HomeMy WebLinkAbout1997-009109 - land alteration PERMIT
CITY OF ORONO PERMIT TYPE: --
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: i- i°- 1 i_�°-
(612) 473-7357 Date Issued: i f- Y` i1,;7'
SITE ADDRESS:
3745 5 WATERTOWN RC)
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DESCRIPTION:
Hser Jc*--,rfrIJ t. Type LAND ALTERATION
REMARKS:
FEE SUMMARY:
Ta_+*ri s Pink.
CONTRACTOR: OWNER: - Applicant -
„/TTs=R IF IFLC1 NEE
WATERTCUN RD-
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THE t.�NDE(�`�.I6NED HEREBY FLEA;1_JE8.T8, `ERM I S$f ON TO A kEAL. 1SPROYSMENTS.
PEC.IFIEli Ate„ AGREES TO DO, ALS. W �I•i�: IN STRICT L+,�'11=� � E WITH.ALL,. �IT`f +#
� }; 1Nt ORDINANCES INAN ES AND
} ►TATE OF MINNESOTA ZIDI ��QE kRE� #IR �I`tT
I
A LICANT-PERMITEE SIG URE ISSUED BY:SIGNATURE
Total Fee: $ Date Received:
Entered By: .�� Permit#: q/o/
CITY OF ORONO - BUILDING PERDYHT 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) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � ZqS_ Wa 4 ZIP:
NAME OF OWNER: ?4 EPHONE: (home) 4ylj) S-3
(work) (o ltt S�
MAILING ADDRESS: CITY: , ZIP
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail):
go".1 oe a
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:�p— j — rfT_
NOTE! Parade of 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.
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 or 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 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 data 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 hits for
six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has beeff 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 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 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. f J
First Middle Inst
1117A ZZ
Address
city, State Zip Phone
I understand my rights as stated above.
igna
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: —S-7'1!;:
PID:
DESCRIPTION OF WORK: rt t (po w ISA C_ V A4S
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ZONING
-----------:-----------`-------
ZONING REVIEW BY: DATE APPROVED: to—
BUILDING REVIEW BY: /V//l 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: ON C:�AL&
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:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250`500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (inhouse): lDv 5 /%✓ E-17-4r'vE
26
BUILDING REVIEW CHECK LIST
UBC: /,1A I CONSTRUCTION TYPE: /V 64-
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)
DG Final Grading/Filling Electrical (State Permit)
Other
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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):
27
111uV j+u-.. V� .V JV4V1 y •
Township 118, Range 23, Hennepin County,.Minnesota, described as follow: ;
Commend1h g-'`#t ,the $outhwest corner of said Southeast
Quarter of the Southwest
Quarter; thence South 89 degrees, 54 minutes 36..seconds East, assumed bearing,
along the' south.line.of said Southeast Quarter of the Southwest Quarter, a
distance of:149.03 feet;,,`thence:North 03 degrees 14 minutes 50 seconds East, a :
distance of 654.94-feet`to:'the.actual 'point"of beginning'of the tract to-be
described; thence,.North 03 degrees.•.14:minutes 80'seconds East, a distance of
: . .446'.69 feet to the centerline of Wate;town-Road (County Road No. 6);.thence
South::67-degrees�'13: minutes 56`seconds.East, along said centerline, a distance {
of '179;.17"feet; thence'.South 00 'degrees 54 'minutes 40 seconds East, a distance 1'-.G:.L ZESCRI2TION, TRACT Y;
of 1031.03 feet to the 'south line of said Southeast Quarter of the Southwest
Quarter; thence North,,89. degrees 5 .4 minutes 36.-seconds West, along said south That part of U%e Southeast Qua,#er of t e Sol
-,line, a distance of 194..51'feet; thence #orth 00 degrees 54 minutes 40 seconds Township 118, Range .23, Hennepin County,;'Min:
West, a distance of 654,:. feet to, thg point of beginning.
Ccaaen ting a: the sout.,west corner o�.said Sc
Coataining' 203,261 Square Feet,. more or less.
Quarte thence South.89:degrees :54 mi;:utes
along the souih•line•of,said ,Southeast,.'QuartA
Su3�ect to pLb'a road easeaenc and other easements, restrictions, aac dis.ar.ce_of.149;03'-feet to'the. actual'point;s
ese_-vaa'os. o:.record, ..if any. described,: t.';ence_North 03 degrees. 14:)ZLicete:
-� 654.9.4 feet;.thence.'-South 00`degrees 54-:a inu{
654.04: .eex;to the south line.of aasd"5outle�
Quarte "' hence, North 89- egrees:,'S4. minutes
line,. a distauca og;;47;50,.teet' o the .actuai`
Containing ,1,5 .531 Square dee., more�f or'•less,r
. r
Subject to easements, restrictioos, sLtd reser
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36.03
,`rad` � •+ / ^ �' 1 . ' .
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CITY OF:ORONO
P5 --k- SITE PLAN _ �< "ORADING PIA- N
0. &.-APPROVED t=-i 1C too
q. 0 APPROVED WITH REVISIONS
0 DI ARP*� VED
BY
DAT ,-L, -57
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. .
House.
-- k�'� end of fence
: -N 3014150"E
10.88'14.17-
. �^; 35,.0/ 704' _ a. x,6.00 -- - x ---- - • x' - Y, —
h' Gar Tract 4
26.0 _
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--- :; ('138 , ;Range 1tn
codtaining-'5;'18-
o ,the Squthwes
50 40'3020 10 0 50 100'. > h50 OnQ Hundred .and
SCALE IN FEET' '