HomeMy WebLinkAbout2002-p05188 - land alteration � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 PosiBs
Crystal Bay, Minnesota 55323 Per'mit Type: User Defined
(952) 249-4600 Date Issued: s�23�2002
SITE ADDRESS: 4245 Chippewa Lane
Maple Plain,MN 55359
PID: 31-118-23-42-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Land Alt w/o C.U.P-Feathering out bottom of mound system-O_
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
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APPLICANT: Owner/self OWNER: Jon&Clea Altman
MN 4245 Chippewa Lane
Maple Plain,MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE � ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessin�, 1-Finance Page 1
. � / ��
Total Fee: $ L � i Date Received: �-� 7 � �
Entez�ed By: , Permit#: f�0 S l �S �
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CIT O� ORONO - BUII.DING PERNIIT APPLICATIOIeT
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �iZY� C,C.` rwq Lc-•it ZIP: S��-S �
-�
NAME OF OWNER: ---.I`J �t �/ �-,-.-5 PHONE: (home)�/Z --�,y yzy�
„ .
(work)
MAILING ADDRESS: FS"q ..,.._Q , CITY: ZIP:
CONTRACTOR: �� -•-..C - PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHOi�1E:
MAILING ADDRESS: CITY: ZIP:
NAl�iE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
v ,,
PROPOSED WORK(describe in detai�: �--��� G�� > � /�
� `.J D Y p �...�.Y.
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $
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 understand this is not a permit and work is not to start without a
pernut; and that the work will be in accordance with the approved plan.
APPLICANT'S AT . � li 2 O� �
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NOTE! Parade o�Homes events require separa't�permct ap roval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGFITS OF SUBJECTS OF D�T�
Subd. 1. Type of data. "Ihe righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information req�rired to be given individual. An individual uked to supply private or confidendal dara concerning himself shall
be informed of: (a)the purpose and intended use of[he reques�ed data within the collecting'stace agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the idenriry of other penons or enriaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigadve dara, pursuant to section 13.82, subdivision 5, to a law enforcement ofFcer.
The commissioner of re�•enue mav place the nodce reauired under this subdivision in the individual income tax or propertv rax refund
instructions inscezd of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of s[ored data on individuais, and whe[her it is class�ed as public, private or confidential. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown�he data without any charge to hicn and,�if he desires, shall be informed of the content
and meaning of[hat data. After an individual has been shown�he private data and informed of its meaning, the dara need not be disclosed to him for
six mon�hs thereafrer unless a dispute or acrion pursuant to chis secrion is oending or addiaonal data on the individual has been collectPd or crea[ed.
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,certifying, and compiling the copies.
The responsible authoriry shall comply immediatety, if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compiiance is not possible. If he cannot comply wich the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to compiy with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individua!may contest the accuracy or compteteness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing�he nature of the disagreement.
The responsible authoriry shall wichin 30 days either: (a)correc[the data found to be inaccu�ate or incomplete and attempt to norify past recipienu of
inaccumte or incomplete data, inctuding recipients named by tbe individual;,or(b)notify the individua!that he believes the data to be correct. Data
in dispu[e shall be disclosed only if the individual's stacemenc of disagreement is included with the disclosed data.
Tiie decerminarion of che respcnsible authoriry may be appealed pursuant to the provisions of the admuvsuacive procedure act relaang to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "RiQhts of subjects of data", we would like to inform you that your req,uest
for a permit or license from the Ciry of Orono or any of its departments may require you to fumish 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 permit 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 permit or license requires Council action to approve, some information may become
public.
5. You have certain ri�hts under Nt.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
�o�� �� ����
First �Siddie Last
—��,2 ,� ,�r� �-Z
Address
,�i�o� o /I�� s�3�� lo%� � �`7-i�z�.Z
Ciry State Zip Phone
I understand my rights as scated above.
Sig —--
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �/Z YS GNi POc�� C�Aiv e
PID:
DESCRIPTION OF WORK: Fi I 1
ZOrT�i tG REVIEW BY: DATE APPROVED: � / � -o Z
BUII.DI�i 1G REVIEW BY: iv/.a DATE APPROVED:
— — --- ------------------------J -------------------------------
FEES TO BE CHARGED: 6�`°'N5 ��VIN��`�"��lcula ed B G' J. �,
isc. ees a y:
PERNIIT Yes i/ No
PLAi�1 REVIEW Yes No SEWER CONNECITON
STATE SURCHARGE Yes No WATERCONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CH�CK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side: �,`C
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal: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: L.ot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): ��'x�n-,P�,N 6 0 ��- �a T-;-a•� d-� /L�.a�.,•a� fysrz�
7
BUILDING REV�`i� CHECK LIST
�C� CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x _
R -
TOTAL
Fstimated Construction Value: $
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ` Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�Final Grading/Filling Electrical (State Permit)
Other
REMA.RKS(IN HOUSE):
-------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
----------------------------------------------------
RENIA1tKS (TO BE NOTED ON PERivII�:
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