HomeMy WebLinkAbout1998-010651 - tearoff/reroof PERMIT
- �IfiY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 '��'��t-'�-j�E�R�
Permit Number. ;;��_;�,.�,�
Crystal Bay, Minnesota 55323 Date Issued: - �- - -
(612)473-7357 f-�'�;` '�t'`'t�'';
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY: ,
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CONTRACTOR: OWNER: - �4��°� ���!i=� -
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APPLICANT/PERM TEE SIGNATURE ISSUED BY:SIGNATURE �
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Total-Fee: �a Date Received: ,
Entered By: ,�:`�; � Permit#: /(��r�� �` ��
CITY OF ORONO - BUILDING PERMIT A PPLICATION
All information must be submitted in full before plan review will be started.
(please print a11 information) .
THE APPLICAt\'T IS: (circle one� OWNER �R CONTRACTOR� � � . �
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JOB SITE ADDRESS: f �
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NAME OF OtiVNER ��J .c_:� -�� " (_ PHONE: (home) � � ���
:" (work)
�nvG�n�xEss: � � �� � � c��; ������,�� l�� crrY: ��-��� ��,� , �-� zze:����'�' cj.
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CO�tTRACTOR: PHO�IE:
CON'TACT PERSON: MOBILE/PAGER: �
1VIAILI�i tG ADDRESS: CITI': ZIP:
STATE LICENSE: #
A�CHITECT�ENGINEER: PHONE:
i�•IA1I�'ii�tG A.DDRESS: CITY: ZIP:
I�,rAME; REGISTRATION#
TYPE OF tiVOR�i: New Addition Accessory Structure
Move � � Remodel/Alteration Land Alteration
PROPOSED'��ORK(describe in detai�: 1 � - a� � � ; �� i� - ; -� �
STORIES: SQ.k�'EET OF EACH FLOOR: � -
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTII�i IA.TED CONSTRUCTION VALUATION (excluding land): $ � ' � _
I hereby apply for a buildinJ 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 Ciry and with
the State BuildinJ 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 accordance wich the approved plan.
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APPLICANT'S SIGNATURE: .��- � �„��.� ; f �'_ �� DA7�: �� '�� �� '� '�i -�1�
NOTE! Parade of Homes evenfs require separate permit approval by Police De,partment and
� City Counci160 days prior to the event. Non permitted events will not be allowed.
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Sec.13.0.:RIGHTS OF SUBJECTS OF DaT?.
Sutd. I. Type o!data. Tha righc�of ir.dividual oa whom the data is Stored o�to be smr:d shall be as set focv`�ia this secdoo. -
Snrd.2. Informatioa reqirired to be�vea indicidual. ?.n icdividual asYed ro supply privat�or conFdendal dara eoncem:ng himseif shail
be ilFormed of: (a) the purpose aad ineed:d use of the rtquau3 da�within the collecdng Stace ageacy,polidcal suhdivision,or sa[ewide ryr�m;
(b)whe�her he reay r°use or is le3ally requir_d�o supply rhe r:quesud daca;(c)any 3rnown coasequeace arisin3 from his supplyiag or cofusing to supply
p;ivaco or co��den3al dam;ar:d(d)che ideedry of o�her pe:soas or enddes a�choriz:d by sc�ta or federbl law to rceive[he dam. This requiremeat shall
r.ot app[y whea an udividu�is asked to supply invesdgarive da3, pursuaac to secdon 13.82,subdivision 5, to a Iaw enforcemea�ofrccec. -
The comrnissioner of revenue mav olace �he nodce r_auir_d under ehis subdivision in the individu�l incone tax or orooem az rFued
�.s:rucdor.s ins::ad of on chose forms.
Sutd.3. Access to data bv indiridual. Upon requesc to a ruponsible au[horiry,an individual shall be inforraed whed:er he is the subject �
of scnr_d daca on individuals,and whc�her ic is elassified as pubiic, privace or conf:denoal. Upon his furcher requesc,an icdividual who is the subjecc
of stored priva!e or public daca on individuals shall be shown ch�dati wichouc any charge to him and;if he desires, shal[ba informed of the eoncent
ar.d meaning of chat dara. Aher tn individua!has been shown the priva�.da�a and informed of iu meaaing,tha dzta need noc be disciased ta hua for
siz�onchs cl:ereaitr.�uniess a dispute or acdon pursuanc to chis secdon is pending or addidoaal dac�on the individual tas been cotlecc�d or ereac�d.
The rspons;b4-auchoriry shall provide copies of the privau:orpublic data upon requesc by the individual subjecc of the da�. Tha tesponsibie aua4ority
may requir_ ttte requesang person to pay th=accual coses of making,cecrifying,and compiling the eopies.
'Il:e responsible auchoriry shall conply immediac:ly,if possibl:, wich aay rcquest mad:punuant to this subdivision,or wichin five days of
the dace of�he r:quesc,ezcluding Saturdays,Sundays and legal holidays,if ic;smtdiate compliance is noc possible. If he cannot compty with the requesc
wichin that dr.ie,he shall so inform�he individual,and may have an adGidonal fivt days wi�hin which to comply wich the request,excteding Sacurdays,
Sundays and legal hotidays.
Subd.4. Pracedure r�hea data is not accurate or complete. An individual may contest tht accuracy or compieteness of public orpri�ate
daci cor.ceming hunself. To exercise chis ri¢h�,an individual shall noa"ry in wridng che responsible auchoriry dtscribing the nature af the disagreemenc
The responsible auchoriry shall within 30 days eicher: (a)cocrecc ehe dsta found to be ic�aceurate or incomplete and attempt to nodfy past recipieau oE
inaccurate or incompte�e dac�, inc[uding re:ipiencs namcd by the ir:dividual; or(b)noafy ctte individuai that he believes rhe data to be correc� Data
in dispute shall be disclosed only if the individual's s��ement of disagrecr,.cnc is indudzd wich[he disctosed daca.
The de[erminaaon of the r�sponsibla authoriry rr�y be appeated pursuanc to 4`�e provisions of che administrarive procedute act refaan� to
contesced eases.
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 Ciry of Orono or any of its departments may require you to fumish cenain private or
confidential informacion. J
You are notified thar.-
1. "Ihe 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 wich other local, state or federal a�encies to the extent necessary to process
� the permit or license.
4. If your requested permit or license requires Council actlbn to approve, some iaformation maq become
public.
5. You have certain rights under NS.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permic.
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I understand my n��cs�as stated above.
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