HomeMy WebLinkAbout1998-010932 - entrance monuments PERMIT
CITY OF ORONO PERMIT TYPE: F;{_ T N_D T N (
4
7275!3'Kelley Parkway- P.O. Box 66
C stat Bay, Minnesota 55323 Permit Number: f}109:_ _;.`
rYDate Issued: 1;};': .i=i-"
(612) 473-7357
SITE ADDRESS:
CH
P. y . ill.
DESCRIPTION:
r N3 T RAN-:E MONUMENTS
MENTS
Buildi»=a Perrni r_. Type SF-ACC =_TRUCTijRE
Bu i l d i i-i'2 We-rN:; Type ENTRAN :E GATS S
tlss 9 Ni=iNBL I:1G _Tn_CT .
REMARKS:
,_;E F ARA T= PERMIT REQ-1t l I REQ FOR Et_E{:TF I CAL `=;TATE) .
FEE SUMMARY: ON
7M
Base Fee �i:��,:�. , _
Tc-t.a 1 Fey=
CONTRACTOR: - A aF P. i c aii t - OWNER:
M T N NEc_-i_i#A F i Q EF LA :E 47:x. i:=iF,:i�t t�:F-AtIF'L_I N _Tt_:�}fir
Si}�,;.} HIGHWAY 1 ;�; THr RCI )i3H RED LA
` M ! . . MN
_ , _i LE Fs TN
(6122) 471-18154,3,
THE UNDERSIGNED ED HEREBY ;�cLQUE�;T�� PERMISSION TO MAKE- THE HEAL '€�i,�E1�# #T�
SPECIFIED AND AGREES TO 00 ALL` WORK IN STRICT coMPL I NCF 1T ALL CITY "
DRONt� i RD NAN�NC:ES ANBD STATEs iF M 1 N�t�NNwSOTA; VILDIN G C�:�N�E, .JIk EN`TS S.
L
APPLICANT,,PERMITEE SIGNATURE 7 C51 ISSUED BY:SIGNATURE ��
Total Fee: $3s..2 5 Date Received:
Entered By: GGi Permit#: /O q 5
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
--------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 20 y� �"�"fp����� ZIP:
NAME OF OWNER: �� ���'�����/ PHONE: (home) 'y 7 S-
(work)
MAILING ADDRESS: A� y3 � � �° CITY: ZIP:
CONTRACTOR: C "C�i2 ����� PHONE: l7/4-5zljr
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: 1-7,4,.OZc/U,0- ZIP: 3-3 r f
STATE LICENSE: #
ARCHITECT/ENGINEER: /y PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail):
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED 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 accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE:
NOTE! Parade !Q,f Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
r
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 this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice rewired under this subdivision in the individual income tax or provem tax refund
instructions instead of on 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 dam on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the dam 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 thereafter unless a dispute or action pursuant to this section is pending or additional dam 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 authority
may require the requesting person to pay the actual costs of making,certifying.and compiling the copies.
The responsible authority 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 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 additional 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible authority 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 notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the dam to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed dam.
The determination 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 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 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.
45!
First Middle Inst
Address
City State Zip Phone
I un*nre
' ts as stat e.
Sign
CHECK OFF LIST FOR ISSUANCE OF PERINUTS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z 4,y TH O 2 0 6tZR �
PID:
DESCRIP'T'ION OF WORK: AfTAArv'G2 nlvo v v
ZONING REVIEW BY: _ DATE APPROVED:
BUII,DTi tG REVIEW BY: �f f/a . DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By: _ N
PERMIT _Yes / No
PLAN REVIEW Yes No Li SEWER CONNECTION
STATE SURCHARGE Yes _� No WATER,CONNECTION
INVESTIGATION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST zoning District: _/moo L 9-e_ _ ------
Fire Department: AJ C_ Post Office: School District:
Lot Area: Sq.R. IVYL Acres Width Depth
Survey Submitted: Yes_ c No Date of Survey:
Proposed Setbacks:
Front (Lake): �jc�.t f- Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hat. 5 Peak Hn S
Lot Coverage:
IA-
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution:# Resolution Date:
Shoreland District:
Avg. Setback: BluffSetback: Lot Coverage:
Exis b g Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS Cin house):
:.
BUILDING REVIEW CHECK LIST
UBC: _ A) 1(4-- CONSTRUCTION TYPE:
Sq Footage S Per Sq Ftg
Basement x
1st Floor . z
2nd Floor x _
Garage
- x _
x -
TOTAL
Estimated Construction Value: °
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire .
Hardcover Removal Mechanical
FootingWater Connection
•Septic Sewer Connection
Insulation Fireplace Lawn Irrigation
Wall Board
Other
Final (Ivlfg.) Well (State Permit)
—�Other Grading/Filling Electrical (State Permit)
REMARKS (IN HOUSE): -----------�` -
----------------- _
REVIEW BY OTHERS: DATE: ----_-----
Access: Existing New -
Access Approval: Date
By.
------------------------------------------- _
REMARKS (TO BE NOTED ON PERINUT):
. .._ 27
1, 1 ,_-
Established In 1902 INVOICE NO. 425713
LOT SURVEYS COMPANY, INC. F.B.NO. 709-39
LAND SURVEYORS SCALE: 1 " _ 40'
REGISTERED UNDER THE LAWS OF STATE OF MINNESOTA o Denotes Iron Mownent
7001 73rd Avenue North 612-660-3093 O Denotes Wood Hub Set
Fax No. 660-3622 for excavation only
Minneapolis, Minnesota 66429 x000.0 Denotes Existing Elevation
ft r u P>j o r z T P r t i f i r a t P ono.o Denotes Proposed Elevation
-�+l*-^ Denotes Surface Drainage
EIDEN CONSTRUCTION 1016,1 Proposed Top of Block
I r>11.0.Z Proposed Garage Floor
--
C-1,��� or O qn �0�(Ipo'tl
Proposed grades are subject 100 S- proposed Lowest Floor
to results of soil test
'�l`�,(`� fType of Building
f',•'itUl'4. . -- _ jj�pc7� ^ I CL7n�— �t!�(�t�'[. IUl/I� Y�AS�FtErJ(
r ir11 t��I :II t,flrlii`•I] O:1`-YJ� 4V) �Q�U�� r✓ C In ��V��1�1
SM:
F3Y % •C_�✓ n ua
--- 0 `L,
d� /
v I�GRONO
ADING PLLAN �
SITE PLAN :-- / Iata9
a la i I-I rsL,V1Slcg4
00
lJ 5 i
fof31O
1 h1^
liso'; / ' _- I/ N I
Icy
a I n
t( I0toL
01 (4
141 0.
101
to �� 1"A4- r ol2.t
4 t' bC -f
ofa.5 L
X0),8 /b Inl
-T /
-.,,may--a,�"• I � � N
I �
long fit
7L) 64
'�ate- ----_ 1----.------I
v y
Lot 6, Block, 2, OLD CRYSTAL BAY ROAD SECOND ADDITION / Ciro)n
Proposed building information must be checked with approved building
plan before excavation and construction.
The only easements shown are from plats of record or informbtion
provided by client.
We hereby certify that this is o true and correct representation of
a survey of the boundaries of the above described land and the �]
location of all buildings and visible encroachments, if any,
IZEV I",E17 Z --)-Ib Signed
Surveyed by us this 6th day of February t g 96 Charles F. Anderton, Min. Reg. No.21753