HomeMy WebLinkAbout1993-005 - shed R PEI�MIT �
� CITY OF ORONO PE�RMIT TYPE: �_; ;� � ���,�=�t�
2750 Kelley Parkway • P.O. Box 815 Permit Number: �:�t�"=:�"_`;
Orono, Minnesota 55356-0815 �-;-,�_�;_;;���:�;
(612) 473-7357 Date Issued:
SITE ADDRESS: �
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FEE SUMMARY: _ _ _
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CONTRACTOR: Q�III�VE.� - ``'�_�. ';�f:.�`-'�-. -�
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE .!/ ,
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.ITY OF ORONO �P�I�TI�N FOR DEMOLITIO� �'�2MIT
3,0. Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
SPECIAI, CONDITIONS & HOLD HARMLESS AGREEMENT
r�**#f*********�*****�******��**�********t:*�**�f********t****�t**t�r:r:t�t***
General Instructions
1. You may be required to obtain other permits,V'i.e. burning, well
--- _.....__�t.____ ..�..._z_.._�
._.� _ _ ...,_... ..
-� abandonmment, etc. -- - -
�12 .�� Work must not begin unless the permit card is available on the job
site.
3 . A 24 hour notice is required for all inspections. Call 473-7357.
�**��*�****************:*******f*t*tt*******f*t*ttt*tt*��**f*�*�**t***�****
JOB SITS ADDRESS: �� 1 � ""�'�'�"r � �
�ccupancy Type: �-
Residential Commercial
�WN$R`S NAME- �Y����t � 4i- l F � �, �.. � � l��<<�r ,�,H� Phone: ��")C- _�,s, ��� ,.� �7 3 �� �a z��
City:
Mai l ing Addres s: � �� -�°
Bus. No. :
":ONTRACTOR'S NAME s ' -�� f Ci ty:
-;ailing Address: < « t=
.�:�rittf'�r�cic�tit�t�:�t�t*t�t�tsir7t�tft�t�t*sff�t�t*7t*�tir�elt�tir*�*�t�t�t*�t�tyt*t!r**�t�tflt�t*ytit�tiryt�t*�tirir*t
�emolition if planned by means of: burning (bysfireldepartment) eauipment
?ermits Issued:
� Burning Fire Department
� Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner
:�ereby agrees as follows:
l. The structure(s) shall be kept enclosed and/or secured until such time
as demolition is complete.
2. Demo I ition debris wi 11 be kept of f adj oining rova 1 i s ob z inedtin
public rights-of-way unless specific prior app
writing f or temporary use thereof .
3 . Foundations shall be completely removed from the ground.
4 . All demolition debris shall be completely disposed of off site in
accordance with all applicable PCA requirements.
5 . Water wells must be abandoned in accordance with State Health
Department regulations.
6. Inspection required when all debris has been removed , before
backfilling.
7. Within 5 working days of ss P�e sh 11 be left clean andaclearpof tall
shall be requested. The
debris, with any excavation filled with earth level with the ada=�eof
ground elevation (except when such excavation is under constru c ion).
� a new building and such new building is actually
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-�---- - _ _ ___..._- - L�
_._. -- -- - - - _ ._ _ . �..
8 . The undersigned owner shall and hereby does indemnify and holc
harmless the City of Orono, its agents, employees and assigns from anc
against aIl claims, damages, losses or expenses, including attorne�
fees, against the City; its agents, employees and assigns arising out
of or resulting from the demolition described herein as performed b�
the property owner, his employees, agents, subcontractors or assigns.
********�*****�**f**f*f*�*t:t�#****�*t*�**�*t*�***f��*#�*t��r*t*t*t�t�*tt�*^
� .. , -- PF•RKITf TYPS AND FE$- CAI.CULATION--.
' $50. 00 Principal Structure
$30. 00 Accessory Structure �� _`���c�� ,
1. Subtotal of above permit requested $ �l" � C:'c:
2. State Surcharge $ • 5d
3 � TOTAL PERMIT FEE (add lines 1-2 above) $ �l� � � �
**�**********t******�****�*f*�***f**�**�*�f**�*******#**t*t************�***
the undersigned hereby applies to the City of Orono for issuance of a
Demolition Permit, agrees to do all work in strict accordance with the
ordinances of the City and the regulations of the State of Minnesota, and
certifies that all statements made on this application are complete, true
and correct. �
SIGNATURL OF APPLICANT: C'� Date: '��.�3�i �3
' CITY OF ORONO - BIIILDING PER�LZT APPLIC�TION
^otal r ee: $ ��i`� -Z �= _ Date P.eceived:
Date P.��rove8:
Er.tered By: ��/ •
Pe*�it� r �j ��
AT.T• INFORMATION MIIST BE SIIBMITT� IN FULL B�FOR.E PZ,AN REVIEW WII�L B8 STARTE�
(See Check-off List Encl.osed)
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Tgg p,ppLICANT IS: (circle one) OWNER r CONTRACTOR
Jos sz� �Dxsss: � �6 /Y OQ�T�.� �"1 �c- }ur�.� � Z1P: S'S3S�
(work) �7�3 --S�-a,�--
*7� •
F oWNER- v 'S' PHONE: (home) �7(0 '6S'7�
:�AILING ADDRESS: � C9-yr�� CI�: ZIP:
CONTRACTOR: C�r�._� P$��"
�AII�ING ADDRESS: �� CITY: ZIP:
STATS LICENSE: �
ARCHSTECT/ENGIIJEER: � fy-� PHONE:
!dAIZ1ZIG ADDRBSS: CITY: ZIP:
���: R.SGISTRATION a
':'YPE OF WORR: New ✓ Addition Accessory Strnc�ure� Move
DemoJ� Remodel/Alteration Renovate Land Alteration
�ROPOSED WORR (describe i.n detail) : K o.� � Q�sQ� � � � � � � �� ��
� O
+�..s �.,�0 /�` �. /�o � ,�.,�.Q�.( -
�'�TORSBS:�_ SQ. FEBT OF EACS FLOOR: /7� �
�30. OF B$DROOMS: GARAGE STALLS: ATT. DET.
" CJ D
'STIMATED CONSTRIICTION VALIIATION (eacludinq Iand) : $ l 7 G C� '
hereby apply for a building permit and I acknowledge that the information
bove is complete and accurate; that the work will be in conformance with the
=dinances and codes of the City and with the State Building Code; that I
�derstand this is not a permit and work is not to start without a permit; and
zat the work will be in accordance with the approved plan. .
.PPLICANT'S SIGNATURE: DATE: `7^ �3 �'y3
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;;`..�,;� o-i ,:�,��:: Post Office Box 66•Crystal Bay,Minnesota 5�323•MuniciPal��
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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:
1. 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 license.
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 Iicense requires Councii action
to approve, some information may become public.
5. You have certain rights ander M.S. 13.04 to review pri�at�
data on yourself.
6, Yaur full name is required to process this applicatian or
permit.
Fi st
iddle Last /
��d � ����rfL�
Address
G-L_._. �, �.� SS 3 s,�
City State Z1p
�7 6 - a � ��-
Phone
I understand my rights as stated above.
Signa re
BUILDING&ZONING—473-7357 • ADMINISTFtATIO`1&FINANCE—�73-7358
� PUBLIC WORKS—473-7359
ASSESSI;VG
i '�►
513.04 RIGHTS OF SIIBJECTS OF DATA � .
gubdivision L TYPe
of data. The rights of individuals on whom the data is r
stored or to be stored shell be ss set forth in this section.
Subd, 2. Information res�uired to be given u'���1" An.individuel esked to
� � supply private or confidentiel c3ata concer a a BmWit�h�in the collecting state agency,
purpose and intended use of the requeste
(b) whether he may refuse or from his
political subdivision, or statewide system; �own consequence arising
required to supply the requested dat8; ��) �Y
su plying or refusing to supply private or confidential data; and (d) the identity of
P
other persons or entities authorized by siVadual iseeskedlto supplyein est gative da a
requirement shall not apply when an ind
pursuant to section 13.8?, subdivision �, to a law enforcement office:.
The commissioner of revenue mav ole�tv tgx re�und inst�ucte°s�nsLeBahoi
subdivision in the individual income tax •r �r �
on those orms. . - -— - " .
Subd. 3. Access to �aYa bY ����L UPon request to e responsible
authorit , an individual shall be informed whether h=�gteeor confident al.e Upon his
Y ubl�c
individuals, and whether it is classified as p � P ublic data on
further request, an individual who is the subject of e to himrlandeif he desires, shall
individuels shall be shown the data witho ofan�y ��g. �ter an individual h�s been
6e informed of the content and meaning the data need not be �isclosed to
shown the private data snd informed of itg meaning� ��uant to this section is
him foc six months thereafter unless a dispute or action p
� ending or additional data on the individ�h h�gte or p blic datarupongrequest by
. P
responsible authority shall provide copies o P
the individual subject of the �ta. Th of making,la�rtl Yingys�d c mpiling the
requesting person to pay the actual costs
copies. ssible, with any request
The responsible s�thority shall comply immediatelYof th date of the request,
made pursuant to this subdivision, or with.in five days
Sundays and lega.l holidays, if immediate compliance is not
excluding Saturdays, with the request within that time, he shall so inform the
possible. If he cannot comply within which to comply with the
individual, and maY ha�e an additio� i v�daY��n.
request, excluding Saturdeys, SundaYS g
Subd. 4. Proced�e when �ata is not ac�urate or complete. An indivi�uel maY
- ublic or private data concerning himself. To
contest the accuracY or comgleteness of p in yy�i� the res�onsible authority
exercise this right, an individual shall notify �ible authority shall within 30
describing the nature of the disagreementi �e r�p° lete and atLempt to
days either: (a) correcf inaccurate vrdincomplete a taeinclu�ngpecipients named by
notify past recipients o
the individuel; or (b) notify the indi��� ��au�,�statementof disagreement is
Data in dispute shall be disclosed only
• included with the disclosed data• � appealed pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases. ,
. �'� � CHECR OFF I,IST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR I�EGAI,: �4� C���� . �O� PID:
DESC�IPTION OF WORR: w E-��O / ��-r^'✓"' ���'� -
----------------Q---------------•------
ZONING REVIEW BY- �Q�ww-- DATE APPROVED: �-2�''�i-3
BIIILDING RL�7IEW BY: DATS APPROVF.D: � '�-5 3
---------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes +� No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes� No WATER CONNECTION
INVESTIGATION FEE Yes No J' PARR FEE
SAC � Yes No G''" SITE INSPECTION
Number of SAC IInits OTHER (specify)
-------------------------------
------------------------------ .
ZONING CHE(� LIST Zoning District: �.�`��
Fire Department: r
Post Office• LvN L11-dG� School District: O�ND
Lot Area: �3��•$'�- Width: Y�f `t• �l Depth: 3 � �•S�
Survey Submitted: YesrC No Date of Survey:
Proposed Setbacks:
Front (�) - �S� I '�' W Right Side: 3(O �
Rear (�r�"j : ��{.S� "�' � Left Side: ! 2.0 N
Adjacent Structures: 3 S � Wetland: ��/�
Building Height: Def. Hgt. � • �L Peak Hgt.
Avg. Setback: Lot C erage:
Existing Pro osed
Hardcover: 0-75 '
75-250 '
250-500 '
500-i000 '
Hardcover Varianc Requir d: Ye No D te of Coun ' 1 Approval:__
Grading: Staff Ap roval Da e: By�
Counci oval. Date:
Septic: Staff App ova7� Date y'
Zoning File:# 3 2 Res lu ion � :
ResoJ.ut� on Date:���
�FHtARKS (1II t10L1S � :
� � .
BQILDING REVIEW CHECK LIST �
4 • -. .
IIgC: � $ � - � CONSTRIICTION TYPE: �-
Sq Footage $ Per Sq Ftg
Basement X - .
lst Fl.00r X -
2nd Floor X �
Garage X -
x =
TOTAL
Esti_mated Construction Value: � � 7 4O�`�
Inspections Reqnired: Work Reqniring Separate Permi.ts:
Site � Plumbing Grading/Fi1J.ing
Footing Mechanical. Fire
—"Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
�FinaJ. (Mfg.) Other
Other , Well (State Permit)
Electrical (Stat,e. Permit)
----------------------0-----------------------
REMARKS (IN HOIISE) : (v ,/�ci,AcYVS �lL�.� — `�''�'►'LL1 C�R�✓l.�z ""� 1�
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�������������������������'������������'���������������������
REVIEW BY OTffiT'RS: DATE:
Access: Existing New
Access Approval: Date BY=
-------------------------------------------------------
RF.JKARR$ (Tp BE NOTED ON PERMIT) :
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