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Home My WebLink About2001-P04517 - land alteration ITY OF ORONO PERMIT C � 27��0 Kelley Parkway - PO Box 66 Permit Number: Po4si� Crystal Bay, Minnesota 55323 Permit Type: UserDefined (952) 249-4600 Date Issued: �0�19�2ooi SITE ADDRESS: 4355 Chippewa Ln Maple Plain,MN 55359 PID: 31-118-23-42-0020 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: FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: OWNER: �'illiam&Ann Crackin 4355 Chippewa Ln Maple Plain,MN 55359 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-�REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MIN E TA B I G CODE REQUIREMENTS. � f LICANT PF,RMITEE SIGNATURE ISSUE BY SIGNATURE Cooies: 1-File(SiQnitures Required). 1-Applicant. 1-Monthlv Reoorts. 1-Assessine. 1-Finance Page 1 Total Fee: $ Date Received: , Ei�tered By: Permit#: CITY OF ORONO - BUILDING PERNIIT APPLICATIOIeT All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER O ONTRACTOR JOB SITE ADDRESS: ��5 �/1��i L N ZIP: �p /A r NAME OF OWNER: (�./lram fi�N�,�'l �'� PHONE: (home)`�5Z 3� ��z3o '/ (work) � E�z �73 vz 3 O MAILING ADDRESS: � 7'�� p�'w�� CITY: � 1'4� ZIP: CONT'RACTOR: /��L- -' � PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NANIE: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration �_ PROPOSED W1ORK(describe in detai�: �R_Ap��> �}�ovND '�>;� �� F�i� �7�7�' �1�TM�fI C�IZ� , 1/v�1�.1�v�e S �Y�1/��\ �'In `�11hUS On r l� (�C' }Q�'n �!'�t� 11��I • STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED 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 unders d this is not a permit and work is not to start without a permit; and that the work will be in cc a i�the pproved plan. APPLICANT'S SIGNATURE: DATE: l(J -�� " �� 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.13.04 RIGH'TS OF SUSJECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information reqirired to be given individual. �.n individual asked to supply private or confidenrial data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collec[ing'state agency,political subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply priva[e or confidencial data;and(d)che identiry of other persons or enriaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdeadve dara, pursuan[to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and wherher it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown[he data wirhout any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuan[to this secrion is oending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual coscs of makin¢, cerrifying,and compiling the copies. The responsible authoriry shall comply immediately, 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 compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excluding Saturdays, Sundays and leeal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this rieht,an individual shall nodfy in wriung the responsible authoriry describing[he na[ure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompte[e and attempt to norify past recipienu of inaccurare ot incomplete data, including recipients named by the individual;or(b)notify the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individuai's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like 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 fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the pemut 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 pemut or license. 4. If your requested permit or license requir�s Council action to approve, some information may become public. j. You have certain rights under M.S. 13.04 (available upon request) [o review private data on yourself. 6, Your full name is required to process this application or permit. First �fiddle Last Address City State Zip Phone I de � ight stated bove. �� gnatur CHECK OFF LIST FOR ISSUANCE OF PERMITS � � FOR OFFICE USE ONLY � ADDRESS OR LEGAL: �f 3�S C i'f � PP L-tn1 vq t�4�v-2. PID: DESCRIPTION OF WORK: _ Co lt��r�r� A��, � __/n��s c � (J� (�"z.�' �rvn�,e ZO�1G REVIEW BY: DATE APPROVED: i b • �� - � � BUILDING REVIEW BY: DATE APPROVED: �_�_ �--- ____� ---- -------------------------------------------------- (o i.�.rc, � sn �� y.hn✓Js t'�o G c.�:P_ FEES TO BE CHARGED• ~� ke�s Calculated By: PERMIT Yes � No PLAN REVIEW Yes No SEWER CONNECITON STATE SURCHARGE Yes No WATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC Units OTHER (specify) ZOYI��G CH�CK LIST Zoning District: c� � Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: � Front (Lake): Right Side: Rear(Street): Left Side: Adjacent Structures: Wetland: Building Hei�ht: Def. Hgt. Peakll';Hgt. I Lot Covera�e: � Grading: Staff Approval Date: By:t Council Approval Date. I Septic: Staff Approval Date: By:� � Zoning File: /# Resolution: # �Resolution Date: I Shoreland District: Avg. Setback: Bluff Setback: L.ot Coverage: Ezisting � Proposed Hardcover: 0-75' ! 75-250' �`; 2�0-500' � 500-1000' �� I Hardcover Variance Required: Yes No I Date of Council Approval: RENLARKS (in house): � _ 7 BUILDING REV�W CHECK LIST �C� —' CONSTRUCTION TYPE: — Sq Footage $Per Sq Ftg Basement x _ lst Floor x = 2nd F1oor x _ Garage z _ R - TOTAL Estimated Construction Value: $ Inspections Required: `Vork Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connection Footing ' Septic Sewer Connection Framing Fireplace Lawn Irrigation Insulation (Masonry) Other Wall Board (Mfg.) Well (State Permit) —+,L�F�� Grading/Filling Electrical (State Permit) Other REMARKS(IN HOUSE): � -------------------------------------------------------------- REV��V BY OTHERS: DAT'E: Access: Ezisting New Access Approval: Date By; —_____------------------------------------------------------------------------------------------------------------ REMARKS (TO BE NOT'ED ON PER�tiII�: 8