HomeMy WebLinkAbout1996-008066 - pool PERM�
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: �;�_I 1 �_f;3 t,�4�
Crystal Bay, Minnesota 55323 _
(612) 473-7357 Date Issued: �_�;:;;�;r ii=,r,
t i:—'f''�:'=�i—
SITE ADDRESS:
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DESCRIPTION: �
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — —
— �-:�����, i r t{��t. —
i=t°`,,s"�L,�'�_�::: ALLH��
:.L;�-.�. �:�'�'T'=��13F Fi�T
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APPLIC PEFiMITEE SIGNATU I ISSUED BY'SIGNATURE '�'`'��L...
Total Fee: $ /�=�� .,� ' DateReceived: �- /�- `I G�
Date Approved:
Entered By: � '�' Permit#: q,���.� �,
CITY OF ORONO - BLTILDING P RNIIT APPLICATION
ALL INFORMATION MUST BE SUBMITTED IN L BEFORE PLAI�t REVIEW WILL
BESTARTED
---------------------------------------------------------- -- -------------------------------------------------
THE APPLICAI�tT IS: (circle one) OV�JN� R CONTRACTO J ,
w�a,�le, �4 � v� , Yv��n .
JOB SITE ADDRESS: �� S .r-� a S � e. � Z�: � 5 <3 S 9
N�iE OF OWNER: ��Ica * ;�.� �e e PHONE: (home) 5 L/D ' 3� ��
(work) ^
MAILINGADDRESS: � b o U CITY: ZIP:
CONTRACTOR: a e s' PHONE: �I
MOB PHONE/PAGER:
MAILINGADDRESS: ��-/-�-��' �� CITY: �ZIP.__ ._�7
STATE LICENSE: # I�����
ARC NGINEER: ��
iVIAILI�iG ADDRE : ('T�`'� ZIP:
����. �ION #
�
��r ��
TYPE OF WORK: N� L �c' � �;-�� sory Structure
Move \ Lar�d Alteration
— ,, , �
PROPOSED WORK(desc � „�� j ��° 1
1 �� '�
i
STORIES: �
NO. OF BED OMS: '� U -�� DET.
�
��� � ' � �' 3 5
ESTIMATED CONSTRUCTIC �
I hereby apply for a building perr, I� _��nation above is complete
and accurate; that the work will b� ., �rdinances and codes of the Ciry
and with the State Building Code; ti j s is not a permit and work is not to start
without a permit; and that the work , �n accor ance with the approved plan.
APPLICANT'S SIGNATURE: ,7`au.R�� o��. DAT'E: �D ' 91'
NOTE! Parade of Homes events require separate p rnzit approval by Police Department and
City Council 60 days prior to the event. Non perm tted events will not be allowed.
9
"'�� � � � i
_ _O ,�. '
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O 0
CI Y of ORONO
,� `: ' =z�� � �z„►���►otr�
': ;-"s �, c� Post Offx�e Box 66
�� ��'�� "- . �'.�r �'~ CC�'StBI BHV��'11IlIlfSOt3�J3Z3�6
i , ...
��kESH�4�
DATA PRIVACY VISORY
In accordance with M.S. li.04, Subd. 2, "Ria ts of subjects of data", we would like to
inform you that your request for a permit or licens from the Ciry of Orono or any of its
departments may require you to furnish certain priva or confidential information.
You are notified that:
1. The information you furnish will be us d to determine your qualification for the
permit or license requested.
2. You may refuse to supply data, b�pt re sal may require that the City deny the
pernit or license.
3. The information may be shared with o er local, state or federal a�encies to the
extent necessary t� process the permit r license.
=�. If your requested permit or license r quires Council action to approve, some
information may become public.
�. You have certain ri�hts under M.S. 13 04 (see followina paQe) to review private
data on vourseli.
(,. Your full name is required to process is application or permit.
PLE?,SE PRP�'T
Sh �'wl M �eha. ���
First Nliddle Last
IS' s +� s•� � �.
Address j
1e. ' �� `� -
�5 � - o �
Ciry State Zip Phone
I understand my riahts as stated above. I
�
Sianature
v TELEPHO!VE-473-7357• F. t-a73-0510
10
• �'
Sec.13.04 RIGHTS OF SLBJECTS OF DAT�
Subdivision 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 section.
Subd. 2. Information required to be given individual. An individual asked to supply
private or confidential data concerning himself shall be informed of: (a) the purpose and
intended use of the requested data within the collecting state agency, political subdivision, or
statewide system; (b) whether he may refuse or is legally required to supply the requested data;
(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 state or federal
law to receive the data. This requirement shall not apply when an individual is asked to supply
investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma�place the notice required under this subdivision in the
individual income tax or pro�erty tax refund instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority, an
individual shall be informed whether he is the subject of stored 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 the data without any
charge to him and, if he desires, shall be informed of the content and meaning of that data.
After an individual has been shown the private data and informed of its meaning, the data need
not be disclosed to hun for six months thereafter unless a dispute or action pursuant to this
section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or public data upon request by the
individual subject of the data. The responsible authoriry may require the requesting person to
pay the actual costs of making, certifying, and compiling the copies.
The responsible authority 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 not possible. If he cannot comply with
the request 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 private data concerning himself. To exercise
this right, an individual shall notify in writing the responsible authority 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 notify past recipients of inaccurate or
incomplete data, including 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 disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions
of the administrative procedure act relating to contested cases.
11
.
A CHECK OFF LIST FOR ISSU 'CE OF PERI�IITS
� FOR OFFICE USE NLY
�DDRESS OR LEG�L: �//�'S� t1n • � � PID: C�(� -��7 ' �3 1� � c� �Z
DESCRIPTION OF �VORK: �-�-� — C"-G
-------------------------
Z0�1ING REVIE`V BY: ;, . �%�..�.,-� DATE APPROVED: � -i y `t�
BUILDING REVIE�V BY: �,,L_.� DATE APPROVED: � - r K -G c.
---------------------------
FEES TO BE CHARGED: Mi c. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes ✓ No SEWER CONNECTION
STATE SURCHARGE Yes .�� No WATER CONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------------------------------------------------------- -------------------------------------------
ZONI'i�1G CHECK LIST Zoning District: r�`-i� Shoreland District : �i�5
/Fire Department: Post Office: School District:
�� <
t.� \�\Lot Area: Sq.ft. Acres Wid Depth
Survev Submitted: Yes v� No Dat of Survey: oN c"� �.
Proposed Setbacks:
�ent (Lake): �-{c;K�� ;' Right Side: ( I U �
�
-�eat (Street): �1�� , i" Left Side: 1 `10
Adjacent Structures: �U � '}' Wetland: I-� ��
Building Height: Def. Hgt. Peak Hgt.
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
�00-1000'
n' ��L ,
1" i�' � Hardcover Variance Required: Yes No Da[ of Council Approval:
�� B Council A roval Date:
� Grading: Staff Approval Date: Y� PP
ISeptic: Staff Approval Date: BY�
� Zoning File: # Resolution: �# Resolution Date:
\.
REMARKS (in house):
26
. �
BLILDLtiG REVIE�`' CHECK LIST
�TgC; �/`� ��" CONSTRUCTION TYPE: lrL�I�
Sq Footage � Per Sq Ftg
Basement X =
lst Floor x —
2nd Floor X —
Garage x —
x =
TOTAL
�
Estimated Construction Value: $ /o �W
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
p�Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
a'�Final Grading/Fiiling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
------------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
------------------------------------------------------------------------------------------------------------------------
REMARKS(TO BE NOTED ON PERMIT):
27
A handsome, yet rugged, design ca��able of turning a y b<<cI���ard
into an overnightsuccess.
Treat your family and friends t� . . . I
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