HomeMy WebLinkAbout1996-008323 - temp sign ' � PERMIT
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� � G�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 'W�I{�N
Crystal Bay, Minnesota 55323 Permit Number: �}R�i�,:rt;.�,;i
(612)473-7357 Date Issued: _
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SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: �i'��4�I�'Y L��TH��`���i�'�:�-!�`i�'�':��
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APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ Date Received:
Entered By: Permit#: ���
CITY OF ORONO - BUILDING PERMIT 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 ADDRESS: �� /�� `� (� �� � ✓��_ �V�'�- ZIP: �S��,� �
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NAME OF OWNER: �r'��� �� �.�-� � �J�/;E I'����J PHONE: (home) ��� �`���
! (work)
MAILING ADDRESS: ` ��� �-'; i-� CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
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PROPOSED WORK (describe in detain: �� ym r� "'�r G� I'1 � �'?' ��t�-lt C-��
; � �� - '�' �' � � ...L �� �'��� '� �� C �
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED 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 Building 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.
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APPLICANT'S SIGNATURE:,.��+- �� �.�c �. -�� lt.� � DATE: �� _��, -�'�'
NOTE! Parade o�Homes events require separate pernzit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA
Subd. I. Type of data. The rights of individual on whom the data is scored or co be scored shall be as set forth in this secdon.
Subd.2. Information req�rired to be given individual. r1n individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data wi[hin the collecdng"state agency, political subdivision,or statewide rystem;
(b)whether he may refuse oi is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing ro supply
priva[e or confidenrial data;and(d)the identity of other persons or enaaes authorized by state or federal law to receive the data. This requiremeot shall
no[apply when an individual is asked to suppty investigadve dara, pursuant to secdon 13.82, subdivision 5, ro a faw enforcement ofFicer.
The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or proQertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon reques[to a responsibfe authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whether it is classified as public, private or conftdenrial. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown[he data wi�hout any charge 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 data and informed of its meaning,the data need not be disclosed to him for
six months thereatter unless a dispute or acrion pursuant to this sec[ion is pending or addiaonal data on the individual has been collected or created.
The responsible authority shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual costs of makine, certifying, and compiling the copies.
The responsibfe authoriry shall comply immediately, if possible, wi[h any request made putsuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is no[possible. If he cannot comply wi[h the request
within that time,he shall so inform[he individual,and may have an addiaonal five days wi[hin which to comply with the request,exciuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individua!may contest thz accuracy or completeness of public or pri�•ate
data concerning himself. To exercise this rieht,an individual shali notify in writing the responsibie authoriry describing the na[ure of the disagreemenc.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipiencs of
inaccurate or incomplete data, inc(uding recipients named by the individual; or(b)no[ify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreemenc is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuanc to the provisions of the admuilstiadve procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of 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. 'I'he information you furnish will be used to determine your qualification for the pemut or license requested.
2. You may refuse to supply data, but refusal may require tha[ the City deny the permit or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
pubiic.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
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First ! � / vliddle „ Last
'� �� ��-C� ,!�7L�_--�
Address � — -� � _ �.�� �
� � . � r��-u�� �� � �>� � � ��� ' ".� .
Ciry —�— State Zip Phone
I understand my rights as stated above.
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