HomeMy WebLinkAbout1998-010046 - tear off/reside .
s PERMIT
CITY OF ORONO PERMIT TYPE: -�
2750 Kelley Parkway- P.O. Box 66 -` ='--='_��'�`�
Crystal Bay, Minnesota 55323 Permit Number: �;�1�i_?i;�.�,
(612) 473-7357 Date Issued: �f;_;;��;��;;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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,�% APPLIC RMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ /J.3 ;:�' _5`- Date Received:
'$ntered By: Permit#: /C�� �
CITY OF ORONO - BUILDING 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 CONTRACTO�
JOB SITE ADDRESS: vZ, .ZIP: �"S � Sl
NAME OF OWNER: ��J L.l,t,r�� b e/L S PHONE: (home) y�3 —�3�oZ,
(work)
MAII.ING ADDRESS: v�.S��u�L.�'1�.�r-�-a( CITI': ZIP:�-�9�
CONTRACTOR � �� C� PHONE: � 8' �}- .�(o y�
CONTACT PERSON: - �- MOBILE/PAGER: �'a..� - L 6 h �
MAILING ADDRESS �y o a CITY:L,,f,,a L�}���ZIP: ,5' d/
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK(describe in detain:j e,g�L a�" �`}�S�`S%r'L� S���^�'C���1,
7`��-- �y ���e:��� /.�d R.2oC..�--New U'��/ s.�.�� 4.��'T'�--��'��`�
STORIES: J � SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /,Z, ODo_ ��
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 with the approved plan.
APPLICANT'S SIGNATURE: �1�����'�G�DATE: � `'/ � � g 8'
NOTE! Parade of Homes events require separate permit approval by Police �epartment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLBJECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be scored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given individual. �.n individua!asked to supply privare or confidendal dara conceaung himself shall
be informed of: (a)the purpose and inrended use of the requesred dara within the collecdng"state ageacy, poliocal subdivisioo,or sratewide rystem;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any Fa�own consequence arising from lus supplying or refusing to supply
• private or confidenrial data;and(d)che idenary of other persons or enrides auchorized by stace or federal law to receive rhe data. This requirement shali
not apply when an individual is asked to supply invesdeadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. -
The commissioner of revenu� mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instrucdons instead of on chose forms. � ,
Subd. 3. Access to data bv individual. Upon requesc to a responsible authoriry,an individual shall be informed whecher he is the subjecc
of stored data on individuals,and wherher it is classified as public, priva�e or confidendal. Upon his further request, an individual who is the subjecc
of stored private or public dara on individuals shall be shown che data wirhout any charge to him and, if he desires, shall be informed of the concent
and meaning of chat data. Afrer an individual has been shown che privace data and informed of ics meaning,the data need not be disclosed to him for
six monchs[hereafter unless a dispute or acdon pursuanc to this secrion is pznding or addidonal data on the individual has been collected or created.
The responsible audioriry shall provide copies of the private or pub(ic data upon re4uest by[he individual subject of che data. The responsible authoriry
may require che requesring person to pay u4e�aca:al•costs of ma;:s3, ee u�fying,'and compiling the copies.
The responsible aurhoriry shall comply immediately, if possible, wi�h any request made�ursuant to this subdivision, or wichin five days of
the date of[he request,excluding 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 rhe individuai,and may have an addidonal five days wichin which to comply with the requesc,excluding Saturdays,
Sundays and legal holidays. ,
Subd.4. Procedure when data is not accurate or complete. An individual may conrest the accuracy or completeness of public or private
data cdnceming himself. To exercise this.right,an individual shall noafy in writing the responsible au�hority describing the nacure of the disagreement.
The responsible authoriry shall within 30 days either: (a)correcc the data found to bz inaccurate or incompiete and attempt to noafy past recipients of
inaccunte or incomplete data, including recipients named by the individual; or(b)noafy che individual that he betieves the data to be correct. Data
in dispute shal(be disclosed only if the individual's statemenc of disagreemenc is included with the disclosed data.
The de[erminarion of the responsible authoriry may be appealed punuant to the provisions of che administrarive procedure act relacing to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of data", we would like to inform you that your request
for a pernut or license from the Ciry 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 fumish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, bl�t refusal may require that the City deny the permit or license.
' � 3. �The information may be shared wlth other local, state or federal agencies to the extent necessary to process
the pernit or license.
4. If your requested pernu[ or license requires Council action to approve, some information may become
public.
5. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this applica[ion or permit.
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First vliddle Last
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Address 1�, C1�„/� � / �/
��`n�a � ' /�N� .�S 4 l � / o i .«� E�
Ciry State Zip Phone
I understand my ri�hts as stated above. .� � �
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Signa[ure
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'/\ Custo�n
CRI Remodelers, Inc.
HOME IMPROVEMENTS 474 Apollo Drive,Suite A Lino Lakes,MN 55014 (612)784-2646
; STATE OF MINNE80TA
�a ���'� a � STAtE OF MN DEPT. OF COMMERCE
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9t.Pwl,MN SS 1 O1 9t,Peul.NiN 551 O1 �'�
'� +r �,`�$� (612):296-6319 (6]2)296-6319 � :�:�
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,RIIt�ODELE��;€<;:.; . REMODEGER
GORPORAITON � CORPOR.AITON
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CEI1lU�T�AI��,�JT�Et� ,
$< _ Eapirea: 03/31/1998
'7 H�s�, by3/31/5t8:�'. CHAU J CARF'ErTTF.R
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CU91��d�IR31NC 7�L-a CE due by 3/31/98
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474 APOLLO DR
LINp IAKE3 bIIJ 33014-0000
DBA:CUSfOM RMDLRS INC
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