HomeMy WebLinkAbout1996-007929 - shed ;,
,► A PERMIT
�iTY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;z:T L('�T i;#t;
Crystal Bay, Minnesota 55323 Permit Number: - - -
i.i(i;°y�;�°�i
(612)473-7357 Date Issued: �_�,�r.��;:;,^j�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — ���r�1 i�_t7—�+. —
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APPLICA T/PERMITEE SIGNATURE ISSUED BY:SIGNATURE • 'G'�.
Total Fee: S ���� � �� �� DateReceived:
DateApproved:
Entered By: -Ci� .
Permit#: 't�:,�j
CITY OF ORONO - BUII..DING PER.LI�IIT APPLICATION
AI.L IiVF'ORI�IATION I�nJST BE SUBiVITT"I�ED IN FLTLL BEFORE PLAi1T REVIEW`VII.L
BE STARTED
THE APPLIC:�:y�I' IS: (circle on OWN OR CONTRACTOR
JOB SITE �,DDRESS: ��(�v��!%2�fhaK�-� ,C� � ZIP: SS�6 7`
N�tiIE OF O`VNER:� So/�v h PH0�1E: (home) ��a- �O�
(.=ror�:; ,�.3�-.�.3��
�IAILI�i 1GADDRESS: �,cM �� CITY: Z�:
CONTRACTOR: PHONE:
��IpBILE PH0�1E/PAGER:
l�1AILTi�1G ADDRESS: CITY: Z��
STATE LICENSE: #
ARCHTI'ECT/ENGINEER: PHONE:
MAII.I�i 1GADDRESS: CITY: Z��
�T�v�: REGISTRATION #
�I�e�1�- D��,Q-i n.5�^�►�c� �aco�-rD r
TYPE OF WORK: New � Addition Accessory Structure
;Vlove Remodel/Alteration Land Alteration
PROPOSED`VORK(describe indetail): � �at.C.e.. (��65�24� w/� `'1/�� �0�16'"��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOI�IS: Gr�R�1GE STALLS: ATT. DET. ���,o-,���
EST��TED CO�'STRUCTION VAI,UATION(eYcluding land): � /,SO b� N� �'���
I hereby apply for a building permit and I acl:nowledge that the information above is complete
and accura�e; that the work will be in conformance with the ordinances and codes of the Ciry
and with the State Building Code; that I understand this is not a permit and �vork is not to start
without a permit; and that the work will be in accordance with the approved plan.
:�PPLIC�'vT'S SIGNATITRE: DATE: �6
1VOTE! Parade of Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SLTB.TECTS OF DATA
Subd. 1. Type of data. 'Ihe righrs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)tho purpose and incended use of the requesced data within the collecring'srate agency,polidcal subdivision,or statewide symm:
(b)whe[her he may refuse or is legally required to supply the Rquested data;(c)any known coasequence arising from his supplying or refusing to suppiy
private or confidenaal data:and(d)the identiry of otber persons or entiries authorized by state or federal law to receive the data. This requutment shaii
noc apply when an individual is asked to supply investigaave dara, pucsuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the noace required under this subdivision in the individual income ta�c or Drocem raz refund
instrucrions instead of on those forms.
Subd. 3. Access to data by indiridual. Upon request to a responsible authoriry,an individual shall be informed whether he is[he subject
of stored data on individuals, and whether i[is classified as public, private or confidenaal. Upon his further request,an individual who is the subject
of stored private or public dara on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the content
and meaning of that dara. After an individual has been shown the priva[e data and informed of its meaning, the data need not be disclosed to him for
six months the.eaft::r unless u dispute ur�ic.;�r+Yursuaru:e :::is seccor.is per_din3 or additio�al data a:rhe individual has been collected or crea[ed.
The responsible authoriry shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible au[horiry
may require the requesting person ro pay the actual costs of making, cerdfying, and compiling Ihe copies.
The responsible authoriry 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 no[possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal five days wi[hin 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 accuncy or completeness of public or private
data concerning himself. To exercise this right,an individual shall no[ify in wriring the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days eirher. (a)correct the data found ro be inaccurate or incompiete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by[he individual; or(b) nocify the individuai that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
The determination of[he responsible authoriry may be appealed pursuant to the provisions of the adminisaadve pcocedure act relating co
conrested 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 fumish 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 ma.y be shared with other local, state or federal agencies to the extent necessary to process
the pemut 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 da[a on yourself.
(, Your full name is required [o process this application or permit.
�
First Middle ' / Lasc
� vE
Address � / �S?/ �
�O /1( J �P -
C�ry State Zip Phone
I understand my rights as stated above.
�•
ig re
CHECK OFF LIST FOR ISSUAI�iCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAI.: �(b(.7 r o 2��T f-��� p�
PID:
DESCRIPT�ON OF WORK: .�l-��
ZONING REVIEW BY: DATE APPROVED: 5�-�-�,�
BUII.DING REVIE�V BY: DAT'E APPROVID: S--v��t�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓� No
PLAN REVIEW Yes ✓ No SEWER CONiVECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No � SITE INSPECITON
Number or SAC Units OTHER (soecify) _ ^
-----------------------------
ZOiVTi�1G CHECK LIST Zoning Districr. G.2 –�� Shoreland District : �
Fire Depanment: t Office: Sc o �tri�
Lot Area: Sq.ft. res
i �" Depth
Survey Submitted: Yes aC No Date of Survey: m/� �� �-�
Proposed Setbacks: ,
Front (I�e}: (ad � Right Side: ((d
Rear (StFeet): I U Left Side: I O`
Adjacent Structures: ,.SC�� -� `Vetland:
Building Height: ef. Hgt. Peak Hgt.
Avg. Setback: Bluff Setback: Lot overage:
Exi ing Propo ed
Hardcover: 0-7 '
75-2 0' —�-
250-
500-1 00'
Hardcover ariance Re uired: Ye o Dace of Council A proval:
Gradin�: aff Approv Date: By: Council A roval Date:
Septic: St Approval D te: BY�
Zoning F' e: # Resol ion: # Resolution D e:
(in house :
BUII..DI�i tG REVIEW CHECK LIST
��: v -� co�rs�zuc�o� �-�rE: v N
' Sq Foota�e S Per Sq Ftg
Basement R —
lst Floor X —
2nd Floor R —
Garage x —
x =
TOTAL
Estimated Construction Value: $� '�(�O �
Inspections Required: `Vork Requiring Separate Permits:
Si[e 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 (�t HOUSE):
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date BY�
REI�IARKS(TO BE�10TED ON PER.�'�1IT):
27
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AF�F�i�`v'h".; `�'�����'' <<::'`:�E;:-'L''riONg AS NOTEC
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o Denotes Iron hlonument � � � � �
X000.0 Denotes Existing Elevation Proposed Top of Foundation Elevation = qgp.p
(000.01 Denotes Proposed Elevation Proposed Garage Floor Elevation = 979.6
�-- Denotes Direction of Surface Drainage Proposed Lowest Floor Elevation = 972.0
I hereby certify that this is a true and correct representation of a survey of the boundaries of:
_ __._.,_ . ..._...._. . ___..Lot.. 4,..61.aCk._.1 ,- F.OR€ST ARMS COUNTRY CLUB ADDITION, �"�` � '
' ,,.^ .-; , :: _ �� -�:. Hennep i n Gounty, Mi nnesota. -
, . . ,
;" ;; , , ;
; Af.fd.of`the,location af all buildings;�if�any, thereon, and all visible encroachments, if a y, from
: or on�soid land. As surveyed by me this?�th d y of Ma 1987 . I
� �/ � � � . . � _�. . . � ` -� . i
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;. -;���,-._� ----�-_---- � ----- -----`- Thomas S. Bergqu
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I .^� . . �.__'—(�__" ".__"___'_'_'_ _.
� � � Y � ` Registered Land Surveyor, Minn. Lic. No. 7725
,,�E"S s°,�, ""j��=�}p• CERTIFICATE OF SURVEY
W N SATHRE-BERGDUIST, INC. K � for
; 106 SOUTH BROADWAY�WAYZATA,MN 35791 7S ZZ
fLMO' DAVID M. ROD CONSTRUCTION
TELEPHONE67Y•476-6000 7�045-10