HomeMy WebLinkAbout1999-011408 - temp sign , PERMIT
���tTY OF ORONO PERMIT TYPE:
� 2750 Kelley Parkway- P.O. Box 66 :=;G;�-;;;
Cry�al Bay, Minnesota 55323 Permit Number: -
Date Issued: `-'i '��""'`
(612)�'3-7357 �:�=,.� =!��:'=;°=i
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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CONTRACTOR: OWNER: — r.;�,��} i,..=:;,t. —
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APPLICANT/PERMI E SIGNATURE ISSUED BY:SIGNATURE �
. Total Fee: $ Date Received: S/m � f
Entered By: Permit#: /�^��
CITY OF ORONO - BUII..DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started. .
(please print all information)
T'HE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SIT'E ADDRESS: �Z `�"� �/2`�G���i h/ G�/ �� ZIP: .�.���/
�
NA1�TE OF OWNER: f��� PHONE: (home)
(work) �73 - 73a-�
MAILING ADDP�ESS: CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAII.Itii'G ADDRFSS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/E11�'GI`i TEER: PHOi�TE:
ViAILING ADDRESS: CITY: ZIP:
NAME; REGISTR.ATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
%�'� ` /�Q f���
PROP SED WORK(describe in etai�: �� �
�� ✓��� �l�t — �Gcc� ��l o o /r(
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTII-i IATED CONSTRUCTION VALUATION (excluding land): $ -
I hereby apply for a buildino 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 pemut and work is not to start without a
permit; and that the work will be in ac rdance w' the approved plan.
APPLICANT'S SIGNATURE: DAT'E: ��� �
NOTE! Parade o Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed. �
• .
� Sec.13.04 RIGHTS OF SUB.IECTS OF D.�T?, '
Subd. !. Tppe o[data. The righcs of individual on whom the data is swced or co be smced shall be u sec focth ia this secrion.
Subd.2. InformatIon required to be Y[vw[ndividuai. An individual uked to supply privarc or confidenrial dara concerning himself sha11
be informed of: (a)che pucpose aad ia�ended use of�he requesced dara wirhia che collecdag Sure ageary.polidcal subdivision,or sra�ewide rystem;
(b)whechet he may refuse ot is.kgally requicsd to sapply the requesud data;(c)any Iaiown coauquence arising from his supplying or rett�siag to supply
private or confidendal data:and(d)the idendry of other persoas or eaddes auchocized by state or federal law to rrceive tbe daa. This cequiremenc shall
noc aQply when an individual is uked[o supply invesagadve dan,pursuanc ro secdon 13.82,subdivision S, m a law enfoccemeat officer.
The corimissioner of rcvenue mav �lace che nodc• reauired under chis subdivision in the individuat income �c or orooertv tax refund
instcucdons inscexd of on[hose forms.
Subd.3. Aecess to data by iadividual. Upon request to a tesponsible aurhoriry,an individual shall be informed whether he is the subjecc
of stoced data on individuais,and whecher it is ctass�ed as public,private or confidenCal. Upon his tt�rther request,an iadividual who is the subjecc
of stoced private or public data on individuals shall be shown the data wirhouc any charge w him and;if he desires,shall be infocmed of the contenc
and meaniag of diat data. Ahe�an individual has been showa che priva[e data and informed o(ics meaning,che data need not be d'uclosed oo him for
six mondu theteafur utileu a dispute or acaon pursuanc w this secdon is pending oc addidoaal dara on the individuai has been collecced or crcated.
The responsibie authoriry shall provide copies of the privare or public dara upon request by the iadividual subject of the data. The nsponsible authoriry
may require rhe requesting persoa to pay rhe accual cosu of making,certifying,and compiling the copia.
The responsible authoriry shall comply immediacely,if possible,with any cequest made pursuanc w rhis subdivision,or withhin five days of
the date of the cequesG exduding Saturdays,Sundays and legal holidays,if immediate compliance is not possibta If he cannoc comply with the cequesc
wi[hin that dme,he shall so inform the individuai,and may have an addidooal five days within which to comply wich the cequest,ezcluding Saturdays.
Sundays and legal holidays.
Subd.4. Proeedure when data is not accurate or complete. M individual tnay contest the accuracy or completeness of public or private
dara conceming himsdf. To exercise this righ�an individuai shall noafy in wridng the respoosible aurltority describing the naare o[the disagreement
The eesponsible auchoriry shall within 30 days eieher. (a)comect the data found to be inaccucdte or incomplete and atcempc to nodfy past recipientt of
iaaccurate or incomQlece data, inetuding�ecipienrs named by[he individuat;or(b)notify the individual thac he betieves�he data to be eocrect Data
iu dispuce shall be disclosed only if the individual's stacemenc of disagreement is included wi[h[he disclosed dara.
The determinadon of the rosponsible auchoriry may be appealed puauanc to the pcovisions of the adminisuarive procedure act nlaang to
contesad cases. •
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2, "Rinc�s of subjects of data", we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of its departmeats may require you to furnish certain private or
confidencial information.
You aze 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 Ciry deny the perm.it or license.
3. The information may be shared with other local�state or federal a;encies to the extent necessary to process
the permit or license.
4. If your requested pecmit or license requires Couacil action to approve� some information may become
pubtic.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full namt is required to process this application or permit.
.
o��r- D� �� � ��v�ud
Firsc �Si dle 1.asc
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Address� 1�' ��`2�� ,/ 7�—�� Z � ,
7 i � T' �
�i�y Snce Zip Phone
I underscand righcs as staced ove.
Sigtuaa
.
, CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: t y y � 5 E-k> IZ-�<--�� t�J!�
PID:
DESCRIPTION OF WORK: �--�-� S� b N
ZO�TING REVIEW BY: - --�W---W-DATE APPROVED: 5 '��' � �7
BUII..DING REVIEW B . DATE APPROVED:
FEES TO BE CHARGED: s��%-' ��-"�___�_ __��_�_�__
"1 v�'�f� Misc. Fees Calculated By:
PERNIIT Yes ✓ No
PLAN REVIEW Yes No SEWER COrfNECTION
STATE SURCHARGE Yes No WATERCONNEC"TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTTON
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning Districr. �c.v G��f
Fire Department: Post Office: School Districr.
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Sueet): I.eft Side:
Adjacent Structures: We and:
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 Setbac : L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Vaziance Required: Yes No Date of Council Approval:
REMARKS(in house):
R
7
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BUII.DING REVIEW CHECK LIST
�C: CONSTRUCTION TYPE:
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x -
Garage x -
x =
TOTAL
F,stimated Construction Value: $ —
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
�Fina1 Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): �
REVIEW BY OTHERS: DATE:
Access: Eaisting New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMII�:
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