HomeMy WebLinkAbout1999-011702 - reroof PERMIT
CITY
ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number:
Crystal Bay, Minnesota 55323 7Date Issued: %.Jj T "
(612) 473-7357
SITE ADDRESS:
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FEE SUMMARY:
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CONTRACTOR: OWNER:
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Op LICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ 93/ S Date Received:
Entered By: �U. Permit#: /I 7 b
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: ' (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: (OSS oLo C�`ts1�(- Ohy iZdA9 ZIP: 5 .S 3 5
r,)L? t{I Gds ScN ouL
NAME OF OWNER: d�O'� 250 I' Z 7 5 PHONE: (home)
(work) ' /y- MY
MAILING ADDRESS: (og J 6)LO C AYs 74t- CITY: LO NG t,� � ZIP:_
CONTRACTOR: M r �n1(, PHONE:
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CONTACT PERSON:-J 'A XY MOBILEIPAGER: 6/Z- b 7 0- 7SO U
MAILING ADDRESS: I b I S 99 r" LA^t e CI'T'Y: 8(-A y Nei, M j ZIP: SSy y
STATE LICENSE: #
ARCHITECT/ENGINEER: 2C l�f 7 C Z 5 /�L PHONE: 3 U - 1 S 6 -U7 9 7
MA.II,Itii `G ADDRESS: CITY: 7 c�vu,z "" ZIP: S .
NAME: REGISTRATION# J 7 y 7
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detail): R-0 0F /-e P✓l t R-S ori Sec-;r`w '4-z
fZept Acc 2,)� 1' y1d o ,.-J5u1,071a� o,� Sf c7io..+5 �J /�-1 r f'=Z,
STORIES: I SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
8
5 D�. v
ESTL MATED CONSTRUCTION VALUATION (excluding land): $ �
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 BuildLng 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 with the approved plan.
APPLICAN'T'S SIGNATURE: DATE: Z
NOTE! Parade !2f Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sm.13.04 RIGHTS OF sumcrS OF DATA '
Subd. I. Type of data. The rights of Individual on whom the data Is sw or to be stored shall be as set forth In this section..
Subd.2. Information required to be given individual. An individual ask to supply private or confidential data concerting himself shall
be informed of. (a)the purpose and Intended use of the requested data within the Boll citing late agency.political subdivision,or statewide system;
(b)whethcrhe may refuse oY is legally required to supplythe requested data;(c)any into consequence arising from his supplying or refining to supply
private or coaSdentiaI data;and(d)tete Identity of otherpenaas oreaddes'audiorized b sate orfederal law to receLye the data. This requirement shall
not apply when an individual is asked to-supply irivesdgadve dam,pursuant to section 13.82,subdivision S.m a law enforcement officer.
The commissioner of revenue may lace the node_reauired under this su ivision in the individual Income tax or roerty tax refund
Instructions Instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible au odd.an Individual shall be informed whether he is the subject
of stated dam on individuals,and whether it is classified as public,private or confide tial. Upon his 8lrther request,an Individual who is the subject
of stored private or public dam on individuals shall be shown the dam without any c e to him and;if he desires,shall be informed of the content
and meaning of that data. After an Individual has been shown the private dam and inf rmed of Its meaning.the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section Is pending or ddidonal dam on the individual has been collected or created.
The responsible authority shallprovide copies of the private or public data upon reques by the Individual subject of the dam. The responsible authority
may require the requesting person ro pay the actual costs of making,certifying,and mpiliing the copies.
The responsible authority shall comply immediately,if possible,with any quest trade pursuant to this subdivision,or within five days of
the date of the request.excluding Saturdays.Sundays and legal holidays,If Immediate mpiiance Is not possible. If he cannot comply with the request
within that time,he shall so inform the Individual.and may have an additional five da r�within which to comply with the request.excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An iadivido may contest the accuracy or completeness of public orprivate
data concerning himself. To exercise this right,an Individual shall notify In writing th respoasibte authority describing the nature of the disagreement
The responsible authority shall within 30 days either. (a)correct the data found to b Inaccurate or incomplete and attempt to notify past recipients of
Inaccurate or incomplete data.Including recipients named by the individual;or(b)a tify the Individual that he believes the data to be correct. Data
In dispute shall be disclosed only if the individual's statement of disagreement is Inc nded with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVSORY
In accordance with M.S. 13.04,Subd.2, "Rights of subjects o�data%we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. The 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 req ire that the City deny the permit or license.
3. The information may be shared with other local,stat or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Counc action to approve, some information may become
public.
S: You have certain rights under M.S. 13.04•(availabl upon request) to review private data on•yourself.
6. Your full name is required to process this applicad a or permit.
l=ust btiddte Last •
//l X1-57 &()1-0 .v G�4� LAN
Address ttct,P pr Ale
City Slue Zip Phone
I understand my rights as stated above.
Signature
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