HomeMy WebLinkAbout1991-003728 - temp sign 1'FIZMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 � 4 �_'����
�Cr stal Ba , Minnesota 55323 Permit Number: ;;r�_,7�;;
Y Y Date Issued:
(612) 473-7357 �"j�•��}�r'��'
SITE ADDRESS: � �
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: __ ,��,��� ����,t. --
WAvEPI�Fi i�i :T
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APPLICANT/PERMITEE SIGNATUR ISSUED BY:StGNATURE (.--�"�
CITY OF ORONO - � PERMIT APPLICATION
Total Fee : $ ���'. �=�' Date Received:
Date Approved:
Entered By: ��� -�
u Permit#: � /�� �
ALI� INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BS STARTED
(See Check-off List Enclosed)
________��_____�_______�___________r.-_�________________�__-___----_-___________-
THE APPLICANT IS: (circle one ) �WNER or CONTRACTOR
� � _
JOB SITE ADDRESS:��� .S :�I��*>�t (: :�,� <� L�(-- L�'�uy "li'�IY"iiI . ZIP: �; t�3 �/
(work)
NAME OF OWNER: ���, ,r. L�����„2 ff'aE'� PHONE: (home)
MAILING ADDRESS: /�� FJ �rl�.j' � CITY: /i 2��fL�1 ZIP: �.S .�'�9�
CONTRACTOR: PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remode�/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : � -c.c� ��
STORIES: SQ. FEET OF EACH FLOORs
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (escludinq land) : $
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.
...._..._ �
. �� DATE: � - - �
APPI�I
CANT S SIGNATIIRE: ,1--�-C� �� �� �
CHECK OFF �IST��OR ISSIIANCE OF PERMITS
� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: l�!SS .SI�O�I.�L�N E D�Z PID:
DESCRIPTI ON OF WORR: �]'���� �I b�
-------------------- --------------------------------- �, 1
--------- -------------
ZONING REVIEW BY: ��,Qo (�it�-- DATE APPROVED: S- I-cl
BIIILDING REVIEW BY: DATE APPROVED:
-----------------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No ►� SEWER CONNECTION
STATE SURCHARGE Yes No � WATER CONNECTION
INVESTIGATION FEE Yes No_� PARK FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------------
ZONING CHSCR LIST Zoning District: ���
Fire Department: /�/ L Post Office: C. School District: /U �..
Lot Area: /v(� Width: /'� L Depth: ��L-
Survey Submitted: Yes No ' Date of Survey: / ' � `�Z
Proposed Setbacks : -- �v; pF �2.� 1�y� c�T cru
Front (Lake) : �ght Side:
Rear (Street) : Left Side:
Adjacent Structur s : Wetlan :
Building Height: Def. Hgt. Pea Hgt.
Avg. Setback: Lot Cover ge:
xi ting Propos d
Hardcover: 0-75 ' '
75-250 '
250-500 '
500-100 '
Hardcover Var ance Required• es No Date f Council Approval:
Grading: St ff Approval Dat : By: Council A proval Date:
Septic: St ff Approval Date: By:
/
Zoning Fi� e: # Resolution Resoluti n Date:
REMARRS (in house) :
BDILDING REVIEW CHECK LIST `� -
pgC; CONSTRIICTION TYPE:
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL
$stimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
Final (Mfg. ) Well State Permit
Other Electrical (State Permit)
R$MARRS (IN HOOSB) :
--------------------------------------------------------------------------
RSVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
---------------------------------------------------------------
REMARRS (TO B$ NOTSD OI�i PERI�IIT) :
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"°°� '}'.'��'� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
�:.""�� �, �;�a,
� - a �;. 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 3ike to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish will be used to determine your
qualification for the permit or I.icense 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 Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva��
data on yourself.
6. Your full name is required to process this appl.ication or
permit.
�F�,� •��� � ��''�-�G�,-�._J
First Middle Last .
� v�s- .s��.-►..�.�.,..�._. (,2�v-
Address
-�N �35 �
Cit State Zip
�7.s":���y.�
Phone
�derstand my rights as stated above.
�
ignatu
� ;
BUILDING&ZOIYIIYG—473-7357 • ADMINISTRATION&FINAfYCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
< �
�.p,� RIGS'I5 OF 3IIBJECTS OF DATA .
Subdivision L Type of data- The rights of individuals on whom the data is
stored or to be stored shall be ss set forth in this section. An.indi�iduel asked to
to be given in�vidual.
g�d. Z, information req�d himself shell be informed of: (a) the
� supply private or confidentiel data concerning
urpose and intended use of the requested �b�whether hee ma�er f� °rt� eg�y
P tem, from his
political su b d ivisio n, o r s t a t e w i d e s y s , �own conseq u e n c e a r i s i n g
required to supply the requested dats, (�) �Y �d (d) the identity of
n or refusing to supply private or con fidentiel data;
supplyi g state or federal lav�► to rece�e�e�ve data
other penons or entities authorized by
requirement shall not apply when an individuel is esked to supply 6
pursusnt to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma lac� taX re°una�tructio uinsteadh°S
subdivision in the individuel income tax or r• er
on those orms. . - --- - - .
Subd. 3.
Aecess to data bY in���' �Pon request to a responsible
authorit , an individuel shall be info med W�uti c h r v t eor confidential-e �7P°n �
y ublic data on
individuels, and whether it is classified as p � P
to him and, if he desires, shell
further request, an individuel who is the sublect of stored private orvidual has been
individuels shall be shown the data witho of�hat data. After an ind�
�e informed of the content snd meaning the data need not be disclosed to
shown the private data and informed of its meaning� ��t to this section is
him for six months thereafter unless a disPute or action p
endin or additional data on Lhe individuel h�ate or public datarupon request by
� P g rovide copies of the p require the
responsible authority shall p
The responsible authority maY �in the
the individuel subject of the ��• certif n and comp g
requesting person to pay the actusl costs of maldng, Yi g�
copies. immediatelY, it pessible, with any request
The responsibls authority she]1 comQly ' of the date of the request,
made pursuant to this subdivision, or within five ��immediate compliance is not
excluding Saturdays, Sundays and legal holidays, .
ossible. If he eannot comply with the request within that time, he shall siin�o h t�e
P hsve an additional five days within which to comp y
individual, and m S turdays, Sundays and legal holidays.
request, excluding
d�a�e when data is not accurate or complete. An ir►dividuel maY
Subd. 4. Proce himself. To
contest the accuracy or completeness�of public or private � the�nresponsible authority
exercise this right, an ind�v�� s� notify � ��e authority shall within 30
describing the nature of the disagreemenL The resp°
� either. (a) correct the data found te be inae��e��u�gPe�ipients namedt by
�
notify past recipients of inaccurate or incomple �
the individusl; or (b) notify the individual t�vi�ual'sistatementofadisagreement is
Data in disP if the indi
ute shall be disclosed only '
• included with the disclosed data• ealed ursuant to the
' The determination of the responsible authority to c�tes ed cases.
provisions oi the administrative procedure act relating
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