HomeMy WebLinkAbout1998-010716 - tear-off/re-roof PERMIT
w C�TY OF ORONO
PERMIT TYPE: �;,; ;;���;:�:y��
2750 Kelley Parkway- P.O. Box 66 Permit Number: ;"�1�t�i?�.�,
Crystal Bay, Minnesota 55323 � _ _ _
(612) 473-7357 Date Issued: ;;��;�;;;_;,:��;;
SITE ADDRESS:
r,�::;:� t�,I t��t�;�T��tu��::s� N���� Ls�
.���
�� f t,� . . t,t-�-1 �.:—__—:1�,--t:7i.`��.
DESCRIPTION:
t�i�::�`—�:fj=�i�F--�;;_!���
�:�111 �.}.aiie'� t''s�l'�'ill�• I Y�':� ="H1��'J���`��J;'��
[ '�—i-ii I!I�
' �.E f� �1��.���� �i_F S'F:, � i�.i{-� �r. �. �.
y..i�$��f�'� �..•'._}'•�ir �-t•=t� ?'��� . ��__+i��L_Ijf�.�.{"��....
REMARKS:
FEE SUMMARY:
`,��:ai_E�}=;i�.�t;;� �_;, t_ ;t x
;�:��� F�:.: �`�i . _
.'{�S1�_�i%i i v}-n .._....__._.�.... �i�.n.m:'..��
�£_3 i_.=i t �"'F�:? s �'�. a.�
CONTRACTOR: — ����=1 ic.��-t+. -- `��T . �..�It= .OWNER:
i:��°T:g��;�`�l t;��,'e�.��; `�;k s�`�'�,.`�: __:�1 t}:_it�i,�. ;V'i):e��i;'i:I C:t ii:°T i��� �_`.�'_
,T,-;� �,, ;-i�1`r` �.�.'� F,t.;� s 1 I t�!'���f+_i;'��:.� �i���±�' Li�
�'!_;i�i��i_!l"�-i f°I;`,i L,��u.:��. l�i�i;l�iCvi i E'';3�,� ��=�:=;�.F�
,=�1'.�:i �.1 i �-�t:;i i�#.
�.7:=:-�i i'�'�
:t�� {"q t: ,---,� �{' _,t a_.._� i.,;::i._.._. . '' .�'�-- f � 1— �'i 3�l:= � �I_ti'� `!, 9� .t-��'=�.` . . _. . ._ .� �:� .. . . .'
, .
.. i y„ E 1 1'..:"T'
...._ S_�i';t�,r{�f'1.��f{aiev�'�'f� r .' . .1.._.. !-...
.-.:-i'--,s r r r-:-s -i i-�e n.--�. ' � ' T � . _ . . =��
�,,. r } i:Z�
�'�E'{` �� .i�� {'{i'�_f r i�a� ' 'i,...�.... . ....4__ ';}�_.. .. . . , �' � ?�.... ... � _ _ ..
�...'_.
. �i,, � i�3z�..7. .._.. .
t . �^ E .` . #t ., �. � � ...
'e• r:: '
� },�:'s :_i.`'n,_:�,iw:=,n�•'._.�-`�. �; �t }�.. '�' `�, r�;_+ : _�� ._ _. ..E.a ,... _. ._. ..... . . ' .
� _��- . . . . __ _ . . .._ . ��._. .. � . . __ . _._ . �
�.� -�.� �Q'� C'�1���'J-�
.C;C�Ek� G`��("'7-
APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
�_ �
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BiTII.DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER O CONTR.ACTOR
JOB SITE ADDRESS: �o(} / /�/�f�/� �{/C7lfL�},i/,d L�.ZIP: 5S3 S Cp
NAME OF OWNER: CU�T�S L-l�t� PHONE: ome) ��,3�U 9 9
(work) 7 -f� �
MAILING ADDRESS: (�l�/ h?Tk.�' �fc�l.t7 Glil� CITY:,C..G�l(� G�-� ZIP: 3 �
CONTRACTOR:(,fJ ,t� cSIJ��' PHONE: S���36 S!
CONTACT PERSON: �� M ILE/PAGER:
MAILING ADDRESS: 7b�' /c���FuJt1��o�' CITY: 1�d'I"-�f ZIP:6-
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N�jME; REGISTRATION#
TYPE OF WORK: New� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�:`�—�-/�Q�� ��/�$�I�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION(excluding land): $ 3 ��� � �
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 accordance wi the approved plan.
APPLICANT'S SIGNATURE� � � � ��
NOTE! Parade of Homes events require 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 SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set focth in this secdon.
Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidential data concerning himulf shall
be infocmed of: (a)rhe purpose and intended use of the tequested data within the collecting state agency,poliacal subdivision,or sffioewide system;
(b)whecher he may refuse oY is legally required to supply ehe requesud data;(c)any lrnown consequence arising from tus supplying or:efusing co supply
private or confidendal daa;and(d)the ideadry of other persons or enddes authorized by stare or federnl law to receive the data. This requirement shall
not apply when an individual is asked to suppiy invesdgadve dara,punuant to section 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the noace rewired under this subdivision in the individual income taz or orooercv taz refund
instrucdons instead of on rhose forms. • .
Subd.3. Accas to data by individual. Upon rcquest to a responsible authority,an iadividual shall be informed whether he is the subject
of storod data on individuals,and whether it is class�ed as public,private or co�dential. Upon his further requesc,an individual who is the subject
of stored private or public data on individuais shall be shown che data without any charge to him and,-if he desires,shall be informed of the content
and meaning of that data. After an individual has bern shown che private data and informed of iu meaning,[he data need not be disclosed to him for
siz months thereafter unless a dispuu or acrion pursuant to this secaon is pending or addidonal data on the individual has been collecud or creared.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the reqaesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsibte authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,ezcluding Saturdays,Sundays and legai holidays,if immediau compliance is not possible. ff he cannot compty with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply wi[h the request,excluding Saturdays,
Suadays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleuness of public or private
data conceming himseif. To exereise this right,an individual shail notify in wridng the respoasible authoriry describing the naturo 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 recipienu of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual that he believes the data to be correcc. Data
in dispute shall be disclosed only if the individual's staument of disagreement is included wi[h the disclosed dara.
The determinaaon of the responsible authoriry may be appealed pursuant co tha Provisions of the administraave procedure act relating to
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 furnish 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 shazed 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.
Fi�� Middle Last
Address
City State Zip Phone
der d my rights as stated above. .
i '(�/���%C,U'/z--� �JU-f�
Signacure