HomeMy WebLinkAbout1993-005136 (Remodel) PEI�MI��� �
CITY OF ORONO PERMIT TYPE: �,�,���j jr��
� 2750 Kelley Parkway • P.O. Box 815 Permit Number: i ir.:;�i_:�:
Orono, Minnesota 55356-0815
Date Issued: �}.�r� �_;��_;:=;
(612) 473-7357
SITE ADDRESS:
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APPUCANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �
' CITY OF ORONO - BUILDING PERMIT APPLICATION
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Total Fce: $ �'•Sr
Date Received: �? ��/� �
Date Approved:
Entered By:^� �: �-�3�
Permit
�L INFORMATION MIIST BS SIIBMITTED IN FIILL BEFORE PI�AN REVIEW WILL BB STAR�ED
(See Check-off List Enclosed)
--------------------------------------_,,----------------------------------------
THE APPLICANT IS: (circle one) �,'or CONTRACTOR
JOB SITE ADDRSSS: � "�,��/ �'/-f�l%_�i�� —/ /�- � ZIP: ;��,� �� �
(work)
N�ML OF OWNER: c,�/ F /�('C� �C t'��-�--�L_%iC%�� PHONE: (home) `�`-7�� �J�� ��
MAILING ADDRESS: ���� `�L��ULI� /'� /�/� CITY: C�C�-� T/�T ZIP: .�����
��;��.1 �C-`!,:'���t"�Z/ _ ` / �����- �;�,.�E'��
CONTRACTOR: PHONB:
�3AILING ADDRESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: '�� PHONE:
MATLING ADDRBSS: CITY: ZIP:
rJ�: RBGISTRATION �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration_� Renovate Land Alteration
PROPOSF.D WORR (describe in detail) : �����/�c'�t���� ��G��� l�-� /(-�'�`�'�� ���
�` �L����/�,� �� i'�'��� ' ��r L��/
STORISS: SQ. FEBT OF EACH FI�OOR:
NO. OF BgDROOMS: GAR1fGB STAI.I,S: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $
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 w rk is not to start without a permit; and
that the work wil 1 be in accordance wi h the approved plan. �
� ����� � '� , � DATE: c� -��5
�PPLICANT S SIGNATIIRE: � ,� ,�C����� -�C/�C'�E�F��'" ��
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� CI'�Y of �R��T�
;� ��-��- � _�
� , � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
�� •
s - � i�; '�;� On th,e North. Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would 3ike to inform you that your request for a permit or
Iicense 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 license 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 iocal, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Zicense requires Counci�. action
to approve, some information may become pub3ic.
5. You have certain rights under M.S. 13.04 to review pri�at�
data on yourself.
6. Yc,ur full name is required to process this applicatian or
permit.
/� /� /? ��� c �- / � ,
l/ ! /' ��(��7 FJ� f l /\-C-C-� L,� /�' �--
First Middle Last
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/���� ���.��-t'f� ���'�,� ��C�t� _
Address
��'t7��1�'-'��l �/l?�/�� � _�����
City State Zip'
/ �
�/ - �� � �
Phone
I understand my righ s as stated above.
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Signa re `
BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING
SI.3.04 RIGH'I5 OF SUB�ECTS OF DATA
Subdivision 1. 'I`ype of data- The rights of individuals on whom the data is
stored or to be stored shall be es set forth in this section.
Subd. 2. Information required
to be given inc�vi�uel• An.individual esked to
� supply private or confidential data concernin�g �gTnWi hin the collect g state agency,
purpose and intended use of the requested
political subdivision, or statewide system;
(b) whether he may refuse or is legally
required to supQly the requested dat8; (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 statUeolr�e�kedlto s pplyeinv st Sat ve data,
requirement shall not apply when an inciivid
pursuant to section 13.82, subdivision �, to a law enforcement officer.
The commissioner of revenue mg olert tgX re�und instQucti ns insteadhos
subdivision in the individual income tax •r r �
on those orms. . --- - -
Subd. 3.
Access to �ata b9 i����' UPon request to a responsible �
authority, an individusl shall be informed whether h r vateeor confident al.e Upon his
individuals, and whether it is classified as public, p ublic data on
further request, an individusl who is the subjecc�ge t��mriv�a'ae if he desires, shall
individuels shall be shown the date withou�fan�y t �ta. After an individual has been
�e informed of the content end meaning the data need not be c�isclosed to
shown the private data and informed of its meaning, ��uant to this section is
him for six months thereafter unless a diSPute or action p
� pending or additional data on the indivif�e h� g e or p bl c dataruponarequest by
� responsible authority shall provide copies o P re�uire the
the individual subject oftrie actusl�cos h of mak ng,l cert fyingy and compiling the
requesting person to pay -
copies. immediately, if possible, with any request
The responsible authority shall comply
made pursuant to this subdivision, or within five �f Simmediategtcompliance eisu not
excluding Saturdays, Sundays and legal holideys,
possfble. If he cannot comply with the request within that time, he shall so inform the
hsve an additional five daYS Within which to comply with the
individuel, and maY 5��� �d legal holidays.
request, excluding Saturdays,
Subd. 4. Proced�'e �►hen data is not accurate or completa An individual may
- ublic or private data concerning himself. To
contest the accuracy or comQleteness of P in yvriting the responsible authority
exercise this right, an individuel shall notify
describing the nature of the disagreement be naccurate or incomplet and att mpt to
days either: (a) correct the data found to
notify past recipients of inaccurate or incomp�t he belie esdthe dataito be correct
the individual; or (b} notify the individual
Data in dispute shall be disclosed only if the individusl's statement of disagreement is
• included with the disclosed data. � aPpe�led pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
CHECK OFF LIST FOR ISSIIANCE OF PERMITS
. � - . FOR OFFICE USE ONLY
� ' ;
ADDRESS OR LEGAL: pID:
DESCRIPTION OF WORR:
---------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED:
BIIILDING REVIEW BY: . DATE APPROVED: ��� I�"�`� 3
FEES TO BE CHARGED: Misc. Fees Ca�culated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------
ZONING CHECR LIST Zoning District:
Fire Department: L� �Post Office: School District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake) : Right Side:
Rear (Street) : Left Side:
Adjacent Structures : Wetland:
Bui�ding Height: Def . Hgt. Peak Hgt.
Avg. Setback: Lot Coverage:
Existin Proposed
Hardcover: 0-75 '
75-250 ' .
250-500 '
500-1000 '
Hardcover Variance Requir cl Yes No Date of Council Approval:
Grading: Staff ApprovaI. Date: By: Council Approval Date:
Septic: Staff Approva7. Date: • BY=
Zoning Fi�e:# ResoJ.ution # • Reso�ution Date:
�F.MARgS (in house) : ,
BIIILDING REVIEW�CHECR LIST
. . � .
IIgC: `�� � CONSTRIICTION TYPE: "
-�_—
Sq Footage $ Per Sq Ftg
Basement X -
lst Fl.00r X -
2nd Floor X -
Garage X -
x =
TOTAL
$stimated Construction Va�ue: $ l DDO
Inspections Rern�;red: Work Requiring Separate Permits:
Site �Plumbing Grading/FiJ.�ing
Footing MechanicaJ. Fire
�Framing Septic Water Connection
Insu�ation Fireplace Sewer Connection
WaZl. Board (Masonry) Lawn Irrigation
�Fina� (Mfg.) Other
Other Wel 1 (State Permit)
El.ectrical (State Permit)
---------------------------------------------------------------
REMARRS (IN HOIISE) :
----------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
-----------------------------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
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