HomeMy WebLinkAbout1998-010648 - storm damage repair - " PERMIT
CITY OF ORONO PERMIT TYPE: I
�2750 Kelley Parkway- P.O. Box 66 � Permit Number: L�`-���='"'='- ' f
Crystal Bay, Minnesota 55323 `-"-`-`'=``*'=`
I (612)473-7357 Date Issued: ; i..;,:_-:�� .:_� ;:
� SITE ADDRESS:
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I DESCRIPTION: . _
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REMARKS:
FEE SUMMARY: ;
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CONTRACTOR: - �.r-���! ������. - OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��
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'Y'otal Fee: $ ;;�=��j, ,�-� Date Received:
' Entered By: �i f Permit#: ,��c'�':';'='�Y`4�
CITY OF ORONO - BUILDING PERNIIT 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 �CONTRACTO�
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JOB SITE ADDRESS: l -� �� d�L' S� ��,�/� �i����: S S� �h `�
NAME OF OWNER: ��-t�--% �_;2'�� �-f-� �� PHONE: (home)
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(work)
MAILING ADDRESS: I � ��- �� C Sf t������`��tizr(�ITY: L`�:�>���L�c�� ZIP: �>> ;��
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CONTRACTOR: `�'"�I ►�% �--% .�ti� �.�- -i�C_C-�,�:���a=�BHONE: `% -- �/C
CONTACTPERSON: ]��r,�Y� ��,���,�ry,���,,.�MO ILE/PAGER:
MAILING ADDRESS: ��, �C, �.������,��sy,� l�-.,.� CITY: %��c�,1�{; ZIP: �S��i�..
STATE LICENSE: # c��n� i z � z
ARCHITECT/ENGINEER: �j� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAlVIE: REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
Move Remodel/Alteration_� Land Alteration
PROPOSED WORK(describe in detai�: ��'S2-�,.� c� «� c��-� S t ���f
t�^J ,�i1 �ativ-s - -� - ( .��. �
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STORIES: �'2 SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�:.:
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ I �-=C�-c=��`
I hereby apply for a building pernut 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 ordance with the approved plan.
APPLICANT'S SIGNATURE: �'�/�t�������DATE: �' ;I (.� l q ��.
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NOTE! Parade o Homes events require separate permit approval by Police Deparlment 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 SUBJECTS OF DATA • ,
Subd. 1. Type of data. The rights of i�uiividual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply privau or co�dential data conceming himself
shall be informed of: (a)the puipose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or
refusing ro suppiy private or confidenaal data;and(d)the identiry of other persons or en6ties authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply invesdgaave data, pursuant to section 13.82, subdivision 5, to a law
enforcement o�cer.
The commissioner of revenue mav olace the norice reauired under this subdivision in the individual income taz or nrocertv tax refund
instrucdons instead of on those forms.
Subd.3. Access to data by individual. Upon request ro a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is class�ed as public,private or confidendal. Upon his further request,an individual who
is the subject of swred private or public data on individuals shall be shown the data wirhout 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 iu meaning,the data need not be
disclosed w him for six mondu thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private 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 making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days
of the date of the request,exclnding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the i�ividual,and may have an additional five days within which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
S�bd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data conceming himself. To exercise this right,an individual shall nofify in writing the responsible authoriry describing the nature of ihe
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found oo be inaccurate or i�omplete and attempt to notify
past recipients of inaccurate or i�omplete dara,including recipients named by the individual;or(b)nodfy the individual tUat he believes the daha
to be correct. Data in dispute shall be disclosed only if the individual's sratement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative prceedure act relating
to contested cases.
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�iry 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 fumish 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 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
public.
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 Middte Last
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Addres
��., �,u�.� /�� ,�� SS�'�`�Z- .s�9 c� �a Z
Ciry State Zip Phone
I understand rights as stated ove.
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Signam
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• CHECK OFF LIST FOR ISSUANCE OF PERMITS
" FOR OFFICE USE ONLY
ADDRESS OR LEGAL: � 33 to ��i Po�n�� C�2c.c�t:
PID:
DESCRIPTION OF WORK: .STp2cn1 1�AMA���, ��P�4 t 2
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ZOVING REVIEW BY: DATE APPROVED: g •( $-Q�$
BUILDING REVIEW BY: DATE APPROVED: � -i cb -g SB
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes No �,� SEWER CONNECTION
STATE SURCHARGE Yes �� No WATERCONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST zoning District: /U(' G(-�'��(�(�
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: We land:
Building Height: Def. Hgt. Pe �Hgt.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: y:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setba : Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): �OD/I,o�2��-�-� � i n � rV'�2c�0� Q c� g(L+rc� U�
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BUILDING RFVIEW CHECK LIST
UBC: `�►` � CONSTRUCTICEN TYPE: VIJ
Sq Footage $Per Sq Ftg
Basement , x =
lst Floor a —
2nd Floor x =
Gazage x =
R =
TOTAL
Estimated Construction Value: $ ((7,��'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
�Final Grading/Filling Electrical(State Permit)
Other
REMARKS(1N HOUSE): �
REV�W BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMII�:
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