HomeMy WebLinkAbout1995-006856 - fill in under overhang PERMIT �
GITY.�F ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: " - - --
Crystal Bay, Minnesota 55323 _ _ _. ._ � ._
(612)473-7357 Date Issued: : ` ` .
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SITE ADDRESS:
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DESCRIPTION:
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CONTRACTOR: OWNER: -- .:��-=� :�_ _:.�;�: --
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I I(:ANT/PF MITFF RIrNATI IRF ICCI IFfI RV�CI(�NATI IRF
� � CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ ��� ��, ��� Date Received: � �a �5
Date Approved:
Entered By: � ' � .
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Permit�: ��
AT•T• INFORMATION MIIST B$ SIIBMITTSD IN FUI�L BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
THE APPI.ICANT IS: (circle one) OWNER�or CONTRACTOR
JOB SITE ADDR$SS: �`/�/C Gr-�SC'.�� P 1- �C.�, }, � f`c�6�c, �t aJ - ZIP: SS��/
K,;,-�l�k.�work) (C 7-���s�/
NA�"+� OF OWIdER: /�ojN�1 T F�S l�l�;�ti ( �L� �, A - S%cn�c'�rs PHONE: (home) �/7�- //7z
�iAILING ADDR.ESS:�y`�L> �SC D F'%- �c� � CITY: L'�k' ON Cp ZIP: SS ..3� /
CONTRACTOR: �� ;; PHONE:
:KAILING ADDRBSS: CITY: ZIP:
�TATS LICENSE: �
ARCHITECT/ENGINEER: /�./� PHONE:
��AIZING ADDRSSS: CITY: ZIP:
S�: RBGISTRATION �
'YPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration � Renovate Land Alteration
PROPClSED WORK (describe 1II detail) : no��y�z ��s/,�<" �' `�c�N C�tJlec / tor-�L�ne) - B�lV�C
�'lA�c1.I �xie, �otr ZcJ1 LL �c ��� t�i�i o'r�r czY-�4 c-� �i�:�T,�::
STORI$S: I SQ. FEBT OF EACH FI,OOR: ,'�.C C
?d0. OF BBDROOMS:�_ GARAGE STAI�S: ATT.�_ DET. $'
ESTIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ %3}c�-t^
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 Building Code; that I
:.nderstand this is not a permit and work is not to start without a permit; and
�nat the work will be in accordance with the approved plan. �
,
APPLICANT'S SIGNATIIRE: � � 1 � Y� DATEs 7�t`S�j�,�
L���
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� _ � � 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:
l. 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 3icense requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 �o review prica��
data on yourself.
6. Yaur full name is required to process this applicatian or
permit.
��1�C�e�t ��',L� s ir,�i�ek �
;�; ��,l 3��+'�5 t=c�S% —
First Middle Last
�9y� c;�s Gv �i ��
Address
�'�G�N C /`-l�V S-S"3 �/
City State Zlp
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Phone
I understand my rights as �stated bove.
/.� � ��' � � L -�
�6ignatur
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
�.� �Gg� Og �B,TECTS OF DATA
Subdivision 1. Type of date- The rights of individuals on whom the data is
stored or to be stored shall be es set forth in this section.
Subd. 2. Information �d
to be given u►d�v��' An.individual e.sked to
� su 1 rivate or confidentiel data concernina �gmWi hin the collect ng state agency,
PP Y P
purpose and intended use of the requested
tem; (b) whether he may refuse or is legally
political subdivision, or statewide sys �c� any �own consequence arising from his
required to supply the requested dat8;
su 1 ing or refusing to supply private or confidentiel data; end (d) the identity o
PP Y state or federal law to receive the data. This.
other persons or entities authorized by 1 investigative data,
requirement shall not apply when �n indi�viaia en orcementuofficer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individuel income tax or ro ert tax re und instructions instead o
on those orms. . -- " .
Subd. 3.
Access to data by indiv��• Upon request to a responsible
authority, an individuel shall be informed whe b C hP=vateeor confident al.e Upon his
individuels, and whether it is classified as p � ublic data on
further request, an individuel who is the subject of sQ to�mri�ae if he desires, shall
individuels shall be shown the data witho of�hat da a• After an no���sc osed to
�e informed of the content and meaning the data need
shown the private data and informed of its ut�or�action pursuant to this section is
him for six months thereafter unless a �sp
endin or additionel data on Lhe indiv�dual h� a e or public dataruponarequest by
� p g. require the
responsible authority s h a ll pro v i d e c o p i e s The hre spo�ible aut�rity�a compiling the
the individual subject oft�e actual.costs of making, certif ng,
requesting person to pay - re uest
copies. immediately, if possible, with any 9
The responsible authority shall comply S of the date of the request,
� made pursuant to this subdivision, or within five �f,Y immediate compliance is not
excluding Saturdays, Sundays and legal holidays, with the
ossible. If he cannot comply with the request within that time, he shall so inform the
P have an additional five days within which to ccmply
individuel, and maY �d le el holidays.
request, exeluding Saturda}�s, S��YS g
Subd. 4. Procediu'e �►hen data is not acc�ate or complete. An individual maY
rivate data concerning himself. To
contest the accuracy or completeness of public or p the responsible authority
exercise this right, an individusl shall notify in writing
describing the nature of the disagreement. The�r�P��ore ncomplet and att mpt to
days either: (e) correct the data found to be ina
notif past recipients of inaccurate or incomplete de beI evesdthe rdatalto be correcL
y eement is
the individuel; or (b) notify the indi if the indiv dusl's statement of disagr
Data in dispute shall be disclosed only ' �u�t to the
� included with the disclosed data• be appeeled p
" The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases•
_ CHECR OFF LIST FOR ISSIIA�iCE OF PERMITS
. .
FOR OFFICE USE ONLY
ADDR$SS OR LEGAL: z 9 ya C/�s� �o�iv r�""`' PID:
DESCRIPTION OF WORK: -t'��, II'V � (��- �X�� '�."�`► V`��" �"'�"��
----------------------���-----------------
-----------=-=------------------
ZONING REVIEW BY: DATE APPROVED: .'�li�-
�
BIIILDING REVIEW BY:_ DATB APPROVED: �-� ' �_f'
-----------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �' No
PLAN REVIEW Yes_� SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No� SITE INSPECTION
t3uir�ber of SAC Units OTHER (specify)
------------------------
ZONING CHECR LIST Zoning Di trict:
Fire Department Post Of ice: Scho 1 District:
Lot Area: Width: Depth:
Survey Submit e : Yes No 1Date o Survey:
I
Proposed Set ac s:
Front ( ak ) : Right Side:
Rear ( tre t) : Left Side:
Adjac nt S ructures: Wetl nd:
Building eight Def . Hgt. P ak Hgt.
Avg. Set ck: Lot Covl`erage:
Exist ng Prop sed
Hardcov r: 0-75 '
� ', 5-2�0 ' _ -.
' 250-500 '
�� 500-1000 '
Hard�over Varian e Re uired: es o Date of Council App val:
Grading: Staff pro al Date: By: Council Approva� Date:
Sep, ic: Staff A ro al Date: BY�
Zoning File:# Res lutio # : Reso�ution Date:
REMARRS (in house :
BQILDING REVIEW CHECK LIST � -
�C: � .- 3 CONSTRIICTION TYPE:
�i�J . .
Sq Footage $ Per Sq Ftg
Basement X -
lst F�oor X
2nd Floor X
Garage X
x =
TOTAL
,�
Estamated Construction Value: $ �5, °Q��
Inspections Required: Work Requiring Separate Permi.ts:
Site �Plumbing Grading/Fi1J.ing
�p Footing �Mechanical� Fire
�Framing Septic Watez Connection
Insu�.ation Fireplace Sewer Connection
�Wa�l. Board (Masonry) Lawn Irrigation
�F'inal (Mfg.) Other
Other Well (State Permit)
�Electrical (State Permit)
-----------------------------------------
�2F.MARR$ (IN HOIISE) :
-------------------------------------------
REVIEW BY OTHF..RS: DATE:
Access: Existing New
Access Approval: Date By�
-----------------------------------------
RF.I�ARFCS (TO BE NOTED ON PERMIT) :