HomeMy WebLinkAbout1996-008337 (land alteration) ��� ���
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Bc !1=�;�_;;� :i��T�•,;�„�i
Crystal Bay, Minnesota 55323 � Permit Number. ;_,;_;;,;`::_;�i
(612) 473-7357 Date Issued: �.�,�;r{k�;;,�t�,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PEFiMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ ��,� :� - - `� Date Received:
Entered By: �� �_ ��% Permit#: `�'-s'� �
CITY OF ORONO - BUILDING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �; y' /� c�' ZIP: � ;��,�,
NAME OF OWNER: �'-,+�i�:! '��' _ � i�� BkIO�E: (home) `;,,:,-.� r- , `�
r (work)
MAILING ADDRESS: `��1��Z>�= CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: _ � ��'��-� '� ��"��� % � A�IOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration �%
PROPOSED WORK(describe in detain: � � - ;'l� ' /�%y'� C't '�� -=�.—/y��''�%-`
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, � i u ' � � �' �l '�� '�.'l f' _.i. (
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
. .; _', i %,..- i._.� . , <:Ji��L
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ' �- � �
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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 will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE:/% � � � �. ��. �� � DATE: % `- > ��
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NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
• �„ . , �
Sec.13.04 RIGHTS OF SUBJECTS OF DAT�1
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 secaon.
Subd.2. Information reqirired to be given individual. An individual asked to supply privace or confidential data conceming himself shall
be informed of: (a) the purpose and incended use of the requested data within the collecang'sta[e agency, poli[ical subdivision, or statewide system;
(b)whether he may refuse oi is legally required ro supply the requested data;(c)any l:nown consequence arising from his supptying or refusing to suppty
priva[e or confidenrial data;and(d)the identiry of other persons or enrides authonzed by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieaave data, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the norice required under this subdivision in the individual income tax or propertv tax refund
instruc[ions instead of on those forms.
Subd. 3. Access to data by indi��dual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of s[ored 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[he da[a wi[hout any charge to him and, if he desires, shall be informed of the contenc
and meaning of that data. Afrer an individual has been shown[he private data and informed of ics meaning, che dara need no[be disclosed to him for
six months thereafter unless a dispute or acrion pursuanc to this secrion is pending or additional data on the individual has been collected or created.
The responsible authoriry shal(provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible authority
may require[he requesting person to pay the accual costs of making, certifying, and compiling the copies.
The responsible authoriry shall compty immediarely, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the cequest,excluding Saturdays.Sundays and leeal holidays,if immediate compliance is no[possible. If he cannot comp(y with the reques[
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 pm�ate
data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of
inaccurate or incomplete data, inc(uding 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 discfosed data.
The decermination of the rzsponsible auchoriry may be appealed pursuant to the provisions of the administradve procedure act relaang to
contested cases.
DAT�, 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 pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested pernut or license requires Council action to approve, some information may become
pubiic.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
First Vtiddlz Last
Address
Cih, State Zip Phone
I understand my ri;hts as stated above.
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Sig [ure
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CHECK OFF LIST FOR ISSUANCE OF PERMITS ~
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FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �r� �o'�y Si t7` {�–�,�
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DESCRIPTION OF WORK: �}�l� ;�LTL.�-�-T�o�►
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ZONING REVIEW BY: - � DATE APPROVED: `'I - Y- `��
BUILDING REVIEW BY: � n, k,� DATE APPROVED: —
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT - ���,>> ►��r��-�n��Yes �� No
PLAN REVIEW Yes No �-- SEWER CONNECTION
STATE SUR`HARG� Yes No f WATER CONNECTTON
INVESTIGATION-FEE Yes No �' PARK FEE
SAC Yes No �"�� SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
PSurvey Submitted: Yes No Date of Survey:
Proposed Setbacks:
�U Front (Lake): Right Side:
� Rear (Street): Left Side:
� Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage: ^$� �
S'f�l�`a,��",yF�
Grading: Staff Approval Date: �i ``�-`�� By: �°• fi Cou cil Approval Date: �-Y'`( �
Septic: Staff Approval Date: r�j� By: "
Zoning File: # Z�1� Resolution: # 3�( Z Resolution Date: y-y -`i �
Shoreland Dist:ict:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
�;� 250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
26
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BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x —
�'� -.; —
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�LFinal Grading/Filling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERMIT):
27
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION TI --�; SCHEDULED "
PERMIT NO. � � COMPLETED
ADDRESS C�1 � �e
OWNE � CONTR.
TELEPHONE NO.
� DESCRIPTION ��--^1 fi'����Z � l d�lJ
LL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
5 FI 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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D COMMENTS:
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d ❑WORKSATISFACTORY:PROCEED PROJECTCOMPLETE
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� ❑ CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �, pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR !- CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next in 4 hours in advance.4 57
OwnerlContr ct on ' ~—,
Inspector. -
White Copyllnspector's File Canary CopylSite Notice