The URL can be used to link to this page

Home My WebLink About2001-P04705 - land alteration ! � PERMIT CITY OF ORONO permit Number: 2750 Kelley Parkway- PO Box 66 P04705 Crystal Bay, Minnesota 55323 Permit Type: User Defined (952) 249-4600 Date Issued: i2iioi2ooi SITE ADDRESS: 3877 Shoreline Dr WAYZATA,MN 55391 PID: 20-117-23-22-0006 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: Site inspection required before work begins FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: T M GREGORY&T A GREGORY OWNER: T M GREGORY&T A GREGORY 3877 SHORELINE DR 3877 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 CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILD G CODE REQUIREMENTS. J �� C � APP CA I EE IGNATURE ISSUEDBYSIGNATURE Covies: 1-File(Si�nitures Required). 1-Annlicant 1-Monthlv Renorts, 1-Assessine. 1-Finance Page 1 � � Total Fee: $ Date Received: Entered By: Pemut#: CITY OF ORONO - BUILDING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all inforncation) THE APPLICANT IS: (circle one) OR CONTRACTOR JOB SITE ADDRESS: � �7 7 S�� 1 � e �� ZIP• .� r,,. s � (��, �� 9S a �- 3 � � NAME OF OWNE�. l� b � �1 , rxorrE: �nom�> ) 7 S MAILING ADDRESS: S' S� (yvor ) S c,. � � � ��' L�:J c �' � zIP•S S� g � CONTRACTOR: �S �- 1� PHONE: CONTACT PERSON: 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(des ribe in detain: _�1 1 1 � p �f' S �ti�S q r�.� r � r`�V�� e n � STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIlVIATED CONSTRUCTION VALUATION (excluding 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 acc ance with the approved plan. APPLICANT'S SIGNA . DATE: 1 � �� d NOTE! Parade Q f Homes events require s e permit approval by Police Depar[ment and City Council 60 days prior to the event. Non permitted events will not be allowed. , � Sec.13.04 RIGHTS OF S[JBJECTS OF D.�►TA Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secdon. Subd.2. Informatioa req�rired to be givea individual. .1n individual azked to supply private or confidendal data concerniag himself shall be informed of: (a)the purpose and intended use of the requesred daa within the collecang 3tate agency,poliuca!subdivision,or sratewide sysum; (b)w6echer he may refuu oY is legally required to supply che requesud data:(c)any Irnown consequence arising from his supplying or refusing to supply priva[e or confidenaal data;and(d)the idenary of ocher penoat or encdes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiy invesdgadve dara,punuaac to secaon 13.82,subdivision 5,to a law enforcement officer. The commissioner of rovenue mav place the noace reauired under this subdivision in the individual income taz or pro�em tax refund instcucdons instead of on chose forms. Subd.3. Access to data by iadividual. Upon rcquesc to a responsible auehoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe�her it is ciassified as pubtic,private or confidenaal. Upon tus further request,an individual who is[he subjecc of stored private or public data on individuals shall be shown ehe data wirhout any charge to him and;if he desires,shall be informed of the content and meaning of chat data. After an individual has been shown ehe private data and informed of its meaning,the data need not be disclosed to him for six months thereafter uniess a dispute or action pursuanc to this secrion is pending or addiaonal data on the individual has been collected or cmated. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of[he data. The responsible authority may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shail comply immediately,if possible,with any request made pursuant to this 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[he request wi[hin that time,he shall so inform[he individual,and may have an addidonal five days within which to compiy wich the request,ezcluding Saturdays. Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conust the accutacy or completeness of public or pri�•ate data concerning himself. To exercise chis right,an individual shall noafy in wri[ing[he responsible authoriry describing che nacure of the disagreement. The responsible authoriry shati within 30 days either: (a)correct che data found to be inaccurate or incomplete and aaempt to nodfy past recipienu of inaccurate or incortplete dara, including cecipients named by rhe individual;or(b)notify the individual thac he believes the dara to be correct. Data in dispuce shall be disclosed only if the individual's statement of disagreemenc is included with the disetosed dara. The decerminaaon of the responsible au[horiry may be appealed pursuanc to the provisions of the adminisaarive procedure act relacing to contesced cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri¢hts 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 departments may require you to furnish certain private or confidential information. 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 shued with ocher local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. 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. Fint Middle Last Address Ciry State Zip Phone I understand stated above. Signamre � . CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY A.DDRESS OR LEGAL: ��Q?� St-�o i�.c-.�.�-� �(� _ PID: DESCRIPTION OF WORK: � .v s a ZOVL�TG REVIEW BY: DATE APPROVED: /�•�o-0� BUII.DING REVIEW B _ /VGr,4 DATE APPRUVED; FEES TO BE CHARGED: ��'�isc�Fees�u�ed B�� PERMIT Yes _� No PLAN REVIEW Yes No SEWER CONNECITON STATE SURCHARGE Yes No WATER CONNECTION IlWESTIGATION FEE Yes No PARK FEE � SAC Yes No SITEINSPECTION Number of SAC�Units OTHER (specify) _ ______________ _--------------------_�___________ ZONING CH�CK LIST Zoning District: /Y� ��-f79Y�l� Fire Department: 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(Sueet): Left Side: Adjacent Structures: Wetl Building Height: Def. Hgt. Peal: gt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # Resolution Date: Shoreland Disuict: Avg. Setback: Bluff Setback: Lot Coverage: Ezisting Proposed Hazdcover: 0-75' 75-250' � 250-500' ; 500-1000' � I Hardcover Variance Required: Yes No Date of Council Approval: REMARI�S(in house): � � � BUILDING REVIEW CHECK LIST UBC: � N�� CONSTRUCTION TYPE: � /l�/� Sq Footage $Per Sq Ftg Basement x = 1 st Floor x _ 2nd Floor x _ Garage x = x = TOTAL F,stimated Construction Value: $ �� Inspections Required• `Vork Requiring Separate Permits: _�Site �,,�,P 4�e��,,.b Plumbing Fire Hazdcover Removal Mechanical Water Connection Footing = Septic Sewer Connection Framing Fireplace Lawn Irrigation Insulation (Masonry) Other Wall Board (Mfg.) Well(State Permit) _�F�� Grading/Filling Elecuical(State Permit) Other REMARBS(IN HOUSE): . _____�__________________�________________ REVIEW BY OTHERS: DATE: Access: Ezisting New Access Approval: Date gy; ----------------------------------------------��-- REMARI�,S (TO BE NOTED ON PERMIT�: Si r� ��vs,/� 2CS �j� __�'�vo2/c 'er/n/� 8