HomeMy WebLinkAbout2000-P02856 - land alteration � �,
PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2gs6
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(612) 249-4600 Date Issued: si22i2oo
SITE ADDRESS: 194o Shoreline Dr
WAYZATA,MN 55391
P ID: 10-117-23-42-0007
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: ANNE NETTLES OWNER: A R NETTLES&A T NETTLES
1940 SHORELINE DRIVE 1940 SHORELINE DR
WAYZATA,MN 55391 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CI'IY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII,DING CODE REQUIREMENTS.
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A LI A PERMITE NA U ISSUEDBYSIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
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Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII.DING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle o NE ' R CONTRACTOR
JOB SITE ADDRESS: ( `� �-(�O ��-�<< u���"C. ZIP: S�"� I
�� � �
NAME OF OWNER: �bl,l,�.�. � Q,��� S PHONE: (home) ��13 l0 8
(work) �f0�-E GO�
MAII.ING ADDRFSS: [°( �p ��(.t,cs�.e,1,�.� CITY: �?�c.�Z�.� ZIP: S�3 i (
CONTRr�CTOR: ��� L Ct.,,�CC�S� ���`' PHONE:
CONTACT PERSON: �l � MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: �Q�l� � � 1i1��� V�.�n y��
1� C.� ��� u rJKtOs U/L (_2.5`� _
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a building pemut 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 pemut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: ��- DATE: ��,a��
NOTE! Parade o,�Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLIBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom rhe data is stoted or co be swred shall be as set for[h in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shal!
be informed of: (a)the purpose and intended use of the requested data wichin the collecting Ytace agency,polidcal subdivision,or sratewide system;
(b)whecher he may refitse oY is legally required to supply the requesud data;(c)any laiown consequence arising from his supplying or refusing to supply
priva[e or confidendal data;and(d)the idenriry of o[her persons or enddes aurhorized by state or federal law ta rcceive the data. This requirement s6a11
not apply when an individual is asked to supply invesrigadve dara, punuant[o secaon 13.82, subdivision 5,to a law enforcement o�cer.
The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income_tax or propertv tax refund
instructions ins[ead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is etassified as public,privace or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown[he data wi[hout any charge to him and,-if he desires,shall be informed of the content
and meaning of diat data. Aftec an individual has been shown[he private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesdng person to pay the actual cosu of making,cerafying,and compiling the copies.
The responsible authoriry shali comply immediately, if possible,with any request made pursuant to tktis subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request
within that dme,he shall so infocm the individual,and may have an additional five days within wluch co comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise[his right,an individual shall nodfy in writing the responsible authoriry describing�he nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct ihe data found to be inaccurate or incomplete and aaempt to nodfy past recipienu of
inaccurate or incomplete data, inciuding recipients named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data
in dispuce shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The decerminadon of the responsible au[horiry may be appealed pursuant to the provisions of the adminisorarive procedure act reladng to
contested cases.
DATA PRIVACY 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 fumish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to detemune 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 license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
g. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signamre
r •
CHECK OFF LIST FOR ISSUANCE OF PERiI�IITS
_ FOR OFFICE USE ONLY �
ADDRESS OR LEGAL: l�1�-i C7 5 l�F o cZx.��w�:. ✓)2 .
PID:
DESCRIPTION OF WORK: ���L
.
ZO�TG REVIE`V BY: DATE APPROVED: <8 — Z 2.-tac�
BUIIrDI�i TG REVIE�V BY: N(/� DATE APPROVED;
FEES TO BE CHARGED: Gl�k�o�^� �sc ees Ca�lcu�a�y: �° c• v.�.
PERMIT Yes �/ No ;
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
ZOiYL��iG CHECB LIST Zoning District: (� ,�< �
Fire Depaztment: Post OfFice: School District: � �
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Street): Left Side:
Adjacent Structures: tland: .
Building Height: Def. Hgt. P ak Hgt.
Lot Covera,e:
Grading: Staff Approval Date: ; By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: i� Resolution Date:
Shoreland District: �
Avg. Setback: Bluff Setb ck: I,otCoverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
Zsasoo�
500-1000'
Hardcover Variance Required: Yes o Date of Council Approval:
RE�IARKS (in house):
7
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BUII,DING REVIEW CHECK LIST
UBC: �- CONSTRUCTTON TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z =
2nd Floor z =
Garage z =
R =
TOTAL
Fstimated 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)
�Final Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): l=�, viu �w� 5 c� o �= �Z� �-� � '�'`�
�'y—E t�. �►�r.c� —r,2 iv N�O — 'rs. lv C� �C. f
REV�W BY OTHERS: DATE:
Access: E�cisting New
Access Approval: Date By:
RENIARKS (TO BE NOTED ON PERMII�:
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