HomeMy WebLinkAbout2003-P06789 - land alteration PERMIT
CITY OF ORONO Permit ►vumber:
2750 Kel�ey Parkway - PO Box 66 Po6�89
Cry�tal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: ioiii2oo3
SITE ADDRESS: 4355 Chippewa Ln
Maple Plain,MN 55359
P I D: 31-118-23-42-0020
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernut Type: User Defined Pernut Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS: �
FEE SUMMARY: PermitFee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/Self OWNER: William&Ann McCrackin
A'1N 4355 Chippewa Ln
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 REQUIREMEN"CS.
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A NT PERMITEE SIGNATURE IS ED BY SIGNATURE
Copies: 1-File(Sienitures Required). 1-Apnlicant, 1-Monthlv Renorts, 1-Assessing, 1-Finance Page 1
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Total Fee: $ `:�C% � �� Date Received: � � ~(� �
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Entered By: ,;�,1iI.. � ; i Permit#: ' C�
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CITY OF ORONa� - BL�I��ING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(,please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SIT'E ADDRESS: �J.S�► l�� {�c� �t� ZIP: S����
NA1�iE OF OWNER: - , u-- � �C'.I��� PxorrE: (home) �I�� `t7(� 7�3�
�
: (work)
MAII.Pi iG ADDRESS: y �� �_i�, �w� L.�v' CITY: Ui7�,� ZIP: S�' :��5
COtiTR.ACTOR: �1 f�.f,+e- - �� R.x� �S PHONE:
COr�'TACT PERSON: ��.����,� ��,,,��-'� NIOBILE/PAGER:
NL4ILING ADDRESS: CITY: ZIP:
ST�TE LICENSE: #
ARCHTTECT/ENGINEER:��� PHONE:
MAIIrI�i iG ADDRESS: l CITY: ZIP:
NAu�iE; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration�_
PROPOSED WORK (describe ir,�detai�: �(��.�- , r� l��f `QU -?.�j �'OS ��-A`(
���� ��2 � t�� ��,f�2-�4� 5 � i C
STORIES: SQ., FEET OF EACH FI.00R:
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.
,;,,
EST�IATED CONSTRUCTION VALUATION (excluding land): $ ���
I hereby apply for a buildinJ pemut 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
permit; and that the work wiTl be: in acc a wi the a proved plan.
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APPLICANT'S SIGNATURE: �-�'✓ = � �`-' DATE: � � ~/� ��
.
NOTE! Parade of Homes even,ts require separate permit approval by Police Department and
City Council 60 days prior to th�e event. Non permitted events will not be allowe.`d.
.._
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual�sked ro supply private or confidential data conceming himself
shall be informed of: (a)the purpose and inte�ded use of the requested data within the collecting state agency,poliacal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the reques[ed data;(c)any Imown consequence arising from his supplying or
refusing tn supply private or confidenrial dara;and(d)the idenary of other persons or endaes authorized by sate or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commiscioner of revenue mav lace the notice re uired under this subdivision in the individual income taz or ro ertv tax refund
instructions instead of on those forms.
Subci. 3. Access to data by individual. Upon request to a responsible authority,an individual shail be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or co�dendal. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed
of[he content and meanin�of that 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 thereaher uriless a dispute or action pursuant to this secaon is pending or additional data on the individual has been
collzcted or created. The responsible authority shalt provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require the requesrin�person to pay the actual costs of making,certifyin„and compiling the copies.
Tne responsible authority shall comply immediately,if possible,with any request made pursuant co 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 wichin that time, he shall so inform the individuai, and may have an addidonal five days wichin which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contes[the accuracy or completeness of public or
private data conceming himsetf. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disae;eement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and attempt to nodfy
past recipients of inaccurate or incomptece dara,including recipients named by the individual;or(b)notify the individual that he believes the data
to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The detemunaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisQaove procedure act reladng
ro contested cases.
DATA PRIVACY ADVISORY
In accordance with N1.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 furnish 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 pemut or license requires CouncIl action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
Ciry State Zip Phone
I u�der t m � st ed abo e. 1
��� �
Signature
6 . .
, _ 2�3
CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY
. A.DDRESS OR LEGAL: �?;Ss C��PP�Z,v9 l�4�vcs
PID:
DESCRIPTION OF WORK: ,C l( iC ,/�,�.�/Jos c� BN�Ls�P
ZO�tING REVIEW BY: � DATE APPROVED: `�- zG -�3
BUII.DING REVIEW BY: � DATE APPROVED: S- z.� -d3
---------------------------------------�------���L ------�------.-�----�----�-;---�;-------------------
FEES TO BE CHARGED: Mi�Fees �lculated By: J
PERMIT Yes .�� No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------•---------------------------------------------------------------------------
Z4ti�VG CHECK LIST Zoning District: c�� (�_ ��
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Wi Depth
Survey Submitted: Yes No ate of Survey:
Proposed Setbacks:
Front (Lake): _ Right Side:
Rear (Street): _ Left Side:
Adjacent Structures: Wetland
Building Height: Def. Hgt. Peal:H .
Lot Covera�e:
GradinD: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resole�tion: # Resolution Date: .
Shoreland District:
Av�. Setback: _ Bluff Setback: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-2�0'
250-500'
500-1000'
Hardcover Variance Required: Xes No Date of Council Approvale
REv1ARI�S (in house): ,
7
. . �
BUILDING REVIEW CHECK LIST '
�C� � CONSTRUCTION TYPE: ,---
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor R _
Garage R _
R =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site 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
REI�IARhS (IN HOUSE): -------�-
-------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing Ne�✓
Access Approval: Date gy:
------------------------------------------------------------------------------------------
REv1ARKS (TO BE NOTED ON PERI�IIT�;
- 8 ,
� EXHIBIT B �/
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� CHIPPEWA LANE u
370.10 N 89'2B'40" £ 2Q0_01
�637 I 124.95 tR.39 - �
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Mcat L.e of Emt 6.SS fee� $oulh 1!?_—•' p �
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- �'� PROPOSED DIVtOING �WE-----�
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� AREA = 1.80 aCkES
SF:EtvlANEK
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Page 6 of 7
rg��.e v' �
DATE TIME
CITY OF ORONO cALLED IN �% - ''�
INSPECTION NOTICE scHEou�E� �C% �3 �� _�
PERMIT NO. PU (o ��'� COMPLETED
ADDRESS �3 S S C-�� J ''-E' �_�,�1 C_ N
OWNER L�.�/ I�� �Yfi] {�Y��/Ci�'ki►�CONTR.
TELEPHONENO. ���� — �� �� ` �� � �"!
� DESCRIPTION >`i r�c�_ l - ���� �I /-� �
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h
Q 03 INSULATION 24/25 WOOD ESURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HO��K-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES�O
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTIOIN TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN__HOURS. p pH0T0 TAKEN
INSPECTOR W{LL AETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION�SSUED
❑INSPECTION REQUIRED.CALlTO ARRANG.E ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnerlContracto ite:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice