HomeMy WebLinkAbout1999-011864 - land alteration PERMIT
CITY. OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 =
Crystal Bay, Minnesota 55323 Permit Number. = .' _._
(612) 249-4600 Date Issued: `�-`= -��-��_��-
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: -- - - - - - --
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APPLICANT' RMIT SIGNATURE ISSUED BY:SIGNATURE �,
�otal Fee: ' �a Date Received: �.
�ntered By: // Permit�: i/ .�ln� '
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CITY OF ORONO - BUtLDING PERMIT Al'PLICA.TIOI�i ` �
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All informa�ion must be submitted in fuli before plan re�iew R�ill be started. .
. (please print all information) . , .
'I'HE A.PPLICA.I�'T IS: � � {circle one) .� O�TNER OR.CONTRACTOR � � . .
JOB SI3TE ADDRESS: � � � ` �`S ca �'�.�� � 2,�. �p: S s �� 1
• � _ �_ ,J -- P�30NE: (home) Lv � a� `-�7�� �t`_7��
i�IA1ti� OF Oti��R 1 J�.-; �� � �41,-� work) � � �C, - r a r� a
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(��_ /I.�. CTTY: � �Y z,�+N� ZIP: s s 3 �=c f
�IAILI�GA:DDPESS: �c��� G�s�� �
CO��I'I'R.A.CZ`OR: � r ��:� � �� � PHOYE: �
CON'TACTPERSON: � MOBILEl�AGER:
1VIA.U,ItiG ADDRESS: C�' ��
STATE LICE�TSE: # _ � �
ARCHI'I'ECT�EITG .Itii TEER:� . . . PHO��: � �
C�y; ZIP:
�xA1I,1�'G ADDktESS: �GygTgA,TION�
. ��:
TYPE OF ti'�OR�i: New Addition Accessory Structure
Move Remodel/Alteration _ Land Alteration�
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PROPOSED ti�OR'f�(describe in detai�: � �w 1 �`'r �`
STOR�ES: _______ SQ•�EET OF EACH FLOOR: DET. � . � .
NO. OF BEDROOI�S: GARAGE STALI�S: .ATT. . . . . -
EST .Tl�i J.A,TED CO�ISTRUCTION VALUATION (excludina lanc�: $ . �
I hereby apply for a building permit and I ac�anowledge that the informatioa�of the Ciry and ith
accurate; that the work will-be in conformance with the ordmances and co
the State Build�n� Code; that I understand this is not a permit and work is not to start without a
permit; and thac the work w' e cordance with the approved plan.
G�__ DATE: ������ � —
APPLICA.��"T'S SIGNA :
NOTE! �Parade of Home� events require separate permit approval by Police Deparlment and
� City Counci160 days prior to tke event. Non permitted events will not be ailoWed.
Sec.13.Q4 RIGFiTS OF SUSTECTS OF DATA - -- • '
Sutd. i. Typs of daca. The righ�t of iadividual on wham�he data is scord or m be sm�:d shalI be u sec forrh ia this sccrion,
Su�-d.2. Iatormatia¢nqirircd to he given iadiridual. ,�,n i�dividual uked w suP?IY Privac_or eoaFdee^al da�eoaceraing hiasalf sh�.n
be iafacmed aF (a)the parpase and in�aded use oE the raqus.�3 dam wichia the ealIecca3 3am ageary.poliacal sutdivision,or samwide ryst�-
(b)whec.`.e:h:-:y r_�s:ar is.legalIy requir:d to suPPtY.che r_quesc:d daca:(c)aay I�owa eaas.-yi:ecce uisi.3 froca his si:ppiyia3 or refi:siag ta su?pt�
privsc:or eaa.:der.:al daa;ar,d(�c�e idencry of acherpecsoes orearida aucyocized by snte arf:'_a_':_:::;r_ceive�e da3. This r_quirc-,eat s�_'1
not a�piy wcea an i:.ciividual is u1:ed eo supply iavudgadve data,parsuace eo s<cdoa 13.83,sut+divisioa3,w a Iaw eafaccemeaco�cer. .• . - �
'Cha ce:-usvssianer of rever.ue mav iace the noace r_�uic:d nnder this subdivisian in the individual ir.come ez or orooertv t3z cefur.d
inmucdons i�susd of an those for,ns,
Subd.3. Access to datz by iadiv1duaI, Upon requesc to a�espansibie au�horiry,aa iadividual shall be informed wha�her he is che subject
of stor:d daa on individuaLs,aad whecher it is et�ssified u public,priva�e or eonF.deaaal. Upea his fursher rquesc,a.a icdividaal who is the subject
of s:or.d priva�ar public data on individuals shall be showa ehe daa wichout iny charge to hia u:d;if he des'ues,shall be infocmed of[�e eaecent
aad m:aaing of�4at data. Ahcr an individua2 hic been shown the private daa u:d infarmed o[iu�eaaing,�he dara aeed not be discIosed�him for
siz monchs�her_after unless a d'upuce or acaon pursuant ta this secdon is peading oc addidooal da�on the iadividuaI has been eolIec�d or ercamd.
Tae cesgac�sbie aud:oriry shall'pcovide eopies of�he priva�orpablic daca upon reGuest by the iadividual subjcct of che daa. �e responsz'bie auchoriry
may tequir_ che cequesdng person to pay che acau!eosu aF cn3kinz.eecdfying.acd eompling the eapies. -
The cesgansib(e auchoriry shall eompiy imn;:diace(y,if pessible,wich any requut s.3de pursua.nt co thi.s subdivisioa.ac wichin five days oF
the dac�o!che teqaes�,exciuding Saturdays,Sundays and 1e3a1 halidays,if'u:smediate compliacce is not pauible. If he caaeot compty with the request
wichin dsat dase,he shall so inform ehe individuaI,ar:d may have an addidonaI five days wicfiin which to eompiy wirh the requesc,ezciuding Santrdays,
Sandays and Ie3aI holidays. . .
5u�d.4. Pzoeedure�►hen data Ls not accurate or eomplete. An icdividual may eonc:st rhe accurary or completr.aeu of publie orprivacc
dara conceming tiunsetf. To ezercise chis right,an individual shaIl aedfy ia wrida�dte respoascl�Ie auchoriry descnbing the naaice of the disagr.emeac
The responsibl:auchoriry shalt within 30 days eic.':er. (a)eocrect rhe daca fonnd to be inaccurat�or i�compie�ar,d atimpc to nodfy pitt recipienes of
inaccucace oc incamptece daca,induding recipiea�s named by[he individual;or(b}noaFy the iadividual thac he believes the dari to be carrect Da�
in dispuce shall be diseiosed onIy if the individeai's smter,sent of d'uagreem:ac is included with the disetosed dam.
The daterminadon of the responsible auchoriry may be appealed parsuant to the provisioru of che adminisQaave pro<edure act reiaang to
eont�s..d cases. � . . .
DATA PRIVACY ADVISORY �
In accordance wich M.S. 13.04,Subd.2, "Righcs of subjeccs of data",we wouId like to inform you that your request
for a permic or Iicense from the City of Orono or any of ia depart�nencs 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 quaIification for the permit or license requested.
2. You r�ay refi�c to suppiy data, but refusal may require that the Ciry deny the permit or license. � �
3. The information may be shared wich o�her Iocal,stace or federal a�eacies to the etcent necessary to procas
the permit or license. '
4. If your requested permit or license requires Council acdon to approve, some information may become
. pubtic, . � - . . . . . �
�5. You have certain ri�hts under M.S. I3.04�(availabie upon requat) to review private data on.yourself. .
6. Your full name is required to process this applicacio❑ or permit. �
Finc � �fiddle �t •
. Addreu � -...
Ciry Sam Zip P�aee
I un�ersf ri�ts as stated above. „
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• CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY •
ADDRESS OR LEGAL: 303� (�v�SC.x� �Po,� �
PID:
DESCRIP'TION OF WORK: o w�4 c�
-----------_------------------------ - ------------------------------------------------------------------ . I
Z0�1T�i'G REVIT`V BY: DATE APPROVED: Q - �5�S' �
BUILDI1tG REVIEW BY: �✓ �� DATE APPROVED:
FEES TO BE CHARGED: G��^� Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes No SEWER CONNECI'ION
STATE SURCHARGE Yes No WATERCONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
Z0�1ING CHE.CK LIST Zoning District: /v�o c f fr+�3�
Fire Department: Post Office: School Disuict: �
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Ri t Side: �
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Rear (Street): Le Side: i
Adjacent Structures: Wetland:
Buildin� Height: Def. Hgt. Peak Hgt.
Lot Covera?e:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: Resolution Date:
Shoreland District:
Avg. Setback: Blu f Setback: L.ot Coverage:
Eu �g Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Da[e of Council Approval:
REMARKS (in house):
7
BUII.DING REVIEW CHECK LIST
�C� /'V�✓�- CONSTRUCTION TYPE:
Sq Footage $Per Sq Ftg
Basement x =
lst Floor R =
2nd Floor x =
Garage x =
R -
TOTAL
Estimated Construction Value: $ -�
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well (State Permit)
�F�� Grading/Filling Electrical (State Permit)
Other
REMARKS(iN HOUSE): .
RE'VIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
REI�IARKS (TO BE NOTED ON PERi'�IIZ�:
8
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