HomeMy WebLinkAbout1992-004715 - kitchen cabinets PERMIT
i �ITi� OF ORONO PERMIT TYPE:
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'1335 Brown Rd. South • P.O. Box 66 Permit Number: i_ii_i�.?�,�
Crystal Bay, Minnesota 55323 Date Issued: ?������%`��=
;612) 473-7357
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CONTRACTOR: OWNER: �' ��°��� '-����;�� —
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PPLICANTPERMITEE SIGNATURE / I��UED BY SIGNATURE
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,,, CITY OF ORONO - BUILDING PERMIT APPLIG'�TION
Total Fee: $ / �-�� � � � Date Received: /,: � /:' 'i� �-
Date P.pprove8:
Entered By: � � �_ , -,
,
Permit Q: � � � �-
AI�L INFORMATION MUST B$ SIIBMITT� IN FULL BEFORE PLAN REVIEW WILL B$ STAR�ED
(See Check-off List EncI.osed)
-----------------------------------�-s--�-----------------------------------------
THE APPI.ICANT IS: (circle one) ' OWNErR or CONTRACTOR
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JOB SITE ADDRSSS: �„�(�.�.-J ��`i �� . .� ��,'��-�ll C"� �/ � ZIP: `j _� _")�� �
., (work) � �� ����
rr� oF owrrEx: -�- ' ,� /`' � L���/�) , Gt � t� l � P$or�: (nome)�����y�'�
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1KAILING ADDRESS: '�d� (�� �� � )t't'�S'/ ��/�"��ITY: �� �1 � ZIP: �-� _7��
CONTRACTOR: .r) C'll�`1° � '`/�GG!(��- PHONE:
MATI,ING ADDR.ESS: C�/)/1� /-C-�)1j'G1. CITY: ZZP:
STATS I,ICENSE: u
ARCHITECT/ENGINEEF2: PHONE:
AiAII.ING ADDRBSS: CITY: ZIP:
Np,�: RBGISTRATION �
TYPE OF WORK: New Addition_� Accessory Structure Move
Demo Remodel/Alteration �/ Renovate Land Alteration
PROPOSF.D WORR (describe in detail) : � /�) j �C�,�/ �17`� 1��� � �� ��'`� ��f '�
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STORI$S: SQ. FEBT OF EACS FLOOR:
NO. OF BEDROOMS: GARAGS STALLS: ATT. DET.
ESTIHATED CONSTRIICTION VALIIATION (eaclnding la.nd) : $ ��� � �r' � �
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 wil i be in accordance with the approved plan. �
/ /� /,� � _/
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A.PPI,ICANT'S SIGNATIIRE: =_ G L�i�.a� � G+�/ L�+ 'G�L�"l/ � DATE: 1� �/� �,�
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4,� � .M�� � . � :� C I'�Y of OR��T�
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Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� _ � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike 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:
l. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
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 Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva��
data on yourself.
6. Your full name is required to process this application or
permit.
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F rst Middle Last
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Address —� ~
l�.-P n i,� 1,1(�� t���t -�� s"� �� _
City State Zlp
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Phone
I understand my rights as stated above.
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Signature
BL`ILDI:�G&ZOVI�IG—473-7357 • AD�tINISTRATION&FItiANCE—473-7358 • PUBL[C WORKS—473-7359
ASSESSI`G
----- - - - -- �� �- .
�_0,4 RIGHTS OF SIIBJECTS OF DATA
Subdivision 1. Type of dat�- The rights of individuels on whom the data is
stored or to be stored shall be as set forth in this section.
gubd, 2, Information required to be g��� ����L An.individual esked to
� supply private or confidentiel data concerning himself shall be informestate aaency,
purpose and intended use of the requested �b�whether he may refu�.se or is ega11Y
political subdivision, or statewide system;
required to supply the requested date; (c) any known consequence arising from his
supplying or refusing to supply private or confidentiel date; and (d) the identity of
other persons or entities authorized by state or federal law to rice�v �gative da a
requirement shall not apply when an individual is asked to supp y
pursuant to section 13.82, subdivision �, to a law enforcement officer.
The commissioner of revenue ma� ropertv tax re�und instQucteons insteadhos
subdivision in the individual income tax •r w
on those orms. . - -- -
Subd. 3. Access to �ta bY in���' Upon request to a responsible "
authority, an individuel shall be informed whether h�vateeor confidenUal.e Upon his
individuels, and w he t her i t i s c l a s s i f ied as public, p u b li c d a t a o n
further request, an individual who is the subject of Se to himrlande if he desires, shall
individuels shall be shown the data withou�fan�y ��8. After an individual hes been
�e informed of the content and meaning t� �ta need not be �isclosed to
shown the private date and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
, � pending or additional data on the indi o�f the hr vate or p blic datarupon request by
responsible authority shall provide copies P require the
the individual subject oft�e actual�cos h of mak ng,l certi yingy and compiling the
requesting person to pay -
copies. immediately, if possible, with any request
The responsible authority she11 comQly of the date of the request,
made pursuant to this subdivision, or within five days
excluding Saturdays, Sundays and lege �tdw��.n t�mtim ghe hall so nfo m the
possible. If he cannot comply with the r 9 within which to comply with the
individuel, and may have an additional five days
request, excluding Saturdays, SundaYS and legal holidays-
Subd. 4. Procediu'e �+hen data is not accurate or complete. An individual maY
- ublic or private data concerning himself. To
contest the accuracy or completeness of p in �� the responsible authority
exercise this righi, an individuel shall notify �ible authority shall within 30
describing the nature of the disagreement. The respo
days either: (a) correct the data found tcom lete dataeincludingpee�Pi�� ngmedt by
notify past recipients of ineccurate or in p
the individual; or (b) notify the individ�h �n�v dual�s statemen tof disagreement is
Data in dispute shall be disclosed only if
• included with the �isclosed data. ealed pursuant to the
' The determination of the responsible authority to contested cases.
provisions of the administrative procedure act relating
CHECR OFF LIST FOR ISSIIANCE OF PERMITS
` FOR OFFICE USE ONLY
. / i _` ' �-
ADDRESS OR LEGAL: `�% ,}� G� �� � � -�,. j'�_ � PID: � � � � / � ' �
DESCRIPTION OF WORR: � � ' >
-------------------------/--/-� ------------------------_--------------------------
ZONING REVIEW BY: /v ` n DAT$ APPROVED
BIIILDING RSVIEW BY: � DAT$ APPROVED: ( l'�-`�,fl ' `7 Z-
F$ES TO B$ CHARGF.D: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes�� No SEWER CONNECTION
STATE SURCHARGE Yes �No WATER CONNECTION
INVESTIGATION FEE Yes No�� PARR FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------------------------------------------------------
ZONING CHECR LIST Zoning Di trict:
Fire Department: Post Off ' ce: School. D strict:
Lot Area: Width: Depth:
Survey Submitted es No D te of Su vey:
Proposed Setbac s:
Front (Lak ) : ight Sid :
Rear (Str et) : eft Sid :
Adjacent truct res: Wetland:
Bui�ding Heig t: De . Hgt. Peak H t.
Avg. Setback: L Coverage
E isting Proposed
Hardcover: 0 75 '
75 250 '
250 500 '
500- 000 '
Hardcover V riance Requi ed: Yes No ate of Council Appro al:
Grading: S ff Approval ate: By: Council Approval ate:
Septic: St f f ApprovaJ. Da e: B :
Zoning Fil :# s lutio �: Resolution Date:
REMARRS ( ' house) :
BIIILDING REVIEW CHECR LIST
� .----_ .
IIgC: �S� �-3 CONS�RIICTION TYPE: �_ �
Sg Footage $ Per Sq Ftg
Basement X -
lst Fl.00r X -
2nd Floor X =
Garage X -
x =
TOTAL
Estimated Construction Value: $ S,OOa �°
Inspections Required: Work Reqnirinq Separate Permits:
Site � Plumbing Grading/Fil].ing
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wal� Board (Masonry) Lawn Irrigation
Fina7� (Mfg.) Other
Other Well (State Permit)
�El.ectrical (State Permit)
-------------------------------------------------------------------
REIrSARRS (IN HOIISE) :
----------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
--------------------------------------------------------------
REi�SARKS (TO BE NOTED ON PERMIT) :
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