HomeMy WebLinkAbout1998-010727 - shed replacement PERMIT
CITY OF ORONO PERMIT TYPE: _
;,750 Ke11ey Parkway- P.O. Box 66 Permit Number: �"`�€`'�_�`�'-
Crystal Bay, Minnesota 55323 �-'!�-'��-' _
(612)473-7357 Date Issued: ; ���;;:;v;;_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: -�- h:=c�� z i��-:T. --
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: �a �3'a� Date Received: �
E�tered �y: � ' Permit#: /D7a
CITY OF ORONO - BUII�DING PERMIT A.PPLICATION �
A11 information must be submitted in full before plan review will be started.
. (please print all information) . .
� THE�APPLICANT IS: (circle one) WNE OR.CONTR.ACTOR� �� . ' � . �
JOB SITE ADDRESS: �?�� �t�}�y t� �D �z�: � _
. ,
� N�iME OF OWNER: �I��E x . O(-�� PHO�IE: (home) ��� "R1�a--
� (work) '—,
�,�,vGAnnxEss: �7'7S -sft�DY�G� � crrY: o N� _z�:_ SS�1
CON'I'RACTOR: PHOivE: .
CONT'ACT PERSON: � MOBII�E/PAGER: •
MA.II.�ING ADDRESS: CITY: � �:_
STATE LICEI�TSE: # �
AP.CHITECT/Ei�'GINEER: PHOYE: . �
3�IAILYNG ADDRESS: CITY: ZIP:_______
T,*AME: REGISTRATION#
TYPE OF ZVORb: New Addition Accessory Structure_
Move ' � Remodel/Alterati n Land Alteration
PROPOSED tii�ORK(describe in detain• � 5{'�D �
s� o� E c,��:��
STORiES: �_ SQ.FEET OF EACH FLOOR: b �i = I�I�� -
NO. OF BEDROOI�iS: _� GARAGE STALLS: ATT. _� DET. .
. .� .
FST .�i IA.TED CO�'STItUCTION VALUATIO�t (excluding land): $ _� a;���.
I hereby apply for a buildin;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 Buildin� Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be i.a ccordance with the approved plan.
APPLICA.NT'S SIGNAT'URE: DATE: 8—�—Id� .
oF awi��
NOTE! r de of FI� omes ev ts re ire se�arate permit approval by Police Deparlment and
' City Council 60 days prior to the event. Non permitted events will not be attowed.
. �
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type oC data. The ri$h�t of ir.dividuai on whom che data is scoccd or to 6e srnr:d s�ll be u set[o�in this secdon. •
Subd.2. InformaGon reqtrired to be gvea individual. An individual uYed to suppiy privatt or confideadal data concerning himself shall
be iefarmed of: (a) th� purpose aad inc:aded use of the rsquuc�data within the callecdng State agency, polidcal subdivisioa,or stacewide rystem:
(b)whecher he may rfuse or is le3ally requtr_3�o supply the r:quesced dae:(c)any�mown coasequeuce arising[com his supplying or refusing to supply
p;ivace oreor9denri�!dzra;az:d(d)ehe ideeriry of oche.r pecsoas or enriri:s auchociz:d by sc�ee or fed:cal law co receive the daca. This requ�remeacshall _
no�apply when an individual is as4:ed to supply invesdgadve daea,pucsuan�co secaon 13.83,subdivision 5, to a law enforcemeat offceer.
The eom�.ission:r of cevenue mzv olace the noace reauird und-r this subdivision in the individual income Cix or orooem mt refued
ins:rucdor.s insc=ad of on chose forms.
Subd. 3. Access eo data bv indi�idual. lipan rcqucs�en a responsible auchoriry.an individual shall be informed whe�her he is the subject
of smred dae on individuals,and whecher ic is classified u pubiic, privace or confidenaal. Upon his fuc�e�cequest,an individual who is the subjecc
af scor:d privace or public daca on individuals shall be shown che dac�wichoue any charge to him and;if he desires, shall be infoaned of ehe concen�
ar.d m�aning of that dara. Aftcr an individual hu been shown ehe priva�:data and informed of ict meaning. the dara need not be d'uclosed to hua for
siz monchs tl:ereaiur uriless a dispu�e or acdon Qucsuanc to ehis secdon is pending or addirioaal dan on ehe individual has beea eollecad or ereared.
The r_sponsibl:authoriry shall provide capies of che privac�or public data upan cequesc by che iadividu�sl subjecc o[�tie data. The responsible auchoriry
msy cequire the rcquuang ptaon to pay the acaial coscs of m3king,ccrrifying,and compiling che eopies.
'Ihe r.spansible auchoriry shall eonply inmediately,if possible, wich any reques�made pursuant to chis subdivision,or within five days of
the dac:of the requesc,ezcluding Sacurdays,Sundays and Icgal holidayt,i(immediace compliance is not possible. If he cannot comply with�he tequest
wi�hin that drae,he shall so inform the individual,and may have an addiaonal five days wichin which to comply wi�h the requesc,excluding Sa0.ttdzyso
Sundays and legal holidays.
Subd.4. Procedure wh�n data�s not accurate or complete. An individual may contesc the accuracy or eomp[eteness of public orpcavate
dan concernirsg hirrsel(. To exer:ise chis n¢t;c,an individual shall nod"ry in wridng�h:responsibte authoriry describing the nanire of the disagreemeaG
The responsible authoriry shall wi�hin 30 days ei�her: (a)corr_cc che data four.d to be inaccunce or incomple�e u:d aaempt co nodfy past recipieau of
iraccunce or incomplec�data, including re:ipiencs nars::d by che individ�al; or(b)nodfy che individual that he believes�he da�a to be eocrect Data
in dispu�e shalt be disdos:d only if che ir.dividual's sat:m:at o!disagreer,.ent is included with the disdosed da�.
The decerminadon of the responsible au�horiry may be appealed pursuanc to ehe provisions of the admuusaaave p�aceduce act reladng eo
eon[esctd eases.
DATA PRIVACY ADVISORY � �
In accordance wich M.S. 13.0�, Subd.2, "Rights of subjeccs of data", we would li.tie to inform you that your request
for a permit or license from the Ciry of Orono or any of its departments may require you to,furnish certain private or
confideatial informa�ion.
You are notified that:• _
1. The information you fumish will be used to deteimine your qualification for the permit or licease requested.
2. You may refuse to supply data, bu[ refusal.may require that the City deny the pe[mic or licease.
3. The information may be shared with ocher local, state or federal a;encies to the�extent necessary to process
� the permit or license.
4. If your reques[ed permit or licease requcres Council acttbn to approve, some information may become
public.
5, You have certain ri�hts under N1.S. 13.04 (available upon request) to review private data on yourself.
6, Your full name is required to process this application or permit.
�
���It'�l`�� l L � � �L S ��I�-� .
First �Siddle �c
������ � N��Y���o� ��4�
Add«u � L i,�� s�.�.3 I �-�� �����
��v�-'�' -
Ciry Sace Zip Phoae . .
I underst y ri;hu as stated above. , �
,
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� L�
Signan:re
CHECK OF'F'LIST FOR ISSUANCE OF PERi1�IT8 ��,'l��
. ' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: - . Z"Z?S S h4rA��t wo c�✓� �� � .
PID:
DES CRIPTION OF WORK: _ �Nti.�J (Z�0 t,<G2 vJ'�.�.�' �
_ ZOYIlVG RE'VIEti�BY: N � N DATE APPROVED: 9 �Z-S�3 �
BUII.,DTNG REVIEtiV BY:. � � DATE APPROVED: y� - Z -�.�
FEES TO BE CHARGED: • � � Misc. Fees Calculated By: ~� ~
PERMIT Yes c/� No .
pL� ��W Yes No ✓ SEWER C0�IIVECTION
STATE SUR`HARG� Yes �/ No WATER CONNECITON
II�tYESTIGA'ITON-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units � OTHER (specify)
Z0�1ING CHECK LIST Zoning Districc: /()p C(�i�Ll � � �
Fire Depar�ent: Post Office: School District; � ' �
Lot Area: Sq.ft. Acres tiVidth D�p�
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Froat (La.�Ce): . . Right Sid�: . .
Rear(Street): Left Side:
Adjacent Structures: �Vetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: - By: Council Approval Date:
Septic: Staff Approval Date: � gy; � .
Zoning File: # � . Resolution:� Resolution Date:�
Shoreland Dis�-ict: � �
Avg. Setback: Bluff Setback: Lot Coverage: �
� E��B Proposed � �
Hardcover: 0 75'
75-250' . . . .
250-500' . •
500-1000'
. Hardcover Yariance Required: Yes No Date of Couacil Approval:
� v
RENLA.RKS (in house): �
. z � . . • .
• ��` 26
, �i. . .
BUILDING REV�y{t CHECK LIST � � : .
UBC: - U- � CONSTRUCTTON TYPE: �'�l - �
. � Sq Footaae $ Per Sq Ftg
. Basement x . �
.. . . lst Floor . � . x . . — . .
� � 2nd Floor .. . .. • . x .. . . _ . . . .
Gazage . _ . . .. , . .
x _
x
TOTAL .
Estimated Construction Value: $_ Z.��v �- .
- -- Inspections Required: • Work Requiring Separate Permits: �
Site Plumbing Fire _ .
Hazdcover Removal Mechanical � �
Water Connection
Framina Septic __sewer Connection ' ,
� Fire lace
Insulation ��o�) �� Irrigation . .
Wall Boazd (Mfg.) � Well (State Perm.it)
—�F�� GradinglFilling Electrical (State Permit)
Other
. REI�ZA.RF�S (IN HOUSE): --- ----- � _----_
REYIE'4'V BY OTHERS:----____�_------------- D��_ _ w_�_---- .
Access: Exis[in� � rJe�y ' -
• Access Approval: Date •
------------------------------------------ By.
REI�ZARKS(TO BE NOTED ON PERil�II1�; � •
. � � . . .
' � .
._ .. ........� � � . .. . .
.!, ._ . 2 _ . - ___ . - : . _ -- --
-, ._......
- - ---___ _. .
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� -�:.� . . .
�V;:.� .
�� - ��- HARDCOVER CALCULATION WORKSHEET
SETBACK ZOi�TE: (CIRCLE ONE) 0-75' 75-250' 250-500' S00-1000'
EXIS'I7NG HARDCOVER 1N ZONE
A. House x = S.F.
Lengrh Width
z = S.F. -
a = S.F.
a = S.F.
B. Garage x = S.F.
C. Driveway z. = S.F.
x = S.F.
D. Sidewalk z = � S.F.
x = S.F.
E. Patio/Deck x = S.F.
x = S.F.
F. Landscape x = S.F.
Underlain x = S.F.
By Plastic a = S.F.
Or Fabric
G. Other x v = S.F.
Couc�� 5�
TOTAL HARDCOVER IN ZONE - f qY S.F. A
TOTAL PROPERTY AREA IN ZONE - DO S.F. B
?` �L v - B �{ODC x 100 = !
PROPOSED HARDCOYER IN ZONE
A. House x = S.F.
Length Width
X = S.F.
x = S.F.
x = S.F.
B. Gazage z = S.F.
C. Driveway x = S.F.
. x . = S.F.
D. Sidewalk x � = S.F.
x _ � S.F.
E. Patio/Deck x = S.F.
x = S.F.
F. Landscape • x = S.F.
Underlain x = S.F.
By Plastic x = S.F.
Or Fabric �
G. Other x v = S.F.
�� ��� �� TOTAL HARDCOVER IN ZONE - D O S.F. A
TOTAL PROPERTY AREA IN ZONE - S.F. B
A - B x 100 = .�_q
. 14
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