HomeMy WebLinkAbout1995 - 007306 - grading for driveway PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 .'=;F w C; :F I NI)
Crystal Bay, Minnesota 55323 Permit Number: --T
(612)473 7357 Date Issued: 09/0S/96
SITE ADDRESS:
1801 .Tf ST Ft'?' .3T ......
. N 27-118-2: -44-00 I ...
DESCRIPTION:
(3RAD D e,y11 FOR i �x(' 3 VEVA
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User _ rr: 1 i s l_fAN. ALTERATION
A?_ION
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1.71330 0000
41 ru
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REMARKS:
FEE SUMMARY:
st, 7' . �_ , ``� _:ter:
Total I E„ Fee e - 6i_i. 00
CONTRACTOR: -- Applicant -- OWNER:
iE F��S:-. '�..^..J}�3... x. - . .. N .., �.:.i». _ _ ?.f -'.... !'.'^t Y[M
2837 ALDRICH AVE S 1801 WEST FARM RD
MINNEAPOLIS MN 65408 ORONO MN 55356
THE UNDERSIGNED HEREBY REQUESTS PE RM I S` i ON TO MAKE THE REAL IMPROVE MEN T S
SPECIFIED At"D AGREES TO DO AIL WORK INSTRICT COMPLIANCE WITH AIL CITY O
ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS .
// CK/--; €`
APPI IrANT/PFP�AITFF CII MATT IPF ICCI IFIL RV•CI!,NATI IRF
Total Fee: $ .` DateReceived:
Date Approved:
Entered By: Permit#: /30 .
CITY OF ORONO - BUILDING PERMIT APPLICATION
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL
BE STARTED
THE APPLICANT IS: (circle one) OWNER OR TRACTOR
JOB SITE ADDRESS: //b( J. f--, ZIP:
NAME OF OWNER: �iX4 R e/Ote ti1--
PHONE: (home) q 7 S -- q ( q 3
n 0 (work)
MAILINGADDRESS: goo/ ..,/'. FtivNi2, CITY: Zrry Z/I/_P ZIP:
CONTRACTOR: De /14 (0 (OAU ..4 ---7 PHONE: -7,;./ Y(
MOBILE PHONE/PAGER: 7c4-e7G3 /5-a7 6.-o 73r
MAILING ADDRES�c3e3 7 MIA ..A A'L CITY: />G s ZIP: . --C-'74/,?
STATE LICENSE.
ARCHITECT/ENGINEER: a ) /e PHONE:
MAILING ADDRESS: �l/ CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration T and Alteration
PROPOS D WORK(describe ip.detail): - a._.... k >
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 wo t will be in ac •rdance with the approved plan.
APPLICANT'S SIGNATURE:, AL
DATE: , ,s� yci
NO
TE! Parade of Homes events ,quire 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 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.
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.
llV/qA f- Ac X42,{ (1/2/4,z
First 7 3 /1' Middle / Last
2
2 .� (c Gt //'P c�
Address ! S 4k)' -CC-474Z) .tP ce2,2 -g--2e/
City State Zip Phone
I understandr rights as stated above
Signature
CHECK OFF LIST RFOR ISSUANCE USE EYOF PERMITS
FORFF
ADDRESS OR LEGAL: 10,I w' —41.14' PID:
DESCRIPTION OF WORK: f2AtNe•
DATE APPROVED: fir
ZONING REVIEW BY: I DATE APPROVED:
BUILDL\G REVIEW BY:
��,,,, Misc. Fees Calculated By:
FEES TO BE CHARGED:
PERMIT Yes V No
PLAN REVIEW Yes No SEWER CONNECTION
No / WATER CONNECTION
STATE SURCHARGE Yes pp�g FEE
INVESTIGATION FEE Yes No-� / PARSITE INSPECTION
SAC Yes
Number of SAC Units OTHER (specify)
-
-ZONING CHECK LIST Zoning District:
Shoreland District
Fire Department:
Post Office: School Di• rict:
Lot Area: Sq.ft. h
Acres Width D-pth
Survey Submitter
Yes No Date of Surve, :
Proposed Setbac. :
Front ( ak.): Right Side:
Rear (S reet : Left Side:
Adjace't St crures: We land:
Building Heigh: Def. Hgt. Pe . Hgt.
Avg. Setback:
Luff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000' -
Hardcover V: 'mace Requ' -d: Yes No I .te of Council Approval:
Grading: S : Approval D te: _ By: Council Approval Date:
Septic: Sta Approval Date. — By.
Zoning
Fil, : # resolution: # Resolution Date:
REQ •h• (in house):
26
BL]ILDLNG REVIEW • I: CK LIST
LBC: CONSTRU ON TYPE:
Sq Foot •- S Per Sq 'tg
Basement x =
1st Floor x =
2nd Floor x
IIIIII
Garage x -
x =
TOT. 1
ilfEstima -d Constructi'n V lue: S
Inspections • -quired: Work Requiring S:parite Permits:
Site Plumbing Fire
Mechanic Water Connection
Hart cover Removal
ting Septic Sewer Connection
Fo -
• aming Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
-
V FinalGrading/Filling Electrical (State Permit)
Other
REMARKS (DI HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
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