HomeMy WebLinkAbout1998-010250 - tear off/re-roof PERMIT
CITY OF ORONO PERMIT TYPE:
�2750 Kelley Parkway- P.O. Box 66 ;::,i_i�;�t�j�,�i;
Crystal Bay, Minnesota 55323 Permit Number: {f��}s�:�;}
(612) 473-7357 Date Issued: zYz,�.;i��,�;_;
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ Date Received:
. Entered By: Permit#:
CITY OF ORONO - BUII..DING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE A.DDRESS: �?�,� t',��,� `�;�. ZIP: S .5 3 � `7�
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NAME OF OWNER: f�r_`7��' i ct�r n�, PHONE• (home) ��7t�- 6 S 9g
' (work)
MAILI`i TG ADDRESS: I.�t:;`-� �,%'��«= ��°. CITY: �;v n c�; ZIP: �5.-3F;�/
CONZ'RACTOR: D,Q Cc�,.0 �,�,� PHONE: y3�-5�5 S i
CONTACTPERSON���,��-� MOBILE/PAGER: 3c;� . /c.�,�
MAILING ADDRESS: S��� A;.��,�,s r� /'r,�- �i!' CITY: �'�;<< �� ZIP: �-��7 Y
STATE LICENSE: # 33 �J��
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: i�,�,�_v,�F ,tw�n ,eE���c,F-
STORIES: 1 SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTliV1ATED CONSTRUCTION VALUATION (excluding land): $ ��'�fQ�� �J
I hereby apply for a building pemut 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
pernut; and that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE�_l�c�c��E'�jf'� DATE: s`-�%-Sfj'
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Counci160 days prior to the event. Non permitted events will not be allowed.
1
Sec.13.04 RIGHTS OF SUBJECTS OF DaT?.
Subd. 1. Type of data. The rieh�s of individual on whom[he data is s�ored or to be scored shall be as se�forth in this secdoo.
Subd.2. Infocmation reqirired to be given individual. �.n individual asked to supply privace or confidzndal dara coaceming himself shall
be informed of: (a)the purpose aad intended use of the requested data within the collecdng'state ageocy, polirical suhdivision,or scatewide rystem;
(b)whe[her he may refuse or is tegally required to supply the requested data;(c)any lmovm coasequence arising from his supplying or refusing to supply
• private or conndenoal dara;ar.d(d)che idenriry of other persoas or enriaes aurhorized by s[ate or federal law to receive the data. "Ihis requirement shall
noc apply when an individu�t is asked co suoply invesri�aave daca, pursuanc to secaon 13.82, subdivision 5, to a taw enforcemznt o�cer. -
The commissioner of revenu- mav place the noac� r�ouir�d undAr [his subdivision in the individual income taz or prooem tax reEund
inscrucaons inscead of on those forms.
Subd. 3. Access to data by indi�-idual. Upon request to a responsible authority,an individual shall be informed whecher he is the subject
of scored da�a on individuals,and wherher ic is classified as public, privace or confidenaal. Upon his further request,an individual who is the subject
of scored privace or public dara on individuals shall be shown che data wi�hout any charge to him and,-if he dzsires, shall be informed of the content
and meaning of[hat data. After an individual has been shown the private data and informed of ics meaning, the data need not be disclosed to him for
six monrhs therea[ter unless a dispute or acaon pursuan[to [his secaon is p�nding or addiaonal data on the individual has been collecced or creatPd.
The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subjecc of the data. The responsible authoriry
may requice the requesring per5on to pay thz actual cos�s of makine, cerrifying, and compiling the copies.
The responsible authoriry shall comply immedia[ely, if possible, with any request made pursuan[to this subdivision,or within five days of
the dace of che requesc,excluding Sacurdays,Sundays and legal holidays,if immzdiate compliance is not possible. If he cannoc comply with the requesc
within[hat time,he shali so inform the individual,and may have an addirional five days within which to compiy with the request,exctuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise�his rieht,an individual shall noa"ry in wrian�the responsible authoriry dzscribing the nantre of the disagreement.
The responsible authoriry shall wichin 30 days either: (a)correcc the data found to be inaccunte or incomple�e and attempc to nodfy pasc recipien�s of
inaccurate or incomplete data, including recipien¢named by the individual; or(b)nocify the individual that he believes [he data to be correct. Data
in dispute shall be disc(osed oniy if the individual's sta�ement of disagreement is included with che disclosed data.
The dererminarion of ehe responsibte auchoriry may be appealed pursuanc to the provisions of the adminiscradve procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rishts of subjects of data", we would like to inform you that your request
for a pernut or license from the Ciry 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 require that the City deny the permi[ or license.
3. The informa[ion may be shared wi[h other local, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your fu11 name is required to process this application or permit.
i�' GC����
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I understand my rights as stated above.
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