HomeMy WebLinkAbout1991-003534 - sign ` PERMIT
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` �ITY OF ORONO PERMIT TYPE:
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1335 Brown Rd. South • P.O. Box 66 Permit Number: t?t):::;:�1{.
Crystal Bay, Minnesota 55323 Date Issued: i y�.��:i�/:,=;�,
(612) 473-7357
SITE ADDRESS:
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CONTRACTOR: __ ��,fi� i�;��;t. __ OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, ' � '� CITY OF ORONO - BQILDING PERMIT APPLICATION
, . Date Received: /— ��— � �
�otal Fee: $
Date Approved:
;ntnred By:
Permit#:
�LL INPORMATION MIIST BE SIIBMI7.'TED IN FIILL BEFORE PLAN REVI�W' i�IILL BE STARTED
(See Check-off List Enclosed)
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L'SB APPLICANT IS: (circle one) OWNER or CONTRACTOR
;os s2� Annx�ss: ��\lv 5���.�,�v� �. �CZ�vL ziP: � 3�� �
(work) �-1� C�1�i 6
i� OF OWNER: ����-'� �\`�.� �L � PHONE: (home)�tS S` � I��
�AILING ADDRESS: � �:. 1,�� CITY: V�►W��.�2Z1��''`' ;�.v-yZIP: �> > .� 5 ?f'
��('� ���' 11� c`� �l ��� �l�' � , �-�-'' — ? 7:' C
:ONTRACTOR: �-�.,�-k -- S�-'c�i-._.... . ..��...:� �-Oa�rv��v���=� PHONE: � ��I
iAILING ADDRESS : CITY: ZIP:
'YPE OF WORR: New Addition Accessary Structure� Move
Demo Remodel/Alteration Renovate Land Alteration
�ROPOSED WORK (describe in detail) : ��� >> �.�� CA ���V�'^-�C,��C� �.1 4��
r,
W v�-rL�L� k��- L�� Sl��'�5 i�L�+J �r_� �� va-� �l.�V\��L� � ��� �N'�h.1�c.��rZ L
�TORIES- SQ. FEET OF EACH FZ�OOR:
f0. OF BEDROOMS: GARAGE STALLS: ATT. DET.
� ��� ��1
:STIMATED CONSTRUCTION VALIIATION (ezclnding land) : $ � -= �--� � ` � \- �
hereby apply for a building permit and I acknowledge that the information
bove is complete and accurate; that the work will be in conformance with the
rdinances and codes of the City and with the State Building Code; that I
nderstand this is not a permit and work is not to start without a permit; and
hat the work will be in accordance with the approved plan.
� � - ll � (
PPLICANT'S SIGNAZ'QRE: DATE:
,
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A ,. ,,t.
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CITY of ORONO
Poat Office Box 66•Cryatal Bay,Minneeota 55323•Municipal Offices
• _
� - � � On the North Shore of Lake Minnetonka - -
DATA PRIVACY ADVISOBY
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
license from the City of Orono or any of its departments may require
you to furnish certain private or ._confidential -information. ;. .y�. - , _ ._ _
You are 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 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 Iicense requires Council action
to approve, some information may become pub3.ic.
5. You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Your full name is required to process this apFl.ication or
permit.
�v-�,� ,� � ��,� L�C
First Middle Last
3� � �` c.� �-o�c� S�
Address
���'� W v�- � 1J S S 3 �
City State Zip
�,SS-- � �6 � -
Phone �
I understand my rights as stated above. - -.- : _ _
� _ _ , � -
�-
� �
Signature `: '. __ ...
BUILDING&ZONING—473-7357 • ADMIIYISTRATION 6t FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING , .
�
. r,.� , �
. �.04 RIGSTS OF SIIB.TECTS OF DATA � _ �
of dats. The rights of individuels on whom the data is
Subdivision L T51Pe � � -
stored or to be stored shall be es set forth in tlzis section.
. . S�d. 2. Informatioa required to be giv� ����1" An.individusl esked to
himself sha]1 be informed of: (a) the
� ' supply private or confidentiel data c un�e�a8� Wi� �e collecting state 8gency, . .
purpose and intended use of the req tem; (b) whether he ma� refuse or is legally
political subdivision, or statewide sys �oy� consequence arising from his _ _
required to supply the requested dat8; ;-(�� �Y . _ d (d) the identity of�:
supplying or refusing to supply private or confidentiel data, � 8�
tities authorized by state or federal law to receive the data- This-
other persons or en 1 investigative data,
requirement shall not apply when an indt�via�w en orcementofficer.
pursuant to section 13.82, subdivision 5, ,
The cemmissioner of revenue ma la�t taX re°und�nstructio uinsteadhos
subdivision in the individusl income tax or ro er
on those orms. . - � --- - � .
Ac� � �� � ����. Upon request to a responsible
Subd. 3.
authority, an individusl shall be informed whe��ec hP �ateeor confidential.e IIPen his
individusls, and whether it is clessified as p � ublic data on
further request, en individual who is tbe subject of e to�mrl�v�sae if he desires, shall
individuels shall be shown the �� Wi�O of�hat da a• After an individuel � been
�e informed of the content and meaning � �� n�� not be disclesed to
shown the private data end informed of Its mtean�BBC�on p��nt to this section is
him for six months thereafter unless 8 �P -
� ending or additional data on the individuel h�8 eeor public datarupongrequest by
� responsible authority shall Qrovide eopies of the p require the
the individual subject of the data.. The respensible authority maY �in the
requesting person to pay the actual costs of making, aertifying, and comP g
copies. immediately, if pessible, with any reQuest
The respensibls authority sha1T comply � of the date of the request,
made pursuant to this subdivis�a legs�th uaBY�, ��immediate compliance is not
excluding Saturdays, Sur►daYs
ossible. If he cannot comply with the request wit�i��n w�ch toh mply wfth the
individuel, and mey have �Sundays acid Iegal holi�Ys•
request, excluding Saturdsys,
Subd. 4. Proced�ae when data �s not accsa'ate or comQlete. An individuel maY
ublie or private data concerning himself• To
contest the eccuracy or completeness�ef P �e �ponsibie authority
exercise this right, 8� individual st�all�notify in writi�e authority shall within 30
describing the nature of the disagreemenL"� The resP° 1
days either. (a) correct the data found to be in�e�t8ei°clu�ng reec p enLs namedt by ;
notify past recipients of inaccurate or incomPle � �
the individu8l+ ar �b) notify the indiviaual �t�ausl�s statemer►t of�saS�eement is �
Deta in dispute sheIl be disclosed only if the indi ;
• included with the �selosed data• � BpP�sled pursuant to the � !
' The determination.of the responsible authority to contested cases.
provisions of the administrative procedure act relatinB - . , , ;
. _ _ - �
. �
• „
�� �=
� CHECR OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR L.EGAI.: � r
� � ' PID:
r: i_: �,.�..
DESCRIPTION OF WORR:
------------------------------------------------------------------------------•
ZONING REVIEW BY� '� 6 � DATE APPROVED: ' - `,'
BQILDING REVIEW BY: ' _— DATE APPROVED:
------------------------------------------------------------------------------�
FEES TO BE CHARGSD: 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 CHECR LIST Zoning District: ,� - �
_
Fire Department: ` Post Office: -- - School District:
�ot Area: ' Width: Depth:
;
�urvey Submitted: Yes No Date of Survey: f�� _C� % , �
. �, ,��, . — �
?roposed Setbacks : , •
Front (Lake) : � Right Side: 1 - -
Rear ( Street) : Left Side:
Adjacent Structures : � Wetland:
:auilding height: Def. Hgt. Peak Hgt.
:�vg. Setback: Lot Coverage:
Existing Proposed
3ardcover: 0-75 ' �
75-250 '
250-500 '
500-1000 '
�ardcover Variance Required: Yes ^ No Date of Council Approval: �
Y
�rading: Staff Approval Date: By: Council Approval Date: �
;
Septic: Staff Approval Date: By: �
a
�oning File:# Resolution #: Resolution Date: +
�EMARKS (in house) 1 . , . . r _ 4 . . 3
� . , , - { !
� 1
.. _ ___._ _ _ --- - __ _ - - - - - -_;"_� .
. _ ..__ _. . _._ _ _ --� i� .�
BIIILDING REVIEW CHECR LIST
IIBC: CONSTRIICTION TYPE:
Sq Footage $ Per Sq Ftg
Basement X =
lst Floor x =
2nd Floor x = `
Garage x =
x =
TOTAL
Sstimated Construction Value: $ _ - -
�. _r ;: -
_ ,� -.� ;.;
Inspections Required: Work Requiring Separate Permi.ts: �"�'� �
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)
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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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RF.MARKS (TO BS NOTED ON PERMIT) : �-1' - � ' — .
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CQ COPYRIGHT 1990 BY ATTRACTA SIGN, INC. G�� /
'eh�s• plan• (or draving�, •p�ciiica!lon�, �ch�satic• or dlaqr�wt) �/"
are tha exclusiv property ot !►l'TMCTA SIGN INC. They are tha r��ult
of !he ortqinal work o[ i!• otEicer�, ag�nts or employees. Thsy ac•
tubwitted to you tor tha �ole aurpo�• o! your considuretlon o[ wh�th�r / �.
to purcha�s them oc whether !o purcha�s [to� 11TTMCTA StCN, INC. a •!qn �� v � n 1 l S � A T T R A���
eanutaeturad eccordinq !o th��. Di�tribulion or exibltion o[ the�• �. I C�''
matarial• to anyon• othee than ot[icar• or awployees o! your co�npany,
or the use ot tha�• �nat�risl• to con�truet a •ign •!n�llat to th� on• CUSiOMER A►►ROVAI /
rep�es�nted !n thew i• expr���ly Iosbiddan. In the avent that you .
•hould violate thi• pcovieion (or agre�wantl, you ayr�• to r�in�bur�• '� �
ATTIUC7A SIGN, INC. in tha �mount oI = le co�pen�atlon [oc ' .
th• tie� and •t[ort enlail�d !n crue nq ��• ma �iial�.
�T-=�_q' s3��� , QR� 7420 W. LAKE ST. 612 933-7730
�. ATs ST. LOUIS PARK, MN 55426
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CO COPYRIGHT 1990 BY ATTRACTA SIGN, INC.
Th�s• plan• (or draving�, •pacillcations, sch�matics or dieqras�l
are tha exclusive property of ATTiUCTA SICN INC. They are the Ys�ult
of tha original work of its offlcers, agents or amployees. They are
submitted to you for the eole aurpoae of your consideration of wh�ther � 1 / ' � � A T T�����
to purcha�e them or whether to purchase fzom ATTMCTA SIGN, INC. a sLgn (�� v I /��'
manu[actured accordinq to them. Diittibution or exibition of thete .. i 1 -�
materiale to anyone other than olficer• or employaea ot your company,
or the uee of ihesa materiel• to conatruCt a sign eimilar to tha ona CUSiOMER APYROVAL
represented in them is axprassly torbiddan. In the event that you ' � �
ehould violate chl• proviaion (or agreament), you agre• to relwbur�•
ATTRACTA SIGN, INC. in the amount of S in cospansa[1on tor
. [h• time and aLtort antaSl�d Sn czast nq�i—m��qilal�.
. � OATE SCALE � 7420 W. LAKE ST. 612 933-7730
!-2�l-91 3/.�� -'pTs ST. LOUIS PARK, MN 55426