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Home My WebLink About1990-application �I<r � CITY OF ORONO - BIIILDING PSRMIT APPLICATION Total Fee: $ Date Received: � � �7 -�i � � Date Approved: Entered By: Permit#: AI.L INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIgW WILL B$ STARTED (See Check-off List Enclosed) -------------------------------------------------------------------------------- THE APPLICANT IS: (circle one ) OWNER or CONTRACTOR JOB SITE ADDRESS: /3 ya �es� � rh � �/� ZIP: 5 S.3 � � �'l �� (work) L17�- Z� I I I1AME OF OWNER: F-�- .�212,H �- ��'_a ��(�l's--� PHONE: (home) �702-1�7 0� MAILING ADDRESS: /3�a �PesT" ��v� �('i� CI�= � � w"`°� ZIP: SS 3 ��- CONTRACTOR: � �C'i�-� PHONE: MAILING ADDRESS : �/�✓�-�— CITY: ZIP: TYPE OF WORR: New Addition Accessory�tructure � Move Demo Remodel/Alteration Renovate Land Alteration PROPOSED WORR (describe in detail) : �� !/,Pc� � ,��a/�e� � 02 �-�5�'��°Z �, �a,� �,o-...�,�. h.e�D C ca,��-e.�. ►2 o�-,e�Q Dv►� S� .t��-�.� �. s o�- ov` .a w� STORIES:� SQ. FEET OF EACH FLOOR: NO. OF BBDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALIIATION (ezcluding land) : $ ��SO /1'�aY.i�� 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. APPLICANT'S SIGNATORE: � DATE: �� (Please fill out t e reverse side of this form) �� -�� _�� 1C� d �• ' ' ��; ^ �� CITY of ORONO Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea � s - � � On the North Shore of Lake Minnetonka DATA PRNACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would Iike to inform you that your request for a permit or Iicense 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 require that the City deny the permit or Iicense. 3. The information may be shared with other Iocal, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or Iicense requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 to review private data on yourself. 6. Your full name is required to process this application or permit. ,�,�--vzo lc:Q � I'�'1 e��.-e l/D % _ First Middle Last /3 �� es � �� . f �i ' rz Address �/1/� v w.�.� � � � �3 � �- City State Zip �-} � a • C�7 U� Phone I understand my rights as stated above. Signature BUILDING&ZOIYING—473-7357 • ADMINISTRATIOIY&FINANCE —473-7358 • PUBLIC WORKS —473-7359 ASSESSING � � -- .._... ----- .��_..__ . . .R �.04 RIGHTS OF SIIBJECTS OF DATA � gubdivision L Tppe of data- The rights of individuals on whom the data is stored or to be stored shall be as set forth in this section. gubd, 2. Information required to be g�v� ��' An.individuel ssked to � ' su 1 private or confidentiel data coneerning BmWi�in the cellect g state agency, PP Y purpose and intended use of the requested dat olitical subdivision, or statewide system; (b) whether he ma� refuse or from his p the requested data; (c) any kneH►n consequence arising required to supply rivate or confidential date; and (d) the identity of supplying or refusing to supply p other persons or entities authorized by staau��e�kedlto supplyein est gat ve da a requirement shall not apply when an mdiv pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue ma oleTt tgX re°una u structionsuinsteadhos subdivision in the individuel income tax �r r on those orms. . - -- - - _ Ac� � �� y Upon request to a responsible Subd. 3. � authority, an individual sha]1 be informed�he b�c'pr'vateeor eonfidential.e Upon his individuels; and v�►hether it is classified p ublic data on further request, an individuel v�►he is the subject of st to himriande if he desires, shall individuels shall be shown the data withou�tfatn�t �� ter an individual hes been �e informed of the content and meaning t� �� need not be �sclosed to shown the private dats and informed oi its u��aetion pursuant to this section is him for six months thereafter unless a �P � ending or additional data on the individuh h�8teeor p blie dataruponarequest by ' P require the responsible authority shall provide coples The res onsible authority may the individual subject of the data• P requesting person to pay the aetual costs of making, certifying, and comp�ling the copies. 1mmediatelY, if possible, with eny request The responsible authority shall comQly ' of the date of the request, made pursuant to this subdivisi�olnd le al tholidays,�f�immediate compliance is not excluding Saturdays, SundaYs g possible. If he cannot comply with the request wit witi�ntw�ch toh mp1Y fw h the individuel, and may hsve an additio� i��o days• request, exeluding Saturdays, Sundays g Subd. 4. Proced�a'e when data is not accurate or complete. An individuel maY himself. To contest the accuracY or comQleteness�of public or private � the�nrespens ble authority exereise this right, an individusl shall notify in writing describing the nature of the disagreemenL T�c�a e oc in o p1eL and att pt to days either. (a) correct the data found to be notify past recipients of inaccurate or incomp�t�t�eVesdthe rdatalto be correct the individuel3 or (b) notify the individual Data in dispute shall be disclosed only if the individual's statement of disagreement is • included with the disclosed data. ealed ursuant to the ' The determination of the responsible authority to c�tested cases. provisions of the administrative procedure act relating d�• � ' CHECR OFF LIST FOR ISSIIANCL OF PERMITS FOR OFFICE USE ONLY ADDRESS OR I�EG�L DESCBIPTION: �� es � / -oi�1�► � ('f�'�-� - PID• DESQtIPTION OF WORR: ��(�- / 7 a� � ��D N�� - ------------------ ZONING REVIEW BY: DATE APPROVED: BQILDING REVIEW BY: .DATE APPROVED: pERMIT ISSIISD BY: DATE: ---------------------------------------------------- FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes No SEWER UNIT $ PLAN REVIEW Yes No SEWER CONNECTION STATE SURCHARGE Yes No WATER CONNECTION PENALTY Yes No PARK FEE SAC Yes No SITE INSPECTION OTHER (specify) --------------------------------------------------- ZONING CHECR LIST Zoning District: Fire Department: Post Office: School District: Lot Area: Width: Depth: Survey Submitted: Yes No Date of Survey: Proposed Setbacks : Front (Lake) : Right Side: Rear (Street) : Left Side: Adjacent Structures: Wetland: Existing Proposed Hardcover: 0-75 ' 75-250 ' Hardcover Variance Required: Yes No Date of Council Approval: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: BY� ' Zoning File:# Resolution #: Resolution Date: R.E1rlARRS (in house) : 6 -- -�-- -- ..-- ------- __._ _.----- - - - -----__... . � �� BIIILDING REVIEW CHLCR LIST IIgC: CONSTRQCTION TYPE: BLDG SIZ$: H. L. W. Sq Footage $ Per Sq Ftg Basement X - lst Floor X - 2nd Floor X - Garage X - x = TOTAL Esti.mated Construction Value: $ Inspections Reqnired: Work Reqniring Separate Permits: Site Plumbing Grading/Filling Footing Mechanical Fire Framing Well Water Connection Insulation Septic Sewer Connection Wall Board Fireplace Other Final (Masonry) Other (Manufactured) REMARRS (IN HOIISE) : --------------------------------------------- REVI$W BY OTHERS: DATE: Access: Existing New Access Approval: Date BY= --------------------------------------------- ]ZF1YtARR$ (TO BE NOTED ON PERIKIT) : . 7