HomeMy WebLinkAbout1999-012289 - land alteration - fill � 1 PERMIT
. CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number:
(612) 249-4600 Date Issued: - � ��--�--'
;��'i i: ,t.$>_
SITE ADDRESS:
- - _: ; °i�,
:�:�:_:;�:
- - � -,i -�;:-�:'
DESCRIPTION:
_ .1__. �=�r�;Y;,;i i�. i�r r _,_. �.;��;=i�; :=;�__ . .._.=;'��T;�t;:s;�,�
REMARKS:
FEE SUMMARY:
_ 4:�: - =�_��� ;�
_ __. . _ _______ ��:a�..��.
f'__.f - _ •-_ _. _ . ,_:f i
CONTRACTOR: OWNER: -- ;��,�:_ : ; ; :;,-;;,. --
.. ,.. . �(-3''1 Y
.._...., _. —{��. •
�.;.?:�-;t;� �.; 1 `�i �'—'{ ;�;E
`sY�� �?�'+#:}�i1'•����9'��=..�' i"#�1'"�`E�.�i=." . .._ w :+__ .. Y ._, ,;`, ... _�_} f li-'1�'��.� ! t?.,.. ?","_ .. .. . ._. ,...: 1 ? _
'•a
`„��'t�-#:�FT�� `I���tl.� �t'3�^�,��'�: � ... _ . �...._ .. _#... . ��� `°=-i�i'T�:�" {_:3i�`t�`�.._?'"-.?" _ .,. .' _,..,. . ., i ��-
ii—iiySi`y�E : I-;'�,S�els�_'4iv'-.Y.i^�? �i�L/ .j.,�a '���,?�� t '�fm� T : I s 1 t i
, . � ...:�..: ...� _ .... ... � ....,.•�.. , . 'A � . . . . �.:.,_�f�..: . � . .,.«.� _. ... . ._ ....» ....,. ... . ,. __. _ . J
S
. . .:. . ' _ .. �
�
♦
V
APP�CA P ITEE SI TURE ISSUED BY:SIGNATURE I��G�/ /
I IY
� �
Total Fee: $ Date Received:
Entered By: Permit#: 122��
CITY OF ORONO - BUII.DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print a11 information)
--------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: "f�S�.S�-S 1/Ua,y zc�.tQ /3�° ZIP: .�"'r3.1 y
NAME OF OWNER: G'�,�-,, �a,z,;,.e�r' PHONE: (home)�/� -i�79 5����-
(workj 6i�- 70�_ 7/3/
MAILING ADDRESS: S'f✓`,r wa��o�,�3 GT•f CITY:,�l�.l.�.`'/>�ti ZIP: rs 3 r-�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �: !�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a building pernut and I acknowledge that the information above is complete and
accurate; that the work will be in confom�ance 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.
APPLICANT'S SIGNATURE• DATE: /��1`/��
NOTE! Parade of Homes events req re separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
r �
>
,
Sec.13.04 RIGI�TS O'F SUBJECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information req�rired to be given individual. An individual asked to suppty private or confidential data concerning himself
shall be informed of: (a)the purpose aod inte�ed use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his svpplying or
cefusing to supply private or confidential data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data.
This requirement shail not apply when an individual is asked to supply investigadve data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of reveriue mav�lace the nodce reauired under this subdivision in the individual income tax or orocertv taz refund
instructions instead of ort those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuats,a�whether it is classified as public,private or confidenaal. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the dara without any charge to him and,if he desires,shall be informed
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesring person to pay the actual cosu 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 Saturdays,Sundays a�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 addiUonal 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 ihe accuracy or completeness of public or
private data conceming himself. To ezercise 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 fou�to be inaccurate or incomplete and attempt to notify
past recipients of inaccunte or incomplete data,ic�luding recipients named by the individual;or(b)notify the individual ihat he believes the data
to be conect. Data in dispute shall be disclosed only if the individual's sCatement of disagreement is included with the disclosed data.
The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administrative 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 permit or license from the�ity of Orono or any of its departments may require you to fumish 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 shared with other local, state or federal agencies to the extent necessary to
process the permit 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.
First Middle Last
Address
C��y State Zip Phone
I understand my rights as stated above.
Signature
6
CHECK OFF LIST FOR ISSUANCE OF PERII�IITS
FOR OFFICE USE ONLY •
ADDRESS OR LEGAL: Y SS� Lv�`y'�%� �� �
PID:
DESCRIPTION OF WORK: � �,.. '�ti. C3�,� � Pp►�
ZO�'G REYD�W BY: DATEAPPROVED: / 2"« -4'�
�. BUILDPTG REV�W BY: � DATE APPROYED; /v I�
FEES TO BE CHARGED: I��� Misc. Fees Calculated By:
PERNIIT Yes �No
pLAN REVIEW Yes No v- SEWER COrfNFC1�ON
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
___________ _____M_________-------
ZO�Z�G CS�CS LIST Zoning District:
Fire Department: Post OfFice: School District: �
Lot Area: Sq.ft. Acres � Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side: � � � ,
Rear(Street): Left Side:
Adjacent Structures: We and:
Building Height: Def. Hgt. Pe Hgt.
Lot Coveraoe: '
Grading: Staff Approval Date: B : Council Approval Date:
Septic: Staff Approval Date: B :
Zoning File: # Resolution: # Resoludon Date:
Shoreland District:
Avg. Setback: Bluff Setbac : Lot Covera�e:
� Existing Proposed �
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes N Date of Council Approval: __
REMARKS(in house):
�
7
r • ,
BUII.DING REVIEW CHECI�LIST
�C� "` . � � CONSTRUCTION TYPE:
Sq Footaoe $Per Sq Ftg
� Basement . . . x . _
�. lst Floor . � x � _ . .
. 2nd Floor x _ . �
Gara�e x _
x =
TOTAL
Estimated Construction Value: $
Inspections Required: SYork Requiring Separate Permits:
Site � Plumbing Fire
Hardcover Removal Mechanical Water Connection
F��g ' Septic Sewer Connection �
� Framing . Fireplace Lawn Irrigation
Insulation (Masonry� Other
Wall Boazd (Mfg.) Well(State Permit)
_ �--F�� Grading/Filling Electrical(State Permit)
Other
REi�ZARKS(IN HOUSE�:
REV�W BY OTHERS: DATE: - -
Access: Existing New .
Access Approval: Date gy; �
REI�IARKS (TO BE NOTED ON PEIt�l�fl1�: �~
8
��r� i Ir I�,H i � vr JU(� V L i i
����, GARY F'RAZIER
� � IN THE NE 1 /4 OF SW 1 /4 OF SEC
\ � HENNEPIN COUNTY, MINNES
�
�\ N�th �;n �
� '/4, S o� ' �
� lY��' •"`',, r,. ,
�� .
S
N 88° 6'� E S. ��/ ecr3� ' � y � �i
,---- 170.80 - -., 6� _.�(..-------- ----��--
•- -__.,.�- '��;-- -�---
--�----�.- - - _� ,s5.,,_R _ _ �' '1es9 45,, l� � �'
2 Y� ^
°� ,' � 0 , 4 r N
- _ _ _ _ _,_ I y� � , T ' O
� i ROAD ''"�' � � .
- ' ;, E�st�rn � � ' �
� �D \ � �`� \ cMt� �
� � ,�06 i \ r��nA
� I'^ � � ��f e
M � � � x�8�i�
I ,- BUIDrJ(' t \ '-d°�th � 9 t�
-se.o— �ao I�- � � ,•� qi et'/ �/�
\ �� `'�O��9ht o
� � f
— �9.�— . p � � ���°OdwOy i,
� GARAGE ' � � /nf��otl��o;i�°o
e.o � o a
�•-3a.s='�� � ` \
.��ne \
�EwsTwc -Y ����i� �����b°sed o�f�r j \
s►�n - .,�.
— — A-�es.s— — — — — r� �o \
— — ios.�— - — ��--�.__ ' ock �� � \
-� o�or��te� \
�O� ��ne
f
`'HOUSE � ����ro
' (SEE DETAIL) �d
� CIT�' DF ORQ�HO
�fTE PLA1V GR�4DHVf PLAN
0-APPROVED - ri�L r�� � = �,}.,�
❑ APPRp'J£t� WI�'N REVfS10f�1S
C7 D�S�IPPR ED
� � � BY
N � � D�ATE l Z„- t S�5
r� N (_,,PS�S ��� S� cc y�9�-��
r a--
LE�AL DESCRIPT(ON QF PREMISES :
The East Holf of the West Half of the h
Section 30, Township 118 North, Range :
. Sovth oF +he railroacl r�9�+t'°�''wo,Y•
w . w o : denotes iron marker
M d- Bearings shown are based upon an assur
r-
M �t
0 0
'— '' This survey intends to show the boundar
Z Z the location of on existing house, garage
of a proposed building thereon. It does i
improvements or encroachments.
Eart line of East 112, West 1/2,
NE_ 1/4, SW 1/4, Sec. 3Q - - - - - 7
�
a
vi
t
co
West line of Eost 1/2,�esf��z
- - " - " ' � N£ 1/4, SW 1/4, Sec. 30
� �
� ; 5outh line o1 " - ''
� , ,� NE 1/4, SW 1/4, Sec. 30
� , � ,
` -�--�----------------------
�' - S 89°07' 13" W 335.12 -�� '