HomeMy WebLinkAbout1999-011248 - tearoff/reroof PERMIT
C�.TY OF ORONO PERMIT TYPE:
" 2750 Kelley Parkway- P.O. Box 66 `'��-���-i?��`v��
Cxystal Bay, Minnesota 55323 Permit Number: �_;• �
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(612) 473-7357 Date Issued: �_,:;;;�;�;�.;��:��;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATU ISSUED BY:SIGNATURE �•
• To�al Fee: S Date Received:
Entered By: Permit#: i�:� =` '
CITY OF ORONO - BUII,DING PERNIIT APPLICATION
All information must be submitted in full before plan reoiew will be started.
(please print all information)
THE APPLICAI`"I' IS: (circle one) OWNER O CONTRACTOR
1
JOB SITE ADDRESS: ��-S ���'-��r�C`� Z�:
NA.ME OF Otii�I`'ER: �7c�T" G,S�n� PHONE: (home) z/?�—C�f�y-�
(work) 9c3y- -�av�
1�iAII..I�i TG ADDRESS: �G� CTTY: �3,�;�� ZIP:
CONTRACTOR: ��tc�� ���� �� ��-�. PHO�TE: -��/—��7 7
CONTACT PERSON: � _Sc ,� 11�iOBILE/PAG�R:
MAILT�i'GADDRESS: o?�/2s �,r� �%��� CITY: _l , ra�Qw'� ZIP: �` -�33J
STATE LICENSE: # �d��Z>�. y
ARCHITECT(ENGINEER: PHO�IE:
I�IAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration_� Land Alteration
PROPOSED WORK(describe in detain: ��6� a� � ��–��
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GAR.AGE STALLS: ATT. DET.
a � G/�XJ �
ESTIi�iATED CONSTRUCTION VALUATION (excludinb land): $
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 pernut and work is not to start without a
permit; and that the work will be in acco ance with the app ved plan.
APPLICANT'S SIGNATURE: G DATE: -3�'Z y'�
NOTE! Parade of Homes events require separate permit approval by Police Department and
Cily Counci160 days prior to the event. Non permitted events will not be allowed.
.
Sec.13.04 RIGH'TS OF SUSJECTS OF DATA '
Subd. 1. Type of data. '!he righcs of individual on whom rhe dara is swced or ro be swcsd shall be u set focch ia�his secaon.
Subd.2. Iatormaaon nquired to be�ivm tadividual. An iadividual ufced w supply private or confidendal daa concerning himself sha11
be info�ased of: (a)the purpou a�inteaded use of the tequested dan wirhia the collecang�tate agenry.poGdcal subdivision,or statewide rystem;
(b)whether he tssay retuse ot is.kgatly required to supply the requesud data:(c)any Irnown coauquedce uising from his supptying or refiuing to supply
privace or coafidendal data;and(d)the ideacry of ocher persons o�enrides authorized by sta�e oc fedenl law to receive the data. This requinmenc shall
no[apply when an individual is uked to supply invescgarive dan,puesuant�secdoa 13.82.subdivisioa S,m a taw enfoc�ement officer.
The coc�missioner of rcvenue mav olac- che nodc� rauirod under diis subdivision in the individual income ax or orooem tax relund
instrucaons inscead of on chose fotms.
Subd.3. Access to data bp individual. Upon nquesc to a responsible auchoriry,an individuat shall be informcd whethec he is the subjecc
of smred daca on individuals,and whecher it is class�ed u public,private or confidendai. (lpoa his ti�rrher requesc,aa iadividual who is the subjecc
of scored private or public daa on iadividuals shall be shown che data wichout any charge to him and;if he desires,shall be informed of the contenc
and meaning of chu data. Afur an individual has been shown rhe private data and informed of iu meaning,the dan need not be disclosed oo him for
six mondu theceatur unless a d'�spute or acdon pursuanc to chis secdon is pending or addirional da�a on the individual has been collecced or creared.
The«spansible authoriry shall provide copies of the private oc public data upon nquest by the individuai subjecc o[rhe dua. The responsible authoriry
may tequi�s che requesdng pecson to pay�he accual coscs of making,certifying,and compiling the copia. �
The cesponsible auehoriry shall comply immedia[ely,if possible,wich any tequest made pursuant co this subdivision,or within five days of
the date of the requesc,excluding Santcdays,Sundays and legal holidays,if immediate compliance is noc possible. If he canaoc comply with the requesc
wiehin chat dme,he shall so infocm the individual,and may have an addidooal five days within which to comply wich the«quest,eacluding Saturdays,
Sundays and legal holidays.
Subd.4. Ptoeedure when data ts not aceurate or camplete. M iadividual may contest the accuracy or completeness of pubtic or private
dara conceming himsetf. To exercise this righ4 an individual shail nadfy in wridng rhe cespomible audtority describiag the nature ol the disagreemenc
The responsible aufioriry shall withia 30 days either. (a)correcc the data found w be inaccunte or incomplea and atumpc to aodfy past mipientt of
inaccurace or incomptece daa,including recipieacs named by ehe individual:or(b)nodfy the iadividual thac he betieves�he daca m be correcc Da[a
in dispute shall be disclosed only iP the individual's statemenc of d'uagreement is included with the d'uclosed dan.
The decerminadon of the rasponsible au�horiry may be appealed puauane to the pcovisions of the adminisaaave procedure act mlating to
contesud cases. •
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2, "Righcs 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 ics departments may require you to furnish certain private or
confidential infonnation.
You are notified that:
1. The informacioa 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 raay be shared with other local.state or federal agencies to the exceat necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
S. You have certain rights under M.S. 13.04 (available upon request) to review private data on younelf.
6. Your full name is required to process this application or permit. 7
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I understand my rights as stated above.
Signaare
DATE TIME
CITY OF ORONO CALLED IN � � C�
INSPECTION NOTICE SCHEDULED `-c
PERMIT NO. d� COMPLETED �_ ��
ADDRESS �S � �
OWNER ,.�.�es�. CONTR.
TELEPHONENO. '��/" ���= �
� DESCRIPTION�__ �c�.2.�t7f
L� 01 FOOTING 11 I�IECHANICAL RI 18 EXCAV/GRADING/FILLING
� 0 RA 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q LATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINA� 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
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� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. L PHOTO TAKEN
INSPECTOR WtLL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �� CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ext inspection 24 hours in advance.473-7357
OwnerlContr r site:
Inspector.
White Copyllnspector's ile Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN y�-�'Q " � �I-I S Q/�'!
� INSPECTION NOTICE SCHEDULED �'
PERMIT NO. � COMPLEfED
ADDRESS
OWNER u� � CONTR.�inC�!�o �0.�.
TELEPHONE NO. �J ��- �l � � 7
� DESCRIPTION ,,�'� ;/).�-4
� 01 FOOTING 11 MEC NICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAI 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 D. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEEi YOU:_YES_NO
Z
� COMMENTS:
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d WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W
� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALITOARRANGEACCESS.
Call for the n t inspection 24 hours in advance.473-7357
Owner/Cont o ite:
Inspector.
,�
White Copyllnspector's ile Canary CopylSite Notice