HomeMy WebLinkAbout1995-007140 - demo garage PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Permit Number
Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357
SITE ADDRESS: •
DESCRIPTION:
bullciing Permit iype
EuilOin9 Work Typt:-
REMARKS:
:.--OI.A0ATIONSSALL DEMO DESRIS TO SE (70UNO OT.SPOSED OF OFF SITE
WELL6 MV61 INFECNC,N LI!.40RE
FEE SUMMARY:
urchLrqt:!
CONTRACTOR: OWNER:
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WATERI.OWN RD
THE UNOERSIGNED HEREDY REUESTS PERTON TO MAKE THE IMPROVEENTS
SPEC:IFIED AND AGg-:.E.P.-.:'; pa ViRK STRIC:r COMPLIANCE VITH ALL C:if. Y OF
DROINANCES ANI1 -7::,Tf-vn.1- OF MINNESOTA BUILDING CODE REQJIREMENTS .
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APP (A T PERMITEE SIGNAT'RE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions
1. You may be required to obtain other permits, i.e. burning, well abandonmment, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24 hour notice is required for all inspections. Call 473-7357.
JOB SITE ADDRES : . Ae �G t �'G' �� � -�K ,`
Occupancy Type: A _ Residential Commercial
/ �� d
OWNER'S NA' 1 ` / %�g �` Phone: ch ,/
Mailing Address: C�� a LaC City: vy� a Law
CONTRACTOR'S NAME: Bus. No.:
Mailing Address: City:
Demolition if planned by means of: manual disassembly
heavy equipment
burning (by fire department)
Permits Issued:
# Burning Fire Department
# Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as
follows:
1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is
complete.
2. Demolition debris will be kept off adjoining property and/or the public rights-of-way
unless specific prior approval is obtained in writing for temporary use thereof.
3. Foundations shall be completely removed from the ground.
4. All demolition debris shall be completely disposed of off site in accordance with all
applicable PCA requirements.
5. Water wells must be abandoned in accordance with State Health Department regulations.
6. Inspection required when all debris has been removed, before backfilling.
7. Within 5 working days of superstructure removal, a final inspection shall be requested.
The site shall be left clean and clear of all debris, with any excavation filled with earth
level with the adjacent ground elevation (except when such excavation is to be used as
part of a new building and such new building is actually under construction).
8. The undersigned owner shall and hereby does indemnify and hold harmless the City of
Orono, its agents, employees and assigns from and against all claims, damages, losses
or expenses, including attorney fees, against the City, its agents, employees and assigns
arising out of or resulting from the demolition described herein as performed by the
property owner, his employees, agents, subcontractors or assigns.
PERMIT TYPE AND FEE CALCULATION
$50.00 - Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $
The undersigned hereby applies to the City of Orono for issuance of a Demolition Permit, agrees
to do all work in strict accordance with the ordinances of the City and the regulations of the
State of Minnesota, and certifies that all statements made on this application are complete, true
and correct.
APPLICANT'S SIGNATURE: �/ / / _4,11„/ / Date: 7/4/
OWNER'S SIGNA ' ". 4 "wry
r r Date: /��i 9�
l
APPROVED BY: Date:
CHECK OF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY •
ADDRESS OR LEGAL: y 0&.10 �") r1 PID:
DESCRIPTION OF WORK: G aIA C-C ----------------------
ZONING REVIEW BY: •
DATE APPROVED:
_i4j11._ ______________
BUILDIREVIEW BY: DATE APPROVED: 7-S-`7 S
_____ __ _____ ----------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,/-No
PLAN REVIEW Yes (- No SEWER CONNECTION
�No WATER CONNECTION
STATE SURCHARGE Yes PARK FEE
INVESTIGATION FEE Yes No SITE IEPECTION
SAC Yes No
Number of SAC Units
OTHER (specify)
ZONING CHECK LIST Zoning District: RR-IA
Fire Department:
Post fic7: AO ,A ' chor District:
,� / r-� --
Lot Area:
Width: / / D
Survey Submitted: Yes ,x- No Date of Survey: oma+ t-t Lxt
Proposed Setbacks: Side: 11 0�
Front (Lake) : / Zir (s) Right
O
Rear ( Street) : se Left Side: N(/) W
Adjacent Structures: 3 -1
Wetland: ni +
Building Height: Def . Hgt. 0
Peak Hgt.
got Coverag- :
Avg. Setback:
Existing Proposed ,
p
/
Hardcover: 0-75 ' /
75-250 ' __i
250-500
500-1000 '
Hardcover Variance Requ' red: es No
gate of Council Approval :_.
Grading: Staff Approval Date: By:
Council Approval Date :
Septic: Staff Approval Date: Ipr:
Zoning File:# Re olution # : Resolut on Date:
REMARKS (in house) :
BUILDING REVIEW CHECK LIST
UBC: U - ( CONSTRUCTION TYPE: \jr3
_
Sq Footage $ Per Sq Ftg
Basement "__ - _" - ._x _ _
1st Floor x _ ____
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ ( S,C cO°c'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing _ Grading/Filling
Footing Mechanical Fire
of,Framing - Septic Water Connection
Insulation - Fireplace - Sewer Connection
Wall Board (Masonry) Lawn Irrigation
a<Final (Mfg.) - Other
Other Well (State Permit)
p(Electrical (State Permit)
REMARKS (IN HOUSE) :
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT) :
Total Fee: $ 3 7S Date Received: (o 3
Date Approved: 7 J--9 5
Entered By: 93 Permit#: 7/A,Y
CITY OF ORONO - BUILDING PERMIT APPLICATION
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL
BE STARTED
THE APPLICANT IS: (circle one) OWNE OR CONTRACTOR
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JOB SITE ADDRESS: 4/olio L i /iC.'L A--a---ZIP: ,--5-515-9
ii/iy,,,,iii__ , (:_a_i:_,c, r)//__/-)
NAME OF OWNER: -C ', title("___/1/1/K3.)12,41 i HONE: (home) 6/(I`7 -o&f�
/' // 4,
MAILING ADDRESer,,,/
' A, .,..,/ Y:.4_, �/w _ I ,,ZIP: _fig
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CONTRACTOR. // ea JLi 4 . PHONE: '96 t,//
- qc.),,TA
i/ MOBILEP/A 0NE/P•F.ER:
MAILING ADDRESS• 0 gab J/ .►!/L_, .4 ITY:A/fL/ /j-__ZIP: lair 6
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New X Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSJD WO (describe indetail): , aL) (i2/4 )
zt,,-)0 c i ,Lar._- 21
S RIES: / `5Q. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. XC
� CO
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ /i--; COO
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 se in acco%ance with the approved plan.
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APPLICANT'S SIGNA ,_ �r -� /.��t��. �-' DATE: 1 ���
,, lclGI
NOTE! Parade of Homes ev• is ;;_/ it approval by Po a ep nt and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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CITY of ORONO
1', l`• Municipal Offices
vSkPost Office Box 66
!" , 6%1
Crystal Bay,Minnesota 55323-0066
kESHOly
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 (see following page) to review private
data on yourself.
6. Your full name is required to process this application or permit.
P • SEPRINT
First Middle Last 1
/
Li
Address
/ •
4.t . / - • A.,,tiL• At" /7/ad
City State Zip Phone
I understand my rights as stated above.
/f/L4namrei '
TELEPHONE-473-7357• FAX-473-0510
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subdivision 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 required 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 data 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 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 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.
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