HomeMy WebLinkAbout1998-010355 - storm damage repair - PERMIT
` CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ���_�i�_�I#���
Crystal Bay, Minnesota 55323 Permit Number: t_���_;:�;c�
(612)473-7357 Date Issued: �}�_}��f;:,�:Y�
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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APPLICA T/PER ITEE SIGNATURE ISSUED BY:SIGNATURE
:- � _ .
' Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERIVIIT A�PPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
�______._
--------------------------------------------- ------------_ =-________---�-----------------------
THE A.PPLICANT IS: (circle one) OWNER OR CONTRACTOR�
JOB SITE ADDRESS: I�V C�(,��-Tr.� �r�� �C�,v� ZIP: �39�
,
NAME OF OWNER: ��zJi��( �:+t-t�,�N PHO�IE: (home) `1 �Z� '�'�-7`1
(work)
NZAILING ADDRESS: !�� �I,o�-T� �t �- CITY: �(��J� ZIP: S��`al(
C0�1TRA.CTOR: I.—�� Co� ty'ta�( �v�l���yz-� PHONE: Lf l y�71 Z (
CON'TACT PERSON: �c��� t��a� MOBILE/PAGER:
MAILPi 1G A.DDRESS: 33�1 S��c�.i,�;� `���r�.�.'i CTTY: ��y,t�s..'�co�— ZIP:��
STATE LICENSE: # 22�,�
AF.CHITECT/ENGINEER: �t�o�S� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF `VORI�: New Addition Accessory Structure
Move � Remodel/Alteration�_ Land Alteration
PROPOSED`VORK(describe in detain: 'Q�zpR,��Z ���'i- ri i � ��,�����'� � ��Ntr��+Z�
��tt�e,,� i t� ��c�.t �i �'(�i� -
STORIES: 2-- SQ. FEET OF EACH FLOOR: U �,�������
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTTivIATED CONSTRUCTION VALUATION (exclud.ing land): $ � t 2�����`
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 Buildin� Code; that I understand this is not a permit and work is not to start without a
pemut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: ���� ` V `�-�'V'I DATE: G2 ` I � • ��-�
NOTE! �Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events wi11 not be allowed.
__ '�
Sec.13.0.RIGHTS OF Si1B.TECTS OF DATa
Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be s�ored shall be as set forth in this secaon. -
Subd.2. Information reqtrired to be given indiridual. An individual asked ro supply private or confidzarial data concerning himself shall
ba informed of: (a) the purpose and iacended use of che requesud dara wi�hin the collecang�tat�ageacy, polidcal subdivisioa,or sracewide rysum;
(b)whe�her he may refuse or is legalty required ro supply[he r.qua�ed da�;(c)any Imown coasequence arising from his supplying or refusing to suppty
private or eonndenoai data;and(d)[he idendry of other persoas or enddes au�horized by state or federal law to receive the data. This requiremeac shall
not apply when an individual is asked to supply invesrigaave dam, pursuan�to secdon 13.8?,subdivision 5, to a law enforcemenc ofrccer. -
The commissioner of revenue mav olace th� noace r_auired under chis subdivision in the individual ir:come tax or orooem tax refund
insttucaons instead of on chose forms.
Subd. 3. Access to data by indi�idual. tipon requcsc to a responsible au�horiry,an individual shall be iru`ormed whether he is the subject
of s�ored dara on individuals,and whe�hec ic is classified as pubiic, private or conFdenoal. Upon his furcher requesc,an individual who is the subjecc
of scored private or public dara on individuals shall be shown che data wichouc any charge to him and;if he desires, shall be informed of the content
and meaning of that data. Aher an individu�l has been shown[he priva�e dara and informed of its meaning,tbe data need not be disclosed to hiza for
six mon�hs thereatte.r uriless a dispute or acaon pursuanc to chis secaon is pznding or addiaonal data on the individual has been col(ecc�d or creaced.
The responsible au�horiry shall provide copies of[he privace or public data upon requesc by the individual subjecc of[he daca. Tne responsible autfioriry
may require[he requesring person to pay the actual coscs of making,cerrifying,and compiling the copies.
The responsible auchoriry shall comply immediately,if possible, wich any rzquesc madz pursuant co this subdivision,or wichin five days of
the da�e of the requesc,excluding Sanirdays,Sundays and legal holidays,if immedia[e compiiance is noc possible. If he cannot comp(y with the rquest
wichin chat time,he shall so inform the individual,and may have an addidonal five days wichin wEuch to comply wi[h the requesc,excludin,Saturdays,
Sundays aad legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or compleceness of public arpri�•ate
dara concerning himself. To exercise chis ri¢h�,an individua!shail nodty in wricing che responsible auehoriry describing the nature of the disagreemeat.
The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and aaempt to noafy pasc recipienct of
inaccurate or incomplete data, including recipien�s named by �he individual; or(b)nodfy[he individual that he believes [he da�a to be correct. Data
in dispu[e shall be disclosed only if the individual's stacemen[of disagreement is included with che disc(osed data.
The decerminarion of the responsible authoriry may be appzaled pursuanc to the provisions of the adminiscrarive procedure act reladng to
contesced 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 pernut or license from the City of Orono or any of its departments may require you to fumish certain private or
confidential informacion.
You are notified that: �
i. The information you furnish wiil 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 perm.it or license.
3. The information may be shared wich other local, state or federal a;encies to the excent 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 ri�hts 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 permi�.
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Firsc Middla Last
"�'�� ��.C��� ���5t� � -
Address
�c��S<o� ��. S�` �t 7`� �`71'�-�
Ciry Sate Zip Phone
I u erstand my ri�hts as stated above.
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Signacuro