HomeMy WebLinkAbout1994-006066 - add/remodel PERMIT �
c�IT�"OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 ��`�i�-�;���'�
Orono, Minnesota 55356-0815 Permit Number: �,�k�,�_k�,�
(612) 473-7357
Date Issued: {���f�,,r�_��
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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CONTRACTOR: — �����=1 i c,i�;;.. -- OWNER:
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PL CANT/PERMITE IGNATURE ISSUED BY:S�GNATURE J�iC'�,
a
� , CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ �� ,;,'? Date Received:S���- `1�
Date Approved:
Entered By:�rj�� Permit�: L�U,�-
AI�I� INFORMATION MIIST B$ SIIBMITT� IN FULL BEFORE PI,AN REVIEW WILL BB STAR2'F.D
(See Check-off List Enclosed)
---------------------------------------------�-�-��-^---�---------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
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JOB SITE ADDRSSS: • �� ��' �.�� -�� �`�� ``�. � � I���-,� ZIP:
c.. � � � �
(work)
N� OF OWNER• �f.t/ I C�. _ � �l �c /z �._ PHONE: (home} 1 'i _ <- - � �
. �
MAZI,ING ADDRESS: Z 7 (,� � �r.� � i,:��l"�: �u "'� =- ZIP:
'�:-� , PHONS: �/��"_ � � � Z.
CON�CTOR: I f��r: � �, ,, � , ��� �c^ • � �-
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MATLING ADDRESS: � ��I � ��z-<':� �_�� /: ����' �l' CITY: ,���-'�-� ZIP:
STATS LICENSE: � �;(�(�'�
____ i
ARCHITECT/ENGINEEFt: \�,-1�-.� . 1 �`-t- � 5; �- PHONE: `� �`j C: �: ' �
:
MAILING ADDRBSS: CITY: ZIP:
N��: RBGISTRATION �
TYPE OF WORK: New Addition Accessory Structure Move
Demo� Remodel/Alteration=� Renovate Land Alteration
PROPOSF.D WORK (describe in detail) :�y y�.�,,-� �'�✓�� �t� `-.= e•�- C /�
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'K: � l� ..,.�.C•` ���. .t.
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S T O R I E S: SQ. F E B T O F E A C H F I,O O R: _
NO. OF BEDROOMS: GARAGE STAI.LS: ATT. DET.
ESTIHATED CONSTRQCTION VALIIATION (eacluding land) : $ � �� L� �% ; n c'
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 SIGNATORE: � ��-��-� DATE: -> /� `
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal O�cea
�
� - � � On the North Shore of Lake Minnetonka
DATA PRIVACY 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
I.icense 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 license.
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 Councii action
to approve, some information may become public.
5. You have certain rights ander M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to process this apglicatian or
permit.
\,E' � `' r . "'� -� ^;/t �
First Mi le Last
Address
City State Zip
Phone
I unde,z-s�tand my rights as�stated above.
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S i gna�tkr �
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BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
_.....�._`� .. .
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513.0,4 RIGHTS OF SIIBJECTS OF DATA �
gubdivision L TYPe
of date,- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section. An.individuel asked to
� - gubd, Z. Information re9uit�d
to be given individual.
� � 1 rivate or confidentiel data concerning BmWit�h�in the collect g s gte ag n y�
supp y p uested dat v refuse or is legally
purpose and intended use cf the req tem; (b) whether he ma„ from his
political subdivision, or statewide sys ��� 8ny �own consequence arising
required to supply the requested dat8;
u 1 in or refusing to supply private or con��i federal law to receive he data.1tThis.
s pP Y g state P 1 investigative data,
other persons or entities authorized by
requirement shall not apply when a� lnatola law en orcement offlcer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lace the notice re uired under this
s
ubdivision in the individuel income tax or ro ert tax re und uistructions instead o
on those orms. � - --- � .
t� �� by ����. Upon request to e responsible
Subd. 3. Access
uthorit , an individual shall be informed whe b� h ri�rateeor confidenti8l.e Upon his
a y ublic data on
individusls, and whether it is classified as p � P
date without any chacge to him and, if he desires, shall
further request, an individusl who i� the subject of stored private or�du� � been
individuels sha11 be shown the of that data• After an ind�
6e informed of the content and meaning t� �ta need not be disclosed to
shown the private data and iniormed of i�s u���8ction pursuant to this section is
him for six months thereafter unless a P
� ndin or additional data on the individusl has 8 eeor P�li��taru�narequest by
t Pe g rovide copies of the p require the
responsible authority shall p ilin the
The responsible authority may
the individual subject of the data• certif n and comp g
requesting person to pay the actual costs of making, 3'i g'
copies. immediately, if possible, with any request
The responsible authority sha]l comply S of the date of the request,
made pursuant to this subdivision, or within five �f immediate c�mpliance is not
excluding Saturdays, SundaYS end legal holidays,
ossible. If he cannot comply with the request within that time, he shall so inforth the
P and ma have an additionel five da}'S Within which to comply
individuel, y Sunde and le al holidays.
request, exeluding Saturdays, YS g
te or complete. An individuel maY
Subd. 4. Proced�a'e when data is not a�a ivate data concerning himself. To
contest the accuracy or completeness�of public or p the respo�ible authority
exercise this right, an individuel shall notify in writing
The respcnsible authority shall wiihin 3 0
describing the nature of the disagreement. leie and attempt to
days either. (a) correct the data found to be inaccurate or incomp
notif past recipients of inaceurate or incomplete�e t�eVesdth rdatalto be correct
y or (b) notify the individual that
the individuel3 � the individual's statement of disagreement is
Data in dispute shall be disclosed only ' �u�t to the
• ineluded with the �isclosed data• ealed p
' The determination of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases.
• � CHECR OFF LIST FOR ISSIIANCE OF PERMITS
� FOR OFFICE USE ONLY
� ,
� � �, ��
P.DDRESS OR LEGAL: ,� %� w'�' ,���c"C��:.���-��z�� /�� PID: `i � _� i ;�� -?� � �r'c/ O
D$SCRIPTION OF WORR: 1u=��°'�����-`'�-�
--------------------------
ZONING REVIEW BY: :'��/� DATE APPROVED:
BIIILDING REVIEW BY: � l,�c:/lMc: DATE APPROVED: 5 ' � � ��
----------------- -
FE$S TO B$ CHARGED: Misc. Fees Ca1cul.ated By:
PERMIT Yes �No
PLAN REVIEW Yes No L'�' SEWER CONNECTION
STATE SURCHARGE Yes��o WATER CONNECTION
�INVESTIGATION FEE Yes c/ l�o� PARK FEE
SAC Yes No �--�'� SITE INSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------------
ZONING CHECR I,IST Zoning District:
Fire Department: Post Off ce: hool District:
Lot Area Widt�: D pth
Survey S b itted: Yes No� Da e of Survey:
;
Proposed e backs: ?�
Fron ( ake) : Ri ht Side:
Rear (St eet) : Le t Side:
Adjac nt tructures: " etland:
Bui�ding H ight: Def. Hgt}'. Peak Hgt.
I
Avg. Setba k: � Lot overage:
Exist ng Pr posed
�
Hardcover: -75 ' '
75 250 ' '
250 500 '
�
�
500- 000 '
Hardcover V riance Re i ed: Ye N Date of Counci Approvalo
Grading: St ff Approva ate: ! By: Council. A prova� Date:
�
Septic: Sta f Approval te: � By:
r
Zoning File:# Resolut�ion # . Resolution Date:
, '
�F.MARK$ (in house) : � WO��� S�'� wl v �-P/I�+ � i
BQILDING REVIEW CHECR LIST � �
' . ;
QgC: j�-?> CONSTRIICTION TYP$: �
Sg Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage x -
x = '
TOTAL
���;
Ssti_mated Construction Value: $ ��S `J`' !
Inspections Rem�;red: Work Requiring Separate Permits:
Site Plumbing Grading/Fil�ing
Footing Mechanical Fire
�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
aJ�J: Board (Masonry) Lawn Irrigation
�-Final (Mfg.) Other
Other WelJ. (State Permit)
,�E�.ectrical (State Permit)
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REMARRS (IN HOIISE) :
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY=
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�F.I�fARKS (TO BE NOTED ON PERMIT) : � (,�d� � S�'��� '� /