HomeMy WebLinkAbout1993-005058 - add floor support P�I� IT
CITY OF ORONO PE�RMIT TYPE:
2750 Keliey Parkway • P.O. Box 815 E���1.L��I t�t=�
Orono, Minnesota 55356-0815 PermitNumber: tft_}C��c;_
(612) 473-7357 Date Issued: ���;�,�j,�:_;
SITE ADDRESS:
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DESCRIPTION:
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APP ANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE �.�f
� 1
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ �'�. .� � _ Date Received: �� �9 '�3
--,
Date Approved:
Entered By: �,��/�
Permit v: ; c -
ALI� INFORMATION MIIST BE SIIBMITTSD IN FIILL BEFORE PLAN REVIEW WILL BS STARTED
(See Check-off List Enclosed)
-------------------------------------------�y=-------------------------------
THE APPI,ICANT IS: (circle one) OWNER or CONTRACTOR
' JOB SITE ADDRBSS: J �U ZIP: �_� -�yi �
(work)
NAME OF OWNER-���_j'�f?�"� PHONE: (home) c - �
MATLING ADDRESS: CITY: ZIP:
CONTFiACTOR: � PHON$: r��3 ^� 2f C
MATLING ADDRESS: ��v� �K� �U�• CITY: T U�S /�r� ZIP: SS�/�
STATS LICENSE: � �(`� J /��CJ
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRBSS: CITY: ZIP:
N��: R.BGISTRATION A
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodei/Alteration_j�_ Renovate Land Alteration
PROPOSF.D WORK (describe in detail) : , `�-X�S��� �l� C r
STORIES:_�� SQ. FE$T OF EACH FLOOR:
NO. OF B$DROOMS: � GARAGE STAI.I,S: ATT. DE .�
ESTIMATED CONSTRIICTION VALIIATION (eacluding la.nd) : $
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the wor}c 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 wvrk wiI 1 be in accordance with the approved plan. - �
AL'PLICANT'S SIGNATDRE: DATE: 1l�-�
�
CITY of OROl\TO
Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Officea
i
� - � � 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 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. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or 3icense.
3. The information may be shared with other I.ocal, 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 yourse3.f.
6. Your full name is required to process this application or
permit.
�c�i r
First Middle Last
�s`T �r� /'--�2 S
Address
S�.T �is ✓-a r1c �/�, ss�/��
City State Zip
��� ��v �3�y
Phone
I unde stand my rights as stated above.
c /%�� �
Signatur �
BUILDING&ZOIYING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
�.04 RIGHTS OF SIIBJECTS OF DATA �
Subdivision 1. Z�ype cf data- The rights of individuels on whom the data is
stored or to be stored shall be es set forth in this section.
gubd. 2. Informaticn required to be giv� ����' An.individuel esked to
� ' supply private or confidentisl data concernin g gmwithin the collecting stat agency,
purpose and intended use cf the requested d
political subdivision, or statewide system; (b) whether he ma� refuse or is legally
required to supply the requested dat8; (c) any known consequence arising from his
rivate or confidentiel dats; and (d) the identity of
supplying or refusing to supply p
other persons or entities authorized by state or federal law to rece�veste at ve da a
requirement shall not apply when an individuel is esked to supply g
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue m8 rolert tax re�und instructions insteadhos
subdivision in the individual income tax �r
on those orms. . . --- - - -
Subd. 3. Access to data by i����• �P°n request to a responsible �
authority, an individuel shall be informed whether h�VBteeor eonfident al.e Upon his
individuels; and whether it is classified as public, p ublic data on
further request, an individusl who is the subject of Se to himrland, if he desires, shall
individuels shall be shown the data witho of�hat da a. After an individual 1�es been
�e informed of the content and meaning t� �ta need not be disclosed to
shown the private data and informed of its meaning, u��t to this section is
him for six months thereafter unless a dispute or action p
{ � pending or additional data on the indi�d�h h�8te or publie dataruPen request by
responsible authority shall provide copies P require the
the individual subject of the data. The responsible�E=�f°nity�a compiling the
requesting person to pay the actual eosts of making, 3'1 g�
copies. lmmediately, if possible, with any request
The responsible authority shall comply � of the date of the request,
made pursuant to this subdivision, or within five days
excluding Saturdays, SunagYs �nd le� u�tawl��n�that�t meahe hall so�info m the
possible. If he cannot comply with th 9 �yithin which to comply with the
individual, and may hsve en additional five days
request, exeluding Saturdays, SundaYS snd Iegal holidays.
. Subd. 4. Procefia'e when data is not c o�rivate datla iconcerning himself• To
contest the accuracy or completeness�of pubU in writing the responsible authority
exercise this right, an indiv�duel sha� notify
describing the nature of the disagi'e�d to be naccurpa e ore n ompl tLe and at pt to
days either: (a? correct the data fo
notify past recipients of inaceurate �V���P�t he belie esdthe datalte be correcty
the individual; or (b) notify the in
Data in dispute shall be disclosed only if the individusl's statement of disagreement is
• included with the disclosed data. ealed ursuant to the
' The determination of the responsible authority may be aPP P
provisions of the administrative Qrocedure act relating te contested eases.
- � . �- CHECR OFF LIST FOR ISSIIANCE OF PF�tMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2Z.�$ S t-hA+��w o-c-oP PID: '
DESCRI PTI ON OF WORR: I�O� 5�PO�2T Y-o �'t.cap/�. S y s T�'y*�
------------------------------------------------------------------------------
ZONING REVIEW BY: N I/� DATE APPROVSD:
BIIILDING REVIEW BY: c C�G�-- DATS APPROVED: Y�Ld'"�'7"3
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes v� No �
PLAN REVIEW Yes �' No SEWER CONNECTION
STATE SURCHARGE Yes v- No WATER CONNECTION
INVESTIGATION FEE Yes No � PARR FEE
SAC � Yes NoT� SITE INSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------
ZONING CHECR LIST Zoning Dis ' ct:
Fire Department: Post Office: School District:
Lot Area: idth: Depth:
Survey Submitted: Yes o Date o Sur ey:
Proposed Setbacks:
Front (Lake) : Rig Side.
Rear (Street) : Le t Side.
Adjacent Str ctures: Wetland:
Building Height: Def. H t. Peak t.
Avg. Setback: t Coverag :
Exis ing Proposed
Hardcover: 0 75 '
75 250 '
25 -500 ' -
50 -1000 ' �
Hardcover Variance Re u red: Ye No Date of Council A proval.:
Grading: Staff Approv Date: By: Council Appr val Date:
Septi c: Staf f Approva7. Date: BY=
Zoning File:# Resolution �: Resolutio Date:
REMARRS (in house) :
BUILDING REVIEW CHECK LIST � , �
IIgC: �'� R '.3 CONSTRIICTION TYP$: �--
Sq Footage $ Per Sq Ftg
Basement x =
lst F].00r x =
2nd Floor X =
Garage x =
x =
TOTAL �
$ �"�"�� � -�c�
Sstimated Construction Value:
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Fil7�ing
Footing Mechanical. Fire
_�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wa7.1 Board (Masonry) Lawn Irrigation
_�Fina 1 (Mf g.) Other
Other WeJ.7� (State Permit)
Electrical (State Permit)
-------------------------------=----------------------=------------------------
REMARRS (IN HOIISE) : _
-------------------------------------------------------------------------------
REVIEW BY OTHERS: DATS:
Access: Existing New
Access Approval: Date BY=
R�MARRS (TO B8 NOTED ON PERMIT) :
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7AT�: �I I�---�9 � PERMiT NO. r,.,.....�...
w�.Pi����JV;.D ,q� SU�'v„7?'�D
;�j ,q'}p(`<C���:� ',ti'11'� CC�R�CY�ONS AS NOTED r
'a rl�'t' t\P�R�V�;n -- COKRECT & RcSt.�Bti11T
7}��,su r;�ry7mui�ta aro ior qour 'r�torm�tion. Ail woMc shaii be don+
!n f��ll �timU�it+nr.a witil all a�ypl�caDle buiiding & zoning cade re•
quir�fNni�tr It14'�UGlil'IS iYem3 rtot �octfically noted in th�s revlq�.
`�(��R YHI5 PI.AN SE7 Oti 51TE A7 Al.'-_ TIMES.