HomeMy WebLinkAbout1996-008076 (building-deck) '�� PERMIT
• CITY OF ORONO PERMIT TYPE: �;t}�;..�;�;���;
2750 Kelley Parkway- P.O. Box 66 Permit Number: �_��;;_;;_���,
Crystal Bay, Minnesota 55323 _
(612)473-7357 Date Issued: ���r;,.r 1 ��:��;r=,
SITE ADDRESS:
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DESCRIPTION:
C?EC::f��:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: -- �?�:����� i�����. —
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� APPUCANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE �.
Total Fee: � � 7� �`� DateReceived:
Date Approved:
Entered By: �.,,�; Permit#: f�1 ?� �
CITY OF ORONO - BUII.DING PERII�IIT APPLICATION
ALL Pi 1FORNIATION MUST BE SUBVIITTED L1i FULL BEFORE PLA��1 REVIEW WII.L
BE STARTED
THE APPLIC�:�tT IS: (circle one) WNE CONTRACTOR � �� '
JOB SITE ADDRESS: 323 1 �o��N� Z�� ��
N�v1E OF OWNER: ��r�.2-t��e.,_ PHO�'E: (home)C�iZ �fl� - 04s9.S—
(work)
VIAILII�TG ADDRESS: 3�3 t L�s�o �'i'• 29 • CITY: pe p,.i o ZIP: 5 S 3i�
CONTRACTOR: PHONE:
MOBILE PHO�IE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO�]E: �"'
MAILING ADDRESS: CITY: ZIP:
�,r��;�; REGISTRATION #
TYPE OF WORK: New � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED`VORK(describe indetail):aND l.��.� D�..�t�STz.,G�„zF �3�n �S� T t�-�-T
��u��oR-T5 z' ��v K �v� �e..(c os-�.f . .Z^��(.�vf.!_._ ST�t.uo-�'uYt� is SvPPOR-T40 3�! LovJE�
�4�Gc .
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOVIS: GARAGE STAI.LS: ATT. DET.
EST��ATED CONSTRUCTION VALUATION(escludingland): $ /c�c� o
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 Buildin� 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.
-��.rr.,2.y �rL.cz�E�T—�so�n-�,�- c..w„��
:�PPLIC�'vT'S SIGNATURE: �• �� DAT'E: D� — / 2 — �G
NOTE! Parade 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 allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is scored or to be stored shall be as set fonh in this secdon.
Subd.2. Information required to be given individual. An individual asked ro supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data wichin the collecdng'state agency, poliacal subdivision,or sta[ewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)[he idendry of other persons or enddes au[horized by state or federal law to receive the data. This requirement shall
no[appty when an individual is asked to supply invesagadve dara, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place [he nodce required under this subdivision in the individual income tax or propertv tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request ro a responsible authoriry,an individual shall be informed whe[her he is the subject
of stored data on individuals, and whether it is classified as public, priva[e or confidencial. Upon his furrher requesc,an individual who is the subjec[
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 conten[
and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the actual costs of making, cerrifying, and compiling the copies.
The responsibie authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays, if immediate compiiance is no[possible. If he canno[comply with the requzs[
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal ho(idays.
Subd.4. Procedure rvhen 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 no[ify in writing the responsible authoriry describing the nature of the disagreemenc.
The responsible authoriry shall within 30 days either: (a)cocrec[the data found to be inaccurate or incomplete and attempt to noafy past recipiencs of
inaccurate or incomplete data, induding 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 stacement of disagreement is included with the disclosed data.
T'ne determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing to
` contested cases.
DATA 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 permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested pernut or license requires Council action to approve, some information may become
public.
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 permit.
�'�2,Q � . �a ��c�t c�'
� First vliddle Las[
��, �p 'f�0•
Address
O 2 o r-Tv n�nJ �Y 3 I q �01 Z ��l 1 c��!g s"
Ciry State Zip Phone
I understand my rig s as stated above.
Signa
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 2 31 G4.s� �o�N► 1Zo�
PID:
DESCRIPTION OF WORK: �:,c,��
------------------------------------------------------------------------------------------------------------------------
ZONING REVIE� BY: ..— DATE APPROVED: 6 -�5' `16
BUILDING REVIEW BY: DATE APPROVED: � -t$-�j 6
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 � PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: LR-( C-
Fire Department: ►�V4��v� Post Off ce: W�y—L4ryt School District: wL��-�v t�•4
Lot Area: Sq.ft. �!0 (�3,� Acres Width Depth
Survey Submitted: Yes_� No Date of Survey: nn� F(C,�
Proposed Setbacks:
Front (Lake): Right Side:
I�L C..{� �S �C,4-n�
Rear (Street): Left Side:
/a�3pV-2 �CLK Qv�1'�
Adjacent Structures: Wetland: V n��p.ta2 ,�-Qnw�,�T # 7 C�31'
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback:
Existing Proposed
Hardcover: 0-75'
�s-2so� NU G�Z
250-500'
SOO-IOOO'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
10
BUII..DP�1G REVIEW CHECK LIST
usc: 2-3 co�vs�uc�o� �rE:�rr�
Sq Foota�e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ l(�O O �
—r
Inspections Required: Work Requiring Separate Permits:
Site Piumbing Fire
Hardcover Removal Mechanical Water Connection
Footin� Septic Sewer Connection
�( Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
oL Final Grading/Filling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
REVIARKS(TO BE NOTED ON PERIVIIT):
�,
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ar re art was JOB#
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