HomeMy WebLinkAbout1999-011713 - land alteration PERMIT
C�TY OF ORONO PERMIT TYPE:
` 2750 Kelley Parkway- P.O. Box 66 Permit Number: - ,-
Crystal Bay, Minnesota 55323 =�`�' f%�-`T#�>;`.:-�
(612)473-7357 Date issued: ;=;�� ;�-�; :_r
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE �'�
Total Fee: $ Date Received:
Entered By: Perm.it#:
CITY OF ORONO - BUILDING PERMIT APPLICA�ION � �
All information must be submitted in full before plan review w-ill be started. .
(please print all information)
T�IiE APPLICANT IS: � (circle one) O�TER OR CONTRACTOR
JOB SIT'E ADDRESS: !`���� �� �� � O. ZIP: �� �� �
I�'A11-� OF Oti�TER:�. �� c�" PHONE: (home � --����
- (work) '1�°�`�`��--_
�r�.�rG�nr.Ess�� � �. � �crrY: �n =- _ z�: ���S� 5--�
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CONTRACTOR: P���'
CO�1'I'ACT PERSON: MOBTLEIPAGER:
MA�I�'G ADDRESS: CIT"Y: ZIP:
STATE LICE�'SE: # �
ARCHITECT�E�GII�TEER: . PT30�'E:
MA.ILItii'G ADDRESS: CITY: ZIP:
NA.i�: REGISTRATIO�t#
TYPE OF tiYORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration , .��
PROPOSED tiVORK(describe in detai�: � Y-� ��r � �-e C� .-�� �.�'�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �
EST .Il�i IA,TED CONSTRUCTION VALUATION (excluding land): $ -
I hereby apply for a building permit and I aclrnowledge 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 Build�n� Code; that I understan ihi�s not a permit and work is not to start without a
pernut; and that the work will`be in acc dance�ith the approved plan.
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APPLICAl�"T`S SIGNA '� .� -' ���--���: Z
NOTE! Parade o Homes events require separate permit approval by Police Department and
� City Council 60 days prior to tke event. Non permitted events will not be allowed.
Sec.13.Q4 RIGF3TS OF SUBJECTS OF DATA '
Sabd. 1. Type o[data. The righcs of individual on whom the data is stored or ro be stnrd shalI be as sa forth in this section.
Subd.2. Iatormaton required to be givm indiridual. �n individual uYed w supply privart or confideadal dam eoncerning himself shaIl
be infocmed o`: (a)tfie purpose and intended use oE the requurai dam withia the eollecung State ageury.polirical subdivision,or sca�ewide rys��;
(b)whec�er he tray reEuse oY u.legally tequir.d co suppty the rquesud dsa:(c}aay laiown caastqucnce arising from his supplyiag or refusing eo supp[y
p;iva�e or con::der.aal dara;ar.d(d)tk�e ideadry of a�her persoas or enodes auc�orized by sc�te or federal law to tr�eive ehe da[a. 'Ihis requirement shall
no[apply wren an ir.dividual is asked to supply invesrigadve dan,pursuaac ca s<cdan 13.82,subdivision 5,co a[aw enforcemenc oFficer.
'[he ee:lmissionec of rcvenue mav otace the noace r_auir.d under this subdivision in the individual incorrte nz or orooecrv t�z refund
instrucdons inscead oE on chose fomu.
Subd.3. Access to data by iadiridual. Upon requesc to a responsibie auchoary,an individual shall be informed whaher he is che subjecc
of stnr_d dan on individuals,and whethe�it is classifi:d u public,private or conF.denaal. Upoa his furcher r_quest,aa individual who is the subje:c
of s:or_d priva;e or pubtic dara on individaais shall be shown che daa wichout any eharge to him and;if he desira,shall be infocmed of the eoatenc
aad m:aning of that daa. Afre�an individual has been shown che private dati and informed oC ict meaaing,the daca nerd not be disclosed oo him fo�
six monchs theceafu�unless a dispute oc acQon pursuanc to this secdon is peadiag oc addidoaal dac�on the individual h�been eollected or erea`d.
The responsibie aud:oriry shall�provida capies of che priva�orpublic dara uFon request by che individual subjecc of che dara. The respansible au�hociry
may require the requesdng person ro pay the accual coscs o;maki�g,cecafying,and eompiling che copia.
The responsible authoriry shall eomply ir,ur.edia�zly,if possible,wich any request made pursuant co chis subdivision,or wichin five days of
the dace of�he requesc,excluding Sacucdays,Sundays and legal holidays,if immediaca compliaace is no�possible. If he canaot comply wich the requesc
wichin that dcne,he shal!so inform[he individual,and may have an addidoaai five days within which to comply wich the request,excluding Sacurdays,
Sundays and legal holidays. . .
Subd.4. Procedure when data is not accurate or complete. An icdividual may eonc:st rhe accurdcy or compieceness aFpublic or priva�e
dara conceming tiunself. To ezercise chis right,an individual shall noafy in wridng ehe nspocuible auchoriry describing the nature oF the d'uagreemeac
The responsible authoriry shall within 30 days eitl;cr: (a)correct�he data found to be inaccurdte oc incomplete aad aaempc to nodfy past recipiencs of
inaccutato or incamplete data, including rccipien�s named by che individuat;or(b}noafy the individual that he bclieves the dara to be correcG DaCi
in dispuce shal!be disclosed only if the individLa!'s scater,.en�of disagreement is included with tht d'uclosed data.
The decerminadon of the responsibta auchoriry may be appealed pursuanc to the provisions of[ha adminisaarive procedure acc relaring to
eonteswd eases. •
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04,Subd.2, "Ri;h�s of subjeccs of data", we would like to inform you tha[your request
for a pemuc or license from the Ciry of Orono or any of ics deparcments may require you to furnish certain private or
confidential information.
You aze notified that:
1. The infocmation 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 Ciry deny the permit or license.
3. The information may be shared wich o�her local, s�ace or federal a�encies to the etcenc necessary to process
the permit or license.
4. If your requested perm.it or license requires Council action to approve, soaie information may become
public. .
5. You have certai.n rights under M.S. 13.04 (availabie upon reqnest) to review private data on.yourself. ,
6. Your full name is required to process this application or perm.it.
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I understan �aiy rig .s as stat above.
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• CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �`���= �' s ;�---�,-+ /�� /l�'�
PID:
DESCRIPTION OF WORK: G'��-��,w-�. -
�������������������'�'���������"�������� ���������������������������'�'����������������������''����C���
ZONING REVIEW BY: �� ,��.� DATE APPROVED: � L. �
BUILDING REVIEW BY. DATE APPROVED:
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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 SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: /�.� � ����"'�
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 S'de:
Rear (Street): Left Si :
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File; # Resolution: � Resolution Date:
Shoreland District:
Avg. Setback: Bluff Set ack: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes �o Date of Council Approval:
REMARKS (in house):
7
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BUILDING REVIEW CHECK LIST
UBC: N��� CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ C� ��
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover 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):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMIT):
8
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� - �C glTE PIAN GRAD�ING PLAN
� � �APPROVED —`32c�v�-
❑ APPROVE�D WITH REYISIOi�IS
• Certifi�ate of Suz-v� �.p��,�p�} D�
for �se',cleys, Inc. BY _
O f LC t, 3� $:.O C ic 1� n].��O' �L�.� - Z •G)
ri�nn�pir. County, tJir:n�s t��
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�• � ,s--Draina9v a�d�fiGfy POS�mPnfs-.�_„_� � I I hareby rertify that this is a �
��. true and correct re�:esentation
� I i I � of�a surti-ey o:' the bcur.da:ies of
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