HomeMy WebLinkAbout1999-011301 - deck PERMIT
CITY OF ORONO PERMIT TYPE:
, 2750 Kelley Parkway- P.O. Box 66 " _ -i ;;;;ti:;:
Permit Number: `` ' '
Crystal Bay, Minnesota 55323 �_'i i�_��'.�'�
(612) 473-7357 Date Issued: _ ^
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMIVIAR�:
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CONTRACTOR: I OWNER: _ e�;r::..'� ; ; ._,,-,:_ --
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ ���' �5� Date Received: `f�� `1�
� Entered By: 'rrn Permit#: �I � C� �
� �
CITY OF ORONO - BLTII�DING PERNIIT APPLICATION
All information must be submitted in full before plan revietiv �vill be started.
(please print all information)
--------------------------------------- --. ------------ --------------------------------------------
THE APPLICAl�'T IS: (circle one) �-QWN R�R CONTRACTOR
JOB SIT'E ADDRESS: ��Z � `� � DI_S CC� �t'� 9'C.�: ZIP: � S� 3 �� l
�/C;z'� -Z c���'t l l71 rv
NA.NiE OF OtiV\'ER: �G�lVf I � ��� �'`�.� PHONE: (home) `� 7 I`� S y
(work) �-�7 / ' � `'
�IAII.ING ADDP.ESS: `;r'X r�1 ^� CITY: ZIP:
�, -� -� ��
CONTRACTOR: �G�� Y\ � U C �� �' � PHONE: � � � ' ��%-,
CONTACT PERSON: S C7`�� �,' MOBILE/PAGER:
MAII�I�1'G ADDRESS: �1 �'U �� CITY: ZIP:
STATE LICENSE: #
r
ARCHITECT/ENGII�TEER: �v � �� PHONE: _
�ZATLING ADDRESS: CIT'Y: ZIP: _
�J��; REGISTRATION#
TYPE OF WORK: New Addition� Accessory Structure
��
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detain: � P(} 4��
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
c%C�;
ESTII�i IATED CONSTRUCTION VALUATION (excluding land): $ ?s �
I hereby apply for a buildin�pernut and I acknowIedge 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.
. ; - � ; p � � � �
APPLICANT'S SIGNATURE: � ��'��z'L-E�. ��Z����v�-� DATE:
��
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.Q4 RIGFTTS OF SLJB,JECTS OF DaTa '
Subd. 1. Type of data. The righcs of individual on whom[he data is scorcd or to be scored shall be as sec forch ia this secrion.
Subd.2. Iaformation reqirired to be given individual. An individual asYed to supply privare or confideadal data concerniag himself shall
be informcd of: (a)[he purpose and in[ended use of the requesied dara wichin the collecaag�tate age�cy, polidcal subdivision,or stacewide rys[em;
(b)whe�:er he tnay refuse or is.legally requir.d to supply[he requesud data;(c)any Imown caasequence arising from his supplying or refusing to supply
priva�e or conndenrial data;and(d)the idenary of other penoas or enddes au[horized by state or fedecal law to rcceive the data. This requirement shall
not apply when an individual is asked to supply invesrieadve dan,pursuan�to sccdon 13.82,subdivision S, co a faw enforcemeat o�cer.
The eecnmissioner of revenu� mav pla^� the nodc- rauired und-r this subdivision in the individual income taz or prooem taz refund
inscrucdons inscead of on those forms.
Su6d. 3. Access to data by individual. Upon requesc to a responsible au[horiry,an individual shall be informed whather he is rhe subject
of stor:d daci on individuals,and whecher it is class�:d as pubiic,private or confidendal. Upon his further request, an individual who is the subjec�
of stor.d�rivate or public dara on individuals shall be shown[he dara wirhout any charge to him and;if he desires, shall be informed of the contznt
and meaning of chat data. After an individual has been shown the private dara and informed of ict meaniag,the dara need not be d'uclosed ro him for
siz monchs thereafter unless a dispute or acdon pursuanc co this secdon is pending or addidoaal dara on the individual has been collec[rd or creared.
'Ihe responsible authoriry shall provide copies of the priva�e or public data uFon request by the individual subject of the dara. 'Ihe responsible authoriry
may require d:e requesdng per5on to pay the accual cosu oi making,cerrifying,and compiling the copies.
The responsible auchoriry shall comply immediately,if possible,wich any request made pursuant to this subdivision,or within five days of
the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with the request
wichin that dme,he shall so inform the individual,and may have an addinonal five days wi[hin which to comply wich the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest tha accuracy or completeness of public or private
dara conceming himself. To exercise[his right,an individual shait noafy in wridng che responsible authoriry describing the nacure of the d'uagreement.
The responsible authoriry shall wichin 30 days ei�:er: (a)correc�rhe data found to be inaccurace or incomplece and aaempt to nodfy pasc recipienu of
inaccurace or incomplae data, including recipien�s named by che individual; or(b)nodfy the individual tha[he believes rhe data to be correct Data
in dispu�e shall be disclosed only if rhe individual's statemenc of disagreement is included with[he disclosed data.
The decerminadon of the responsible auchoriry may be appealed pursuanc to the provisions of che administrarive procedure act relaring to
contesud cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Righcs of subjects of data", we would like to inform you tha[your request
for a permic or license from the City of Orono or any of its departments may require you to furnish certain priva[e or
confidential information.
You are notified that:
1. The information you furnish will be used to detemune 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 license.
3. The informa[ion may be shared wich ocher local, stace or federal agencies to the ezcent necessary to process
the pemu[ or license.
4. If your requested permit or license requires Council action to approve, some informa[ion may become
public.
5. You have certain ri;hts under M.S. 13.04 (availabie upon request) to review private data on yourself.
6. Your full name is required to process this application or pecm.it.
�j 0�-l� � v � �'(�C{.`F� C � S � u i Yl �.
F� / l `I �Q�.� � � ��ddic�� Last �
Addres �, �� I � i � V ��� —( / (� �� L/ ` l � ( ��J'
`�\�
Ciry Sace Zip Phone
I underspand ri;hts �s s[ated above.
� �� �
Signacure
CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 21 S�-1 (�l S� �o r�T '(�—o.4-�
PID:
DESCRIPTION OF WORK: Qc=�IC
-------- ------------------ ---- -----------------
ZOY�TG REVIE�V BY: DATE APPROVED: �- /-�t�
BUILDING REVIEW BY: DATE APPROVED: �-{- ( - �j
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes _sC No
PLAN REVIEW Yes � No SEWER CONNECI'ION
STATE SURCHARGE Yes �/ No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
-------------___-------------------------------------------------------------------------------------------------
ZOlvI�TG CH�CK LIST Zoning District: C R. - l�-
Fire Department: ►�Yt.����✓J Post Office: tf��Al�"(/�-'�a School District: c�S�b+v��
-r--
Lot Area: Sq.ft. i f,y'LZ,�Z 5 Acres .Z C>Z Width �S Depth � �-S • /�-�
Survey Submitted: Yes�_ No Date of Survey: S•Zj -9�--
Proposed Setbacks:
Fron[ (�$�e): �� � Right Side: 1 3�
Rear (�r-eet): ��� Left Side: y 1
Adjacent Structures: S� � Wetland: � � A
Building Height: Def. Hgt. c�� K Peal:Hgt. (`�� I�
Lot Coverage: I`'�•(�
Grading: Staff Approval Date: /\J � �- By: � Council Approval Date: —
Septic: Staff Approval Date: /`T ( /� By: —
Zoning File: # — Resolution: # — Resolu[ion Date: —
Shoreland District: �-/�S
Avg. Setback: /�r/µ Bluff Setback: fV/P- L.ot Coverage: � y. �
Existing Proposed
Hardcover: 0-75
75-250' �— ��O
250-500'
500-1000'
Hardcover Variance Required: Yes No�_ Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
UBG R' 3 CONSTRUCTTON TYPE: �/v
Sq Footage $Per Sq Ftg
Basement x =
lst Floor z =
2nd F1oor x _
Garage R _
x =
TOTAL
Oo
Fstimated Construction Value: $ �(� —
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�Footing ' Sep[ic Sewer Connection
—2� �'r��g Fireplace Lawn Inigation
Insulation (Masonry) O[her
Wall Board (Mfg.) Well (State Permit)
—�S.F�� Grading/Filling Electrical(State Permit)
Ocher
REMARKS(IN HOUSE): -� wM
-------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
--------------------------------------------------------------
RENIARKS (TO BE NOTED ON PERivII'1�:
8
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fI` / /i�:� k�j� 1:1/ la�� /�� ,,� 53o0HIGN.WAYrOtSOUTH �
�CL11 EJ � � MINNC-TONKA,MlNNESOTA 55�a�
�� SURVF.Y/NG & ENGJNEERING CO.
;:�
' 82100 JOB NUM(�ER STANDARD SYMBOLS
�1 ZO 117 2:� SE�ITVI�PIRN
<�: "p' Denotes 112" ID pipe with plastic plug
� Todd Robideau CLIEi�T bearing State Rec�istration No. 9235, set.
.�
�
�' see reverse side LCGAL ���" Denotes iron monument found.
DE�CRIPTiON "
��
�: "-�" Denotes cross chiseled in concrete surface. r�
�a
"9B2x5" Denotes existing spot elevation measure�l ``�
,�;; at the point marked by "x", in this case, ;'�
:= 5/21/82 982.5 feet above mean �ea IeveL ,;
;� 6�4�82 DATE SURVEYED `
;;,. D/�TE DRAFTED ��g82x5" Denotes proposed spot elevation at the �s�
;,;� 30 SCALE IN FEET PER INCH ' point marlced by "x". �;
, ;:
:;., �-
-`" PROPOSEu E�EVATION�: none " >" Denotes proposed direction of storm water ��
r:; ,
.C, � runoff. ;�
:s� FIRST FLOOR ;
:
�-:,, TUP OF FOUNDATION CERTIFICl1-jION
�,` '
;., y GARAGE FLOOR {i:
LOWEST FLOOR �'�
'� � I hereby certify that this plan, survey, report .F
�,: SANITARY SCWCR or specification was prepared by me and that I ,?
'�: BENCHMARK ELEV�ITION ��
� BENCHMAF�{< am a duly Registered Land Surveyor and Profes- f?
`� DESCRIPTION sional Engineer under the Laws of the State of � r t
;�.
�tinnesota. � z' !� !`
``� /I'��;�• �- j�l � �,�1 :7.
" �� /Jarnes H. Parker, Minn. Reg. No. 9235
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