HomeMy WebLinkAbout1995-007090 - building PERM T
GI�iV OF ORONO PERMIT TYPE:
��/'50 Kelley Parkway- P.O. Box 66 -
Crystal Bay, Minnesota 55323 Permit Number: . _.:,:::,.
(612)473-7357 Date Issued: _. _�":'_��°��::=
SITE ADDRESS:
DESCRIPTION:
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CONTRACTOR: WNER:
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APPLICA T RMITEE SIGNATURE I ISSUED BY:SIGNATURE . � rGli .
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CITY OF ORONO - BUII.DING P T APPLICATION -`�
Tota� Fee: $ /��- �� Date Received:
Date Approved:
�ntered By: � ' `� , � Q
�� Permit�: 0 �
AT.T• INFORMATION MDST BE SIIBMITTSD IN FIILL BEF RE PLAN REVIEW WILL B$ STAR�ED
(See Check-off List En I.osed)
--------------------------------
--�- ------- ----------------------------------
THE APPLICANT ZS: (circie one) OWNER or CO TRACTOR
JOB SITE ADDRRSS: '� � ( 1 � � ZIP: �j 5 J��/
�yb- �"� ' i �
� ,,�, � � � (work) 517�� �-�f/d S
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2��ME OF OWNER: 1��/�1 lJ���"'" PHONE: (home) �7�-!l �C�7 7
MATI,ZNG �DxEss: ��{-tv S �� S, ��. ��. cI :f n�,�O zzP: S53��
C ONTRI�CTOR: �' PH���
Ia�iII.ING ADDRESS: CI ZIP:
STATS LICENSE: � I
�.RCHITECT/ENGINLER: PHONE:
:�..AIZING ADDRSSS: CI ZIP:
x�: RB ISTR.ATION u
':�YPE OF WORR: New Addition Acce sory Structure Move�
Demo Resnodel/Alteration Renov te Land A teration
PROPOSED WORR (describe in detail) : c� I C� ���
�/ " ��� '�F Gz.M- '(1.� ,r .
STORIES: SQ. FEBT OF EACH FI�OORr �
2�0. OF BEDROOMS:� C�RAGE STAI.I�S: AT . DET.
� ,
ESTIMATED CONSTRIICTION VALIIATION (eacluding 1 d) : $ ��(�(.vv��
� hereby apply for a building permit and I cknowledge that the information
:bove is complete and accurate; that the wor will be in conformance with the
��dinances and codes of the City and with the State Building Code; that I
::nderstand this is not a permit and work is n t to start without a permit; and
��at the work will be in accordance with the a proved plan. �
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A�'PLICANT'S SIGNATURE:F-'"�'k-' 1 V� �. DATE:
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CITY of ORONO
`M Post O,ffice x 66•Crystal Bay, Minnesota 55323•Municipal Offices
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„ � _ � e On the North Shore o Lake Minnetonka
DATA PRNACY AL�VI ORY
In accordance with M.S. 13.04, Sub . 2, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confide tial information.
You are notified that:
1. The informativn you furnish �wi 1 be used to determine your
qualification for the permit or Iice� se requested.
2. You may refuse to supply dat'a, I ut refusal may require that
the City deny the permit or licenise.
3. The information may be shar�ed with other iocal , state or
federal agencies to the extent nece sary to grocess the permit or
license.
4. If your requested permit or Ii ense requires Councii action
to approve, some information may be ome public.
5. You have certain rights under M.S. 13.04 to revzew pri�ate
data on yourself.
6. Your full namP is required to rocess this applicaticn or
germit.
,Q�l,��/� K�C t�tZ1� � Su�
First Middle Last
lvS KS ► F ,
Address ,
�,(C� �/ � S3"3 �J cl
City State � Zip
�-�� - ��� -� �
Phone
I understand my rights as stated a ove.
,��� �� �
Signature
�
BUILDING&ZONING—473-7357 � ADMINISTRATION&FINA CE—473-7358 • PUBLIC WORKS —473-7359
ASSESSING
�`� �._____..—_-- —- .
513.04 RIGHTS OF SII&TECTS OF DATA
Subdivision 1. Type of da�- The righ SQ�tion�vl�u� on whom the data is
stored or to be stored shall be as set forth in thLs
Subd. 2. Information require
d to be given in�iv��`L An.individual esked to
su ly private or confidentiel data concernindg �am�hin the collect ng state agencY,
PP
purpose and intended use of the requeste
olitical subdivision, or statewide system; (b) whether he may refuse or is legally
P the requested data; (c) eny known consequence arising from his
required to supply rivate or confidential data; end (d) the identity of
supplying or refusing to supply P state or federal law to receive the data. This_
other persons or entities authorized by investi ative data,
requirement shall not apply when an individual is 8sked to supply g
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue n►a p1ertV taX reound instr�uctionsui steadhos
subdivision in the individu8l income tax or pr�
on those orms. - --- - - .
Subd. 3.
Access to �ata by in�vidual• UPon request to e responsible
authority, an individusl shall be informed�whe b�C'hPrrvateeor confident al.e Upon his
individuels; and whether it is classifled p ublic data on
further request, an individual who is the subject of se to�mrlv�a�ae if he desires, shall
individuels shall be shown the date witho ofan�y ��g, After an individuel has been
�e informed of the content and meaning the data need not be disclosed t�
shown the private data snd informed of its meani�+ ursuant to this section is
him for six months thereafter unless a dispute or action p
ending or additional data on the individu e h�gte or publ c datarupon request by
' P require the
responsible authority shall provide copies o t P ilin the
the individuel subject oftrie actual•costs of mak ng,l�ert fYingyB�d �omp g
requesting person to pay -
copies. ssible with any request
The responsible authority shall comply immediately, if po ,
made pursuant to this subdivision, or withi lida e dif Simmediateatcompliance eisu not
excluding Saturdays, Sundays and legal ho ys�
ossible. If he cannot comply with the request within that time, he shall so in�or h the
P have an additional five da}'s within which to comply
individual, and maY �d le al holidays.
request, excluding Saturdays, SundaYS g
Subd. 4. Procediu'e w►hen data is not accurate or complete. An indll�e�•mTo
contest the accuracy or completeness of public or private data concerning
ht an indiv�dual shall notify in writing the responsible authority
exercise this rig , nsible authority shall within 30
describing the nature of the disagreement. The respo
days either: (s) correct the data f ound to be lete datae including ree�Pi�� namedt by
notify past recipients of inaccurate or incomp
the individual; or {b) notify the individual that he believes the data to beementcis
Data in dispute shall be disclosed only if the individuel's statement of disagr
• included with the disclosed data. be BpPe�ed pu�'suant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases•
CHECR OgF LIST FOR ISS ANCE OF PERMITS
, FOR OFFICE US ONLY
ADDRESS OR LEGAL: yy 6 S a!9 yS//-�C� �oA� PID:
D$SCRIPTION OF WORK: WIA�-e-
--------------------
-- ----------------- -------------------------- -�_----
ZONING REVIEW BY: D1ATE APPROVED: �f""��"�"`s � 2 ��
BIIILDZNG REVIEW BY: � DrATB APPROVED: ��� C�' Z I 'SS
---------------------- -
FEES TO BE CHARGED: Misc. �'ee Ca].cu�ated By:
PERMIT Yes � No
PLAN REVIEW Yes � No SEWE CONNECTION
STATE SURCHARGE Yes�� Na WATE CONNECTION
INVESTIGATION FEE Yes No PA�K EE
SAC Yes No SI E INSPECTION
Number of SAC Units OTHE (specify)
----------------------------------------r- -----------------------------------
ZONING CHECR LIST Zoning istrict:
Fire Department• /���- Post Office: I " School District:
Lot Area: 2• l�G�t.��
Width: Zdb•°!$ Depth: 42�•�Y
Survey Submitted: Yes_�C No Date of; S rvey:
c a -7—! • &�
Proposed Setbacks: � �
.7
Ri ht Sid �
Front (�e) : 3F5'`1 g
Rear (9�tz-�t.) : 1$' � Lef t Side 32� I
Ac�'jacent Structures : `j0� IWetland: ���
� Peak H t. ?
Buil.ding Height: Def . Hgt. ��7 (f g
Avg. Setback: �t overage: /'v�//`�"
Existing Pr posed
Hardcover: 0-75
75-2 '
250- 00 '
500- 000 '
Hardcover ariance eq ired: Y s No ouncil Approval :
Grading: Staff Appr v 1 Date: ' By�: Cou cil Approval Date:
Septic: Staff Appro Date: BY=
Zonin Fil.e: # Res lution Re olution Date:
S (in house) :
I I
BIIILDING REVIEW CHECR LIST
IIBC: �'1/( - l CONSTRIICTION TYPE: '�� '
� Sq Footage $ Per Sq Ftg
Basement -x =
lst F�oor x =
2nd Fl.00r x = :
Garage x = �
x =
TOTAL
Bsti_mated Construction Value: $ (o , O QO��
Inspections Required: Work Requiring Separate Permi.ts:
Site PZumbing Grading/Fi��ing
D<Footing Mechanical Fire
_�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
pt.,Fina 1 (Mf g.) Other
Other We�1 (State Permit)
Electrical (State Permit)
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REMARKS (IN HOIISE) :
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�
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approva�.: Date By:
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REMARRS (TO BE NOTED ON PERMIT) : 5'T'(Lvc�7v2� ►��s% yv�-# �� C� �
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