HomeMy WebLinkAbout1999-011766 - reroof � � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _ _ -- .
Crystal Bay, Minnesota 55323 Permit Number: __
(612)473-7357 Date Issued: j _ '.���_F`i^
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ �s,,�,� �,,,�,;.;T. _ _;�- . ; �;_: OWNER:
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APPLICANT/PERMITEE S NATURE ISSUED BY:SIGNATURE '�j��`,�J
' �'� Date Received: � I g
` �_,�__.__--
Total Fee: $ � (7�1 � �
Entered By: . Permit#: r� � �,� !
. CITY OF ORONO - BU�.DING PERMIT APPLICATION ` ' � ',
� � . - � ; !
.A]1 informa�ion must be submitted in full before plan review will be started. . ; �
� . - � (please prini all information) : . . �
� � ircle one � . O�NER OR CONTRACTOR � .. � . � . . . �
� APPLICA3rTT IS: � � (c ) . . I
aoB si� �nnxEss: 580= � �Jo�� �1rr� l�i. zrn: � i
- �S�9� G�or.�j - PHONE: (home)
NA11�IE OF OYY��R: �� . �
� (work) � �
NI.AII..IYGAI�DF•ESS: �4c� kndx /�i,r S CTI'Y:��lp/S Z�:�� �
CONT'RACTOR: G✓e.S S � PHONE: Sy��3��_ .
CONT'ACT PERSON: ILE/PAGER:
MAII,�G ADDRESS:
����'3 f}�C /U CITy; � ZIP: _.�����
STATE LICENSE: # ��.5,S�S� � • .
� ARCHIT'ECTlEl\'GTi�'EER:� . . . � � . PHO�'E:.� �
iVtAII►T1�'G ADD�tESS: CTTY: ZIP:
� NAME: REGISTRATION#
TYPE OF tiYORK: New Addition Accessory Structure
Move � Remodel/Alteration_� Land Alteration
PROPOSED ti'�ORK(describe�n detai�: ���� �
STQRIES: SQ.FEET OF EACl3 FLOOR: .
1�0. OF BEDROOI�IS: � GARAGE STALISs AT'"I'. _ DET. • . �
T .n'i IA,TED CONSTRUCTIO�I VALUATIO�I(excluding lancn: $ �5 3lO 6''—- •
ES
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in ca�formance with-the ar.dinances and codes of the Ciry and with
the State Buildi.n� Code; that I understand this is not a permit and work is not to starc without a
pemut; and thGc the work will be in accordance ' the approved plan.
APPLICANT'S SIGNATURE: ,� • DATE: �����
NOTE! �'arade of Homes events require separate permit approvat by Police Department and
' Cily Counci160 days prior to the event. Non permitted events will not be aIlowed.
. . . � `
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Sec.13.Q4 RIGFiTS OF SVBTEGTS OF DAT?, - __ _ . . �
Sutd. 1. Type oL data. The righcs of individual oc whom the data is srocsd or co be stored sha)I be u sec focch ia chis secriom
• Subd.2. Intocmatiaa nquired to he givm iadividuat. an iadividuat uked to suPPIY Privare or coafideadal daa conceraing!►imself shaIl
be infoc�ed o�: (a)the purpase aad iaceaded usc of the requured dan wichia the coIIecdng Etate ageary.poli6al subdivisioe.o�sncewide rystm;
� - (b).whet�er h:s.ay r.hise or is legally requir:d m suppiy the requesc:d dst�:(cj any t�owa eoasequeaca uisiag ftnm his supptyiag or refusing w supply • .
. privat�or eon.�der.ea.I dara;and(�[�e ideadry of ocher persoas or eaddes aucfiarized by sace ar fe�e�'L:u ta r.ceive the daa. This requiremeac shall
�not apply wµea an icdividual Is uked to supply iavurigadve daa,pursaaac to secdoa 13.82.stibdivisioa S.oo a law eafoccemeat ofncer. .• . • � �
T�ta cer.�rtsissiofttr Of revenue mav olae-•the noac� r�uird und•r this subdivision in the individual ineome ex oc orooertv eaz ceFi�ad
insttueaons i.*uuad of an chose foems. ' • � .
Subd.3. Access to data by iadividaal. Upon nquesc to a cespoasible auehodry,an individual sball be informed whe[her he is the subjeec
ef stoc;d daa on individuals.aad whecher ic is tiassihed u public,priva�or eonE.deadal. Upoa his furcher zeques�aa iadividnal who is rhe subj:.c
o!sioce�i privace ar publie daa on iadividuaIs shall be showa�he daa wirkout any charge to him and;if he des'ues.shall be infocmed ot the eoacenc
aud meaaiag o[chat data. Afu�aa individual has beea shown the pdvatb dan ar.d iaformed o!ics meaning,the daa ne:d aot be disclosed oo him tor
six moadis thereafmr unlas a d'ispuce o�acaon pursuanc to this secdon Is peading or addidoaal data on the tadividuat has been coUec�d or eceaced.
The cesponsibte authoriry shallprovide eopies ot the privu orpublic dara upon request by the iadividuaI subjece of the dam. The respoan'bie aucfloriry_
may cequire the requescing pe�son to pay che acacal cosu of makiag,eerafying,aad comp�ing the eopiu. '
The responsible auchoriry shall eomply immediacety.if possibie,wich aay tequat made pursuanc w this subdivision,o�wi�hin five days of
the date of die requa�excluding Sacurdays.Sundays and tegal hatidays,if immediate complianee is not pou3te. If he eanaoc comply with the tequesc
wi�hin that dcue,he shall so inform rhe indlvidual,and may have an addidoaal five days withia which to eomply wich the requa�excludiag Saturdays,
Sandays and legal holidays. � . . , - ,
Su�d.4. �roeedure whw data Ls nat accuratt or complete. M iadividaal may eontut the aetunry oc eompleteaess a[publlc orprivace
data eoneeming htcaself. To ezeccix this cight,ae individuai shaIl nadFy la wridng the cespoasibte authoriry dactlbiag the aature olthe disagreemeac
The cespoasible auehoriry shall wichia 30 days either. (a)eornect rhe dara taund to be inaccunre oc uuomptete aad aaempc w nodfy put reeiplencs of
inaccucue or Incomptece daca.including«cipiencs narised by che individual;or(b)nadfy the lndividual that he believes dse dara w be cocreet Dati
ia dispace shall be d'uciosed onIy if the individaal's sacuaenc oi dtugreem:at is included wirh the disdoud dam.
. Zhe determinadoa o!the responsible auchoriry may be appealed pursuanc to the provitions of the adminisaadve pcacedum aa retaaeg to
contesed casas. ' . • • � •
� pATA PRIVACY ADYISORY ' �
In accordance with M.S. 13.04,Subd.2, "Ri�hhts of subjects of data".we would like to inform you that your request
for a peraut or Iicense from the Ciry of Orono or any of its depaztments may require you to furnish certain private or
coafidential information.
You aze notified that:
1. The information you furnish wilI be used to determiae your qualificadon for the permit orlicense requested.
2. You may refiue to suppty data, but refusal may require that the City deny the permit or license. � �
3. The informatioa may be shazed wich o�her local,s[ace or federal asencies to the excenc necusary to process
the permit or license. �
4. If your requested permit or license requira Council actioa to approve, some information may become
. pubtic. ' � • . �. � • .. � � � . . .
.'S. You.have certaia rights under M.S. 13.04�(available upon requat) to review private data on.yourself. . . _ .
6. Your full name is required to process this application or permic.
Fusc • �tiddle Last •
_ . _.....,.
Addc+ess �
C«Y , Stue Zip Y�oae
I underscand my scated above.
Signamre • .