HomeMy WebLinkAbout1997-009060 - land alteration PERMIT
�I� OF ORONO PERMIT TYPE: - -
2750 Kelley Parkway- P.O. Box 66 ��'�� ��"� �'`u�`-'
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Permit Number: ��lt?'�!���w��_'
Crystal Bay, Minnesota 55323 - -�- --:
(612)473-7357 Date Issued: _ ��s�i:',-�?:��::'
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: _ . .
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FEE SUMMARY:
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CONTRACTOR: O�IILN�R;. � _ _ --. - W.�
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY �
ADDRESS OR LEGAL: '? c <�-� � z�° - . L,
PID• !' ; 1 ?L - _ ``� �5�'c_ � ='`,�-,z
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DESC ION OF WORK: �� !► L�Z�z_'<i`*I C�:`\,; - � -�'�� f-" � "r,<<� >, t�-
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ZONIl�tG REVIE�V BY: ��Z���� DATE APPROVED• C.s-- �� l
BUII..DING RE`VIEW BY: DATE APPROVED:
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FEES TO BE CHARGED: Misc. Fees Calculated By:� —
PERMIT Yes ✓w' No
PLAN REVIEW Yes No _� SEWER CONNECI'ION
STATE SUR�HARG�� Yes No i WATER CONNECTION
INVESTIGATION-FEE Yes No � PARK FEE
SAC Yes No �=' SITEINSPECTION
Number of SAC Units �- OTHER (specify)
-------------------------------------------------------�-V-------7-�, �. / ' --------------------------------
ZONING CHECK LIST Zoning District: - '�� I ��'�'�, t_� �
/ %,
Fire Department: G— , Post Office: ` '� '��. School District: �- "��
Lot Area: �. c.� t / �� �-' Acres Width Depth
Survey Submitted: Yes T� No Date of Survey:
Proposed Setbacks: ,
Front (Lake): " Right Side:
Rear(Street): �'� Left Side: `�
Adjacent Structures: ` Wetland: `
Building Height: Def. Hgt. "` Peak Hgt. -
Lot Coverage: —
/ �. � � -- �
Grading: Staff Approval Date: (��'` � � � By:;�,� Council Approval Date: � �� �����
Septic: Staff Approval Date: --�- By: -
.,,� ('� � ---��-a �� •=��_ �� �
Zoning File: #G-�--�' Resolution: �# _j�� � Resolution Date: �•' �7
Shoreland Dist:ict: 'y�.:. S
Avg. Setback: �,--� Bluff Setback: %��'1��S�'l LotCoverage: ./��
Exis[ing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
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Hardcover Variance Required: Yes No X Date of Council Approval: y_
REMARKS (in house):
• 26
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BUII.,D � REVIEW CHECK LIST �
UBC: CONSTRUCTION TYPE:
Sq Fo Qe $ Per Sq Ftg ,%
Basemen[ z = �`
lst Floor x —
2nd Floor z =
Garage z = '
x = �
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TOTAL
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Estimated Construction Value: $
Inspections Required: WoPk Requiring Separa Permits:
Site Plumbing ��. Fire
Hardcover Removal Mechanical �`.�Vater Connection
Footing Septic Se�+v,,er Connection
Framing Fireplace Lawn�trigation
Insulation (Masonry) Other ���,
Wall �d (Mfg.) Well (State Pe 't)
Fin Grading/Filling Electrical (State Pe�it)
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REMARKS (IN HOUSE):
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REVIEW BY OTHERS: - DATE:
Access: Existing New �
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Access Approval: Date By: �
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'� REMARKS(TO BE NOTED ON PERI�II1�: �'�r��j;,U c_. �)= �'��p 4:,��
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Entered By: Permit#:
CITY OF ORONO - BUILDING 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 one) OWNE R CONTRACTOR
JOB SITE ADDRESS: 7Z5 (o�- atJ�..- f..I ZIP: ��'`-�� /
NAME OF OWNER: '`�JE7��.� �.}�,1�. C. �,(- C�..�(� PHONE: (home)
(work) (e►�-4z�- 481�_
MAILING ADDRESS: ?d0 S�t?�,�-�1r. ��ct� CITY:�Z.i9-r-.� ZIP:-`Z�+-
1Z�q'p
CONTRACTOR: L.�q�N►.�Sc-�t�` ��l.�l.�t nn�rT�r1 PHONE: 40Z �i.�' (Q���
CONTACTPERSON: ���W._._ �ciS-tT�z_ MOBILE/PAGER:
MAILING ADDRESS:l(.t�t a,n c.t-}F'_N r� �d. CITY: �,N � � �7�. ZIP:���-
STATE LICENSE: #
ARCHITECT/ENGINEER: Il�r2to C�o�.F LEves�y �f�f K�HONE: �I 3"�i�}Q '�� Z-T
MAILING ADDRESS:Q�n-���; ,,v 4!� � �Zv4 CITY:pv i �w�p�ZIP: 14��sAS [d(�Lt Z-
NAME:�Pm Grrrac� t�..,�.�s l�►.sfr_ REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration�
PROPOSED WORK(describe in detai�: f��� �� ���t,� pt�.v�-t"�
�,��1.-� GE�7�U �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $�r�G, �'`j0
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 pernut and work is not to start without a
permit; and that the work will be in accor nce w' the approved plan.
APPLICANT'S SIGNATURE: DATE: �Z '
NOTE! Parade of Homes even requ' e 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 SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in chis secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data coocerning himself shall
be informed of: (a)the purpose and incended use of the requested data within the collecting'state agency,potiacal subdivision,or sratewide system;
(b}whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising fmm his supplying or refusing to supply
private or confidenrial data;and(d)the idenciry of other persons or enriaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce required under this subdivision in the individual income_tax or propertv tax refund
instructions instead of on those forms
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shail be informed whether he is the subject
of stored data on individuals, and whe[her it is classified as public, private or confidendal. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and,�if he desires, shall be informed of the con[ent
and meaning�f chat data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secaon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the actual costs of making,certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additiona(five days within which to 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 conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by che individual;or(b)nodfy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pu�suant to the provisions of the administrarive procedure act relating 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 pernut or license from the City 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 pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut 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.
���w�, .�O �S O N �eD ��� {Ul�(�SC.-t�L- �fz- C7t,J N�� —
First Middle Last
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Address �hJ �-L t /„ / Z _��/ ..��--'�
I����7 �� �.f� [ U
Ciry State Zip Phone
I understan my ri t stated above.
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