HomeMy WebLinkAbout1998-010665 - new roof ` � PERMIT
� CGT� OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��`-�=�-_�-'�'`3`'
Permit Number: t`a i i:ar��=.�
Crystal Bay, Minnesota 55323 Date Issued: f_;;�;/`�!-„���;�;
(612)473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: - ����i i F.���t - OWNER•
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APPLICANT/PERMITEE SIGNATURE SSUED BY:SIGNATURE
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Total Fee: $_ /C� �.- .� �! Date Received: -ot.�� �� ,
��ntered By: r�z�i Permit#: �
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CITY OF C)�ONO - BITILDING PERMIT APPLICATION
All information must be submitted in full before plan re�iew will be started.
(please print all information) .
THE APPLICAhT'I' IS: (circle one) ���YNE R CONTRACTOR� � � . ��
JOB SITE ADDRESS: �/ �J S �v c� �. T/y �f--/c�✓-�� `�.'ZIP: �.� � � � /
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� NAME OF Oti'YNER: -`�l�L.0 J�o,Tl /�U;SS C LL PH0�1E: (home) �G/�) y������ �
(work)
MAII,ING ADDRESS:�/�7 S�./v. -�iyc��G ���CIT"Y: G'�C? �v c. ZIP: ��;� � � /
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co�.cTOR: ,� t`� v�� � �c��v.S i. ���a - Pxo�: � �
COr�TACT PERSON: �--A r y �tc YG'�.� MOBILE/PAGER: � � �
I�ZAII.liYG ADDRESS: �/�'1 �: ,/'>��..i,�o-�v , �� CIT'Y:/�7 t~�/�'L � ur��� � IP: ����i i/%�'
STAT'E LICEI�TSE: #
AFCHITECTlEi�'GINEER: PHONE:
;tiI�iAILLI�i tG ADDRESS: CITY: ZIP:
I�'AME: REGISTRATION#
TYPE OF tiVORb: New Addition Accessory Structure
Move ' Remodel/Alteration X Land Alteration
PROPOSED'S�ORK(describe in detai�: � C I-�'/ �i� C�C� �
STORIES: SQ.k'EET OF EACH FLOOR: • -
NO. OF BEDROOMS: GA�.GE STALLS: ATT. DET.
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EST .Il�i iAT'ED CONSTRUCTION VALUATION (excluding land): $ /�� �
I hereby apply for a buildinJ permit and I aclrnowledge 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
permit; and that the work will be in acc dance with the approved plan.
APPLICA.NT'S SIGNAT'UREr_ �?�� �����t-�- DATE: � '� `� - / �
NOTE! �Parade Qf Homes evenfs require separate permit approval by Police Department and
� City Counci160 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGFiTS OF SZ(B�TECTS OF D:�Ta
Su�d. 1. Type o[data. The righcs of individuai oa wham the dara is smr.3 or w be scnr.d shall be as sec focch ia this secdon. -
Subd.2. Intarmaaoa required to be givea individual. An iadividual uked to suppty pcivate or coafidenaal dam eoaeerang himself sbaIl
be iePormed of: (a)tht pucpose aad inrended use of che requesL-d daca withia the collecdng Staue ageaty,polidca!subdivuion,or sac-wide rystem;
(b)whaher he may refuse or is le3ally requir_d to supply the r:quesc:d daca:(c)any lmowa coasequeace arisiag fromhis supptyiag o�refusing to suppiy
pcivar_oreon.'4dendai data;u:d(d)the idendry o(asher pecsoas orendries aachocized by snte or fedaral law ro receive the dam. This tequiremeat sball
�r.ac appty when an individu�i is asked to supply invesrigadve dan,pursuaac co secdon 13.82,subdivision S,co a law eafoccemen�ofFicer. —
'[tte commissiona of reveaue mav vlace the nocce t=auir:d under this subdivision in the individuaI income tax or orooem taz tefued
insttucaor.s ins�exd of an chase faRns.
Subd.3. Access to data by iadividual. Upon request w a resporuible au�horiry,aa individual shall be inforraed wh:�t:ec�e is the subject �
af smrd daca on individuals,and wh:�her ic is class�:d as pubtic,privac-or co�dendal. Upon his tur�her requesc,aa individual who is the subjeec
of scor.d privace ar public da�a on individuais shal!be shown the daca wichouc any chuge to tiim and;if he desires,shall be infocmed of the eon�eat
aad meaning o[chat dara. Afcec an individu3l h�been shown the priva�.dara and iaformed of iu meaaing,che dara need not be d'uclosed to hica for
six mon�hs chereah:c unless a dispuce or acaon pucsuanc to chis secdon is pending or addidonal data on the individual has been coile:�d or ereated.
The r.sponsible au�horiry shall provide copies of the privare or publie da�a upon req¢est by the iadividual subjecc of the dan. The responsible anthociry
msy require rhe requesang pecson to pay the accual cosu of making,cecdfying,aad compiling the eopies.
The responsible auchoriry shall eoc:�piy immediacely,if possible,wich any request made pursuanc co this subdivision,o�wiehirt ftve days of
the dace of che requesc.ezcluding Satu�days,Sundays and legal holidays,if immediate compliance is not possibte. If he eaaaot compty with the tequest
wirhict that dme,he shaU so inform che individual,and may have an addiaonal five days within wEuch ro compty wich the requesc,exc[uding Saaudays,
Sundays and legal hotidays.
Subd.4. Pracedure Khen data is not aecurate or complete. An individual may eoatesc the accuracy or eompleteness oEpublic orprivate
daci concerning tiir.uetf. To execcise chis righc,an individual shall noafy in wriang the respoasible au�horiry desccibing the naare of the disa;reemeaG
The raponsibie authoriry sh�lt wichin 30 days eithec: (a)correcc the daca faund w be inaccunce or incomplece and attempt to nodCy past recipieau of
inaccunte or incomplece daca,inciuding recipiencs named by�ha individual;or(b)noafy the individual that he believes ehe data to be eoaect Data
in dispute shalt be disctosed only if the indir•idual's statemsnt o[disagroement is included wi�h rhe disetosed dae.
The dececminadon o!the responsible authoriry may be appealed pursuane to rhe provisions of che adminiscrarive proceduce act nladng w
eontesced easas.
DATA PRIVACY ADVTSORY � ,
In accordance wich M.S. 13.04,Subd.Z, "Righ,ts of subjects of data",we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of its departments may require you to fumish certain private or
confidential informacion. y
You aze notified that:•
� 1. 'Ihe information you furnish will be used to determine your qualification for the permit or license requated.
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 ocher local, state or federal agencies to the exteat necessary to process
' the p�rmit or license.
4. If your requested permit or license requ�res Couacil actibn to approve, some information maq become
public. .
5. � You have cenain ri�hts under M.S. 13.04 (available upon tequest) to review private data on yourself.
6. Your full name is required to process this application or permic.
G o�,�'� y � _ .� �-� Y o�. � .
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Address M y� y�L � !�v G� O' v ! /✓v �� �/� / / / ����" �/
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Ciry State Zip Phone
I uaderstand my 'ghcs as stated above. � _
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