HomeMy WebLinkAbout2000-P02609 - land alteration 'CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: P02609
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(612) 249-4600 Date Issued: 8/31/200
SITE ADDRESS: 3020 Watertown Rd
LONG LAKE,MN 55356
PID: 33-118-23-33-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(50 I+cu yds
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
$100.00 ENGINEERING FEE,$25.00 INSPECTION FEE,$75.
FEE SUMMARY: Permit Fee: $ 75.00 Valuation: $ 0.00
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TOTAL FEE: $200.00
APPLICANT: STEINER&KOPPELMAN OWNER: J R RENCKENS&D A RENCKENS
18340 MINNETONKA BLVD 3020 WATERTOWN RD
DEEPHAVEN,MN 55391 LONG LAKE MN 55356
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 BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNAXURE 0 ISSUED BY SIGNATURE
Copies: City,Applicant,Assessor,Finance Pagel
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Awa-28-2000 02:24pm From-CITY OF ORONO +9522494616 T-457 P-002/003 F-060
Total Fee: $ Date Received:
Permit#:
Entered By: 1�cnecl
CITY OF ORONO - BUILDING PERNIIT 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: �o;o GtrF�u.�r1 �o9Q ZIP':
NAME OF OWNER: ,7,0_W0C 4 �F.Ur..t l PHONE: (home)Al->) 5�9.2jAp
(work)<j9ti)
MAILING ADDRESS: S�p'o ��� iFra 'CITY: ��1/0w>W ZIP: —,9CWz
CONTRACTOR: '1i 4- KCpPCL(vnA-j,; PHONE: H'I 3-5435
CONTACT PERSON: -T,m G 'Ccw,nce' MOBILEIPAGER:
MAILING ADDRESS: Lb 3t(c CITY: t - ZIP: 5�5_:N 1
STATE LICENSE: #
AItCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z1p:
NAINIE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration X --
PROPOSED WORK(describe in derail); , Com- be ck- hti 1 k 22 f-aLx c{
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 4 e= DATE: -phy"o
NOTE! Parade 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.
9
CHECK OFF LIST FOR ISSUANCE OF PERJNHTS
FOR OFFICE USE ONLY
ADDRESSOR LEGAL: -_z p Z.0 c_u ATz,- z w ti a" -
PID:
DESCRIPTION OF WORK: G02A0%N b
ZOINENG REVIEW BY: DATE APPROVED: g- 30-D 0
BUILDING REVIEW BY: — DATE APPROVED:
r
EES TO BE CHARGED: (onA01,1� Misc. Fees Calculated By:
ERMIT Yes ✓ No
LAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SrMINSPECTION
Number of SAC-Units OTHER (specify)
ZO,NLN, G CHECK LIST Zoning District: /N0 G 14�
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:
Rear (Street): Left Side:
Adjacent Structures: W-.tland:
Building Height: Def. H-t. P -Hat.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: y:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
'7 5.0 0 5701 -+- Cv3t G. V.
%00.00 6 N
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BUELDING REVIEW CHECK LIST
UBC: _ CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
1st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ _
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):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
8
Aug-28-2000 02:24pm From-CITY OF ORONO +9522494616 T-457 P-003/003 F-060
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual an whom The,data is stored or to be stored shall be as set forth in this section,
Subd,2. Ynformation required to be given individual. An individual asked to supply private or conrrdcndal data concerning himself shall
be informed of: (a)the purpose and intended use of the requcsmd 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;(e)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, purstlant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue rmy place the notice required under this subdivision in the i dividual income tax or property 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 dao on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is die subject of stored
private or public dare on individuals shall be shown the dare 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 nor be disclosed to him for six months
thereafter 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 authority may require rhe
rcquesring person to pay the actual costs of making,certifying, and compiling the copies.
'lite responsible authority shall comply immediately,if possible,with any request made pursuant To this subdivision, or within five days of the
data 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 die 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 conrtst the accuracy or completeness of public or private dam
concerning himself- To exercise this right,an individual shall norify in writing the responsible authority describing the nature of the disagreement. Tho
responsible authority shall within 30 days either: (a)correct die data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate
or incomplete dam,including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall
be disclosed only if the individual's statement of dissgrccment is included with the disclosed data.
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 fon'the permit or license requested.
21 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.
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I understand my rights as stated above.
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