HomeMy WebLinkAbout1998-010588 - tear-off/re-roof ,^
PERMIT
t: C�'i'1� OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -�i��=�'���`�
Crystal Bay, Minnesota 55323 Permit Number: ;_;�_}c;4;;_;
(612)473-7357 Date Issued: t��_;,•3;�::�_;;«;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: _ � OWNER:
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APPLI ANT/P TEE SIGNATURE ISSUED BY:SIGNATURE
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.To�ah'Fee: $ � Date Received: �
Entered By: ' Permit#:
CITY OF ORONO - BUII�DING PERMIT APPLICATION � -
All information must be submitted in full before plan review will be started.
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. (please print all information) - . ,
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. 3`HE APPLICA1tiTT�IS: (circte ane)� O�NER O ONT�tACTO " - . . -
JOB SITE ADDRFSSi � , ZIP::. �. _ �.. -
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• NAME OF OWNER: ��`I� �( G�li�j/�,`ZY� PHONE: (home) -_//�
..�.; _ , (work) . . .
MA.Q,ING�ADDRFSS: � S:�d CITY:1��l�� ZIP: � -
f�L�P.. .
CO�TTRACTOR:�� f �� ' � - • � PHO�TE: ���'- � 3 �:� :. .
CONTACTPERSON: � MOBILE/PAGER: �
MAB.TNG ADDRESS: 3 Gf�-C�/ CITY:�o�,, �� ZIP:�C� �
STATE LICENSE: # . - . . . _
A�'.CHITECTIENGI�TEER: .PHONE: . � , .
MA,]LING ADDRESS: - CITY: � ZIP:
NA�ZE: REGISTRATION#
TYPE OF tii�ORB: New Addition Accessory Structure �
Move � - RemodeUAlteration Land Alteration
PROPOSED WORg(describe in detai�: ��Fi� '� 4�� �� ��
� � � �� s�
STORIES: - SQ.F'EET OF EACH FLOOR: . • � � -
NO, OF BEDROOMS: . GARA,GE STALLS:� ATT. DET. �
. . : . . ;. . .� � - - ..: .� , �: . . . .a� .� . .
ESTI�IZAT'ED CONSTRUCTION YALUATION(excluding land): $ � 1 '�7'� �
I hereby apply for a building permit and I aclrnowledge that the i.nformation above is complete and
accurate; that the work will be in conformance with the ordinances and codes.of the Ciry and with
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the State Buildin� Code; that I understand this is not a permit and work is not io start without a
permit; and that the work will be in accordance 'th the approved plan: � -
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APPLICANT S SIGNAZ'LJRE. DATE. 4 �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 witl not be atlowed. �_ �
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Sec.13.a4 RIGHTS OF SLTBJECTS OF DATA ,• ; .
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Subd. 1. Type o[data. The righcs of[ndividual on whom the dan is stoced or to be swc=d shali be as set focth ia this sadon. �
Sabd.2. Iaformation required to be girea iadiddnal. An individual uked to suppiy priwa�e or confidendal daa coacecning himselt shall
be iaformed o[ (a)the purpou aad iateaded use of the sequested daa withia the collecaag Stace agenry.polidcal subdivision.or smtewide system;
(b)whahec he may refuse or is IegaUy requtred to suppiy the cequesced daa;(e)aay imown eoasequence arising fcom his supplying o�retiutng to supply
` privacs oreoafideadaI dan;and(d)the ideadty of othecpersoas oreacdes a�thorized by snre ocfedetal law w receive the dan. This tequiremencshall
•no�apply when an individual is uked m supply invea3gadve daa.pucsuapc co seedoa 13.82.subdivision S.w,a law enforcement officer. �- : : � �
The cominissioner of revenue mav otace�he nodce r_auired under this subdivision in the individual income tax or orooectv ax�efund
insrrucdons inscead of on chose focros.... '
Subd.3. Aecess to data br ladi.idual. Upon requesc to a cesponsibte auchoriry,an individusl shall be informed whuher he is the subjeu �
of scoced dac�on iadividuals,and whe�her it is elass�ed as public.private or confidenaal. Upoa his[uRher request�aa iadividual who Is the subjecc
of swced private or pubtic daa on individuals shall be shown che dan wichout any charge to hlan and:if he desires,shall be lntocmed of the coatent
uid meaaing o(t�iai dan.�Aher an individail has beea showa the pcivace dan and iaforaud of Ics meaaing.ehe daa need not be d'ucloud to him for
ai�c mocuhs chereaiter unless a dispu�e o�acaon pursuanc w chis secaoa is pending or addidooal daa on the individual has beea collaad oc ereued.
The respoasible authociry ahali p�ovide copies of the private or pubtie dan upon requesc by the iadirtdual subjecc of the daa. The nspont�le w�otiry
may cequire the requaang pason to pay che acaial eosis of making,cecdPying,a�comp�ling the eopia. '
The cesponsible authoriry shaU wmply immediatety.if pouible,wirh aay requat made pursuant m this subdivision,or widua five days of
the dace of che requaG ezeludiag Saaicdays.Sundays and legal holidays,il lmmediate compliance Is notpossible. Ithe eanaot compty with the request
w'uhia rhat dme,he shatl so infocm die Individuai.and may have an addidoc�al five days widiin which oo comply wirh the reques4 excluding Saaudays.
Sundays and legal holidays. _ ��
Subd.4. Procedure when data is not accurate or complete. M individual may eoetesc rhe accuncy or completeness o[pubUc or private .
dan eonceming hinself. To ezercise this ri$hc,an i�ividual shall nod[y in wridng the nsponsble sudwriry descdbing die aaaice o[du disagneemeat.
The raponsible suthoriry shall within 30 days eicher. (a)correet the dan faund oo be inaccunce or Incomplete aad attempt to nodfy past iectpieots o[
� inaccurite or incomptete daca,inciuding recipients named by the ir:dividuai;or(b)aodfy d�e individwl thac he believes the data to be eocrat Dan
in dispute shall be disclosed ody if the individual's statemenc o!disagreemea[is tnduded wtrh�he disclosed dan.
The dececminadoa o!the responsible aurhoriry may be appealed pursuant to the provisions of the ada�iniseadve procedure act retatiag to
contesad u.us. .
. ` DATA PRIVACY ADVISORY _. ' � . . ,� � .
In accordaace wich M.S. 13.04� Subd.2, "Righ.ts of subjecu of daca",we would like to inform you that your requat
for a peraut or license from the Ciry of Orono or aay of its departments may require you to furnish certain private or
confidential information. . . "
You are nodfied that:. - .
i. The inforcnation you furnish will be used to detcrmine your qualificatioa for the permit or license requested.
2.� You may nfuse to supply data, but refusal may require that the Ciry deny the permit or license.
3. ?he informatioa may be shazed with ocher locat�state or federal agencies to the excent necessazy to procas
' the.permit or license.
4. If your requested permit or license requires Council actloa to approve, some information maq become
public. .. . ...
. 5. � You have ceriain ri,,rhts under M.S. 13.04 (availalile upon request) to review private data on you�self. �
� 6. Your full name is required to process this application or pe 'c. . • _ � � ,
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Addcess , �. - . . •
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Ciry . Sate -_ �_ Zip- - Phone ,
I understaad my rights as state abovo � ; ' �� �,
Signacuce � , _ . . . . • . . . . • . . �