HomeMy WebLinkAbout1998-010434 (Land Alteration) PERMIT
��ITY OF ORONO PERMIT TYPE:
` �750 Kelley Parkway- P.O. Box 66 `��=��� �'������'
Crystal Bay, Minnesota 55323
Permit Number: q y�t 7�,:_�,
. (612)473-7357 Date Issued: `j��t��i`��;;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — A���f�i c�i��• —
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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�'otal Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BLTII�DING PERMIT APPLICA�'ION � .
A.11 information must be submitted in full before plan review will be started.
(please print a1l information) . .
THE APPLICANT IS: (eircle one) OWNE R CONTRACTOR��� � � . � �
aos srrE A,nnxEss: Zzo 5 ��, ;� �o� �a ,� z�: ss 3 � 6
' NAlYIE OF OWNER: �o h-�-� 1�l�r�s�v� �✓'�C e PAO�IE: (home) ��� '�'3� �
(work) syo -3z� ��'n��fi �
MATLING ADDRESS: �2 o S .,�}G�%�5'�� ���` CTTY: •�� � ZIP: �.s 3��
��-e3e��.� Exca��-�� PHONE: -- �.
CONTRACTOR: S � 5 "�
CONTACTPERSON: p o � �5��� � MOBIIJE/PAGER: �
MAILING ADDRFSS: � CITY: — ZIP:
STATE LICENSE: #
A�F.CHITECT/ENGINEER: PHO�TE: —
MA.II..ING ADDRESS: � CITY: �— ZIP: --
N�; � REGISTRATION# �
TYPE OF ti'VORK: New Addition Accessory Structure . )
Move � � Remodel/Alteration Land Alteration oC (���� w�� Px�^�'�(
PROPOSED'4VORK(describe in detai�: e�--�� ���� � � <<v e w�� � Sa� �Q s a�S
�v.t �N G T�(�n.► �/(.c�v c•� _
STORiES: SQ.FEET OF EACH FLOOR: '
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET• - � .
�'��e --��ll -•�-��voc�<<ro /�ocl�s
FSTII�i IATED CONSTRUCTION VALUATION(exclud.ing land): $ � h,,�,,,��
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 Ciry 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.
' NAT'URE: ����-� /�/�� DATE: 6 � /� ��C�
APPLICANT S SIG
NOTE! X'arade 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 attowed.
�
Sec.13.Q4 RIGHTS OF SU'B�TECTS OF DAT?i
Subd. 1. Type of data. The righc�of individual on whom[he dara is stored or co be swred shalI be as set fonh ia this secdon. '
Subd.2. IaFormaGtoa required to be givea iadividual. �1n individual asked to suppty privace or confidendal data concecning himself shall
bz infotmed oE: (a)the purpose aad inrended use of the�quesced data wichin the coUecang§tate agenry,goliccal subdivision,or sratewide ryscem;
(b)whedier he may refuse or is legally tequiced to supply rhe requested data;(c}aay Imown coasequence arisin3 from his supplying or refusiag to svpply
private or coafldeaaal dara;and(d)the ideadry of othcr persoas or earides aurhorized by state oc federal Iaw to receive the data. Tl�is requirement shall
not appiy whea an individuaI it asked to suppiy invesdgadve dam,punvant to secdoa 13.82,subdivisioa 5,to a law eaforcemeat o�cer. � I
The eommissioner of revenue mav olace che nodce raauired under this�vbdivision in the individuaI income tax or vroaertv mz cefund I
insrruedoas inscead of on[hose forms.
Subd.3. Aceess to data by iaditiiduaI. Upon request to a responsible authoriry,an individual shall be informed whecher he is tfie subject
of smred data on iadividuals,and whe�her ic is dass�ed as public,privace or conFdendal. Upoa lus furrher requesc,an iadividual wha is tlie subjecc
of swred privace or public dara on individuals shall be shown che dara wichaut any charge w him and,-if he desires,shall be informed of che cantent
and meaning of that data. Aher an individual has been shown�E►e privace data and infarmed of it5 meaniag,the data need not be disclosed m him far �
six monchs chereaiur unless a dispute oc acaon pucsuanc to this secaon is panding or addidonal daa on che individual has been wllecced or creued. I
The respoasibte au�horiry shall pcovide copies of the private or public data upon requese by the iadividual subjecc of che dara. Tlie responsi'ble auchariry I
may require rhe cequesting person to pay the accual coscs of making,cerrifying,and comp�ing the copies.
The cesponsible authoriry shail eomply immediacely.if possible,with any request mada purntant to rhis subdivision,or wirhict ftve days of
the dace of the reques�excluding Saait+days,Sundays and tegal holidays,if immediate compliance is not possible. If he eannot comply wich the requesc �
within that time,he shall so inform�he iadividual,and may have an addiaonal five days wichin whIch to compiy with the request,exc[uding Saturdays, �
Saadays and legal hotidays. -
Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public orpri��ate
dac;coaceming himsetf. To exercise chis right,an individual shall noafy in wriang the responsible auchoriry describing the nacure of the disagceemeac
The responsible authoriry shall within 30 days eicher. (a)correcc[he data faund ro be inaccuca[e or incomplece and aaempt to nodfy past reciptencs of
inaccurate or incomplete daca, including recipiencc named by�ha individual;or(b)nodfy the individaal thac he believes rhe data to be correc� Data
in dispute shalt be disclosed onty if the individual's satement of disagreemen[u inclnded wich the disclosed dara.
The decerminadon of the responsible auchariry may be appealed pursuaat to che provisions oF che adminisaaave procedure act telaCng to �
contesced cases. {
DATA PRIVACY ADYISORY � I
In accordance with M.S. 13.04, Subd.Z, "Rights of subjects of data",we would like to inform you that your request �
for a pennit or license from the Ciry of Orono or any of its departments may require you to furnish certain�rivate or
confidential information. �,
i
You aze notified that:• � i
I
1. The information you furnish will be used to determine your qualification for the permit or license requested.
�. You may refuse to supply data, but refusal may require that the City deay the permit or license.
3. The information may be shazed with other locat, state or federal agencies to the extent necessary to process
' the permit or license.
4. If your requested permit or license requ'tres Council action to approve, some information may become �
public. I
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 permic.
• i
Frst �fiddle I.ast �
Address
Ciry State Zip Phoee
I understand my rights as stated above.
Signaaere .
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• CHECK OFF LIST FOR ISSUANCE OF PERA�IITS
' � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �z�� q-�o r�e�A 0� w � .
� PID:
DESCRIPTION OF WORB: P�- a � �i L�,.
ZO�tING REVIE'�BY: - DATE APPROVED: P� -�� ��
BUII.DING REVIEW BY:. � � . . DATE APPROVED: . .
FEES TO BE CHARGED: � �,,a�.�„�� Misc. �ees Calculated By:
PERMIT Yes c/' No
PLAN REVIEW Yes No SEWER CO��TNECTION
STATE SUR`H��iRG� Yes No WATER CONNECITON
1NVESTIGATION-FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC Units OTHER (specify)
ZO�TING C�CK LIST Zoning District: 2�-r� f� �
Fire Department: _�� �-c: Post O�ce: (�� School District: �
Lot Area: Sq.ft._ 0'��C�H�I�@ Acres Width Depth
Survey Submitted: Yes No o� Date of Survey: _� �'��
Proposed Setbacks:
Front(Lake): _ Right Side: � .
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Building Heioht: Def. Hgt. Peak Hgt.
Lot Coverage:
� Grading: Staff Approval Date: By: Council Approval Date:
� .
Septic: Staff Approval Date: }3y; .
Zoning File: # Resolution:�/ Resolution Date:� •
Shoreland Dis�-ict: �
Avg. Setback: Bluff Setback: Lot Coverage: � .
' Existing Proposed
Hazdcover: 0-75'
75-250' . . . .
250-500' � •
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
� �
REIVIARKS('in house):
.
� _ .
� "` 26
, �t� . . .
BUII,DING REV�y� CgECK LIST . .
UBC: CONSTRUCTIOY TYPE:
� Sq Footage $ Per Sq Ftg
. Basement x
_ . lst Floor , � � X � . — ' .
- 2nd Floor . . � . x .. • . '
.� G�e . X _ �. � � .
� x _
TOTAL
Esti.mated Construction Yalue: $ •
Inspections Required: • Work Requiring Separate Permits:
Site Plumbing Fire �
Hazdcover Removal Mechanical �
Footin Water Connection
� Septic Sewer Connecdon
. Insuaaton F�e��o�) O���gation
Wall Boazd (Mfg.) Well (State Perm.it)
�'F�� G�d�g��l�b Electrical (State Permit)
Other
. REI�ZARKS (1N HOUSE): ' � �
REVI�tii�BY OTHERS:_w�_���__ DATE: w�w�
Access: Existing New -
• Access �Approval: Date •
------------------------------ By�
REMARKS(TO BE NOTED ON PER.�l�Li1'j: • -
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