public,Privace or eonF.deaaal. Upoa his fur�her r_quest,aa iadividaaI who is the subje�c
a!stor.d priva�or public data on individuaIs shalt be shown che daa wichaut any eharge to him and;if he dairu,shalI be intocmcd of t�e eontenc
aad m:aning of�at data. Ahcr an individuaI his beea shown che private daci ar.d infarmed of iu meaaing,the dam ne:d aoc be disclosed Lo him{or
siz monchs eher_aftnr unless a dispute or acaon purnean�to this secdon is pead'usg oc addidoaal daci on the iadividual has beea eoUec�d or erea�d.
Tae resparuble aut2:oriry shali'pcovide eapies of�he privat:or pablic dara upon cequat by the iadividual subjccc o[che daa. �e respoas4bie au�horiry
may requir_ che e.qu:sring penon to pay che accual cosu at rnaking,cecrifying,ar.d comp�ling tiie eapia. �
The resgonsibte auchoriry shall eompiy imra:diateiy,if possibie,wich aay request a�de pursuant ta chis subdivision�oc wichia five days oF
the dam of th�reques�ezciuding Sacutdays,Sundays and legal haiidayz,if inmediate compliance is not pessbte. If he canaec eompiy wich the request
wichin dsat dme,he shall so inform ttse individuaI,u.d may have an addidoaa!five days withia which to comply wich the reque.st,ezcIudiao Sacurdays,
Sandays aad lega2 holidays. , . . �
Sutd.4. Procedure when data is not accurate or eompiete. An individual may eonmsc the accurdcy o�eompleteaeu otpablic or privac:
dara cocsceming tivaself. To execcise this righc,an individual shall eadfy Ia wridn�d�c respoas�te au�hodry descnbiag the aanire of the d'uagreemeac
The respoasible auehoriry shall within 30 days eie.':er: (a)cocract che dara found to be inaccurat�or incompiem aad actempt eo norify past recipienc�oE
inaccuraca or incampiece data,inctuding rccipieacs named by the individua2;or(b)coriFy the iadividual that he believes the daca to be correcc Da�
in dispuc:shall be disclosed onIy if the individuai's sca�emenc of d'uagreem:ac is induded wirh the d'uclosed data.
The de�erminaaon of the rtsponsible au�horiry may be appaaled pursuant to the provisions of tha adminisQarive procedure act telaang to
eonc�s�d cases. � . . . .
DATA PRIVACY ADYISORY �
In accordance with M.S. 13.04,Subd.2, "R.ights of subjeccs 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 furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualificacion for the permit or license requested.
2. You may refuse to suppiy data, but refusal may require that the Ciry deny the permit or license. � �
3. The information may be shased wich ottier local,stace or federal a�encies to the ettenc necessary to procus
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 ri�hts under M.S. 13.04�(available upon request) to review privace data on.yourself. .
6. Your full narae is required to process this applicatioa or pecmit.
Fusc - 1�tiddle �t •
. Addreu __.., _..
Cir� Snte Zip P�aae
I underscand my ri�ts as stated above.
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iignacure .