HomeMy WebLinkAbout1998-010828 - chimney repair .
� PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;�^��{_�,���vf;
Cr stal Ba , Minnesota 55323 Permit Number: . _ _
y Y Date Issued: `-"{-''`�'=
(612)473-7357 i i j;_���:,;�;;4;
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPUCANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �f
Total Fee: $ Date Received:
Entered By: ,�� Permit#: /�'> � ty'
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 OR�CONTRACTOR `i
JOB SITE ADDRESS: �G � �"G " ,� ��z z.'�ZIP: �Ij �� `'l C
, 7
NAME OF OWNER: � ���� `� ` PHONE: (home) n ������
, (work)
MAIL�TG ADDRESS: �. ��_CITY: �` ZIP:,SS�'�
CONTRACTOR:�� G�u� . Z PHONE: ��o�?�'D �
CONTACTPERSON: ` v��� MOBILE/PAGER:
MAILING ADDRESS:�y3i..3 ?� _/.�� �,' � CITY:..�� ��/'. ZIP: .5.s ���/
STATE LICENSE: # �'�y�- ,,
, �
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�i�, �,,/'�u`-��� ��—�-��1
�"L�-�-�Z� �/�..� �L��-� �������
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
G���
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � ���� �
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 ' ordance with the approved plan.
;
APPLICANT'S SIGNATURE� /i�G�� DATE: /� '�S^ ��
NOTE! Parade of H �es ents require separate permit approval by Police Department and
City Council 60 days pnor to the event. Non permitted events will not be allowed.
Sec.13.04 RIGH'I'S OF SLJBJECTS OF DaTA
Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the cequested data within the coilecting'statc agency,polidcal subdivision,or sratewide system;
(b)wherher he may refuse oY is legally required to supply the requested data:(c)any lrnown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the idenriry of other persons or enades au[horized by state or fede�al law to receive rhe data. This requirement shall
not appiy when an individual is asked to suppiy invesdgaave dara,pursuanc to section 13.82, subdivision 5, to a law enforcement ofFicer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on�hose forms.
Subd. 3. Access to data by individual. Upon requesc 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 confidendal. Upon his further request,an individual who is the subjecc
of stored private or public data on individuals shall be shown che 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[he private data and informed of its meaning,the data need not be disc(osed to him for
six mon�hs thereafter unless a dispute or acrion pursuanc to rhis secdon is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the actual cosu of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediacely, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,exc(uding Saturdays,Sundays and lega]holidays,if immediate compliance is not possibte. If he cannot comply with the request
within that rime,he shall so inform the individual,and may have an addirional five days wirhin which to comply with the request,excluding Saturdays,
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 pri��ate
data concerning himself. To exercise this right,an individual shall nodfy in wriring 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 incomple[e and attempt to norify past recipiencs of
inaccurate or incompiete data, including recipients named by the individual; or(b)notify 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 decerminadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 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 City 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 pernut 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 perm.it.
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I understan rights as stated above.
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