HomeMy WebLinkAbout1998-009947 - tearoff/reroof PERMIT
�iTY OF ORONO _ .
PERMIT TYPE: �„n�s j����;.;�_
�' 2750 Kelley Parkway- P.O. Box 66
Cr stal Ba , Minnesota 55323 Permit Number. �.'i_�'`��='�'
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(612) 473-7357 Date Issued: C7::'!' �:�%;�=�
SITE ADDRESS:
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REMARKS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ,
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� Total Fee: $ , ' _02' Date Received:
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Entered B Permit#: ���y 7
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CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all informatzon)
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THE APPLICANT IS: (circle one) OWNER O�CONTRACTOR
JOB SITE ADDRESS: �� l�y.�L�I.I�O�n �0�}GQ ZIP: �.5�,3�/ �
NAME OF OWNER: Sfie�le�m A-�� C6l-►�mPU� PHONE: (home) ,3 ` �c�
(work)_
MAII,ING ADDRESS: ,�� rYlt�-�(..�l.�X;IJ ��CITY: ' - ZIP: �'j�
CONTRACTOR: {� u�{� ��(l� ` PHONE: ��,�"S 3� �
CONTACT PERSON: S e P� MOBILE/PAGER: ^
MAILING ADDRESS: 17��.5 („�. I� a4 CITY: �� h1� ZIP: ��7
STATE LICENSE: # ,�3�
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: l�- r 6 f Q�� �(j� � v f�t� ��c ��
���.L F � h.cus w �. � � �� � �i-:s rz,� r�
C c� ar S.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /'� .� ��
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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 ermit nd work is not to start without a
permit; and that the work will be ' ccordance with e a o�ved plan.
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APPLICANT'S SIGNATURE: DATE: v� -I ?J � C �
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.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendai data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, polidcal subdivision,or sratewide system;
(b)whether he may refuse or is legally required to supply tbe requested data;(c)any lrnown coasequence arising from his supplying or refusing to supply
� private or confidendal data;and(d)the idenriry of other persons or enrities authorized by state or federal law to receive the data. This requirement shali
not apply when an individual is asked ro supply invesriearive dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav ptace the norice reouired under this subdivision in the individual income tax or propertv tax refund
instructions instzad of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individuai shall be informed whether he is the subject
of stored data on individuals, and whe�her it is c(assified as public, private or confidential. Upon his further request, an individual who is the subject
of stored private or public data on individuals shali be shown rhe data wichout any charge to him and, if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secdon 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 au[hority
may require the requesting person to pay the acrual costs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
within that time,he shall so inform the individual,and may have an addicional five days within which to comply wi[h 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 pm•are
data conceming himself. To exercise chis right,an individual shall nodfy in wridng the responsible authoriry describing[he nacure of the disagreemen[.
The responsible authority shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt ro notify past recipients of
inaccurate or incomplete data, including recipiencs named by [he individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individuai's statement of disagreement is included with the disclosed data.
The determinadon of the responsible authority may be appealed pursuant to the provisions of the administra[ive procedure act reladng 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 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 City deny the pemut or license.
3. T'he information may be shared with other local, state or federal agencies to the extent necessary to process
the pemut or license.
4. If your requested pernut 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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City State Zip Phone
nderstat4 my r' ts as ted ab ve.
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