HomeMy WebLinkAbout2000-P03034 - land alteration PERMIT
' �I^TY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po3o34
Crystal Bay, Minnesota 55323 Pe►'mit Type: User Defined
(612) 249-4600 Date Issued: 9i2�i2oo
SITE ADDRESS: 4360 Chippewa La
MAPLE PLAIN,MN 55359
P I D: 31-118-23-42-0015
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NQTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: DANA LAMOINE OWNER: L E MARTINEAU/J M MARTINEAU
4360 CHIPPEWA LANE 4360 CHIPPEWA LA
MAPLE PLAIN,MN 55359 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 REQUTREMENTS.
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APPLI ANT PF,RMITEE SI NATURE I UED BY SIGNATiJRE
Copies: City,Applicant,Assessor,Finance Page 1
, � . 4 �J�.�
Total Fee: $ ��'� �� Date Received:
Entered By: Permit#: ,�}-U3� 3
CITY OF ORONO - BUILDING PERMIT APPLICATION
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) WNER R CONTRACTOR
JOB SITE ADDRESS: � 3 6 0 C{���p�w c� �� ZIP• S� 3��`�
` (c�u� 6i� 747 �3�6
NAME OF OWNER: \�A�� �.�. . �.e.M o���� PHONE: (home) ;��� t�-1 �0
(work) 6 f�: 3`I I �i S �1
MAILING ADDRESS: �-3 60 C�...��t w�, � CITY: d/Zp��� ZIP: S 3 S
CONTRACTOR: rn�G ��.,�.c�c�� PHONE: K73-7N�tG
CONTACT PERSON: 5/,g. MOBILE/PAGER: Gt Z 3 a�r G��7
MAILING ADDRESS: y385C ifrPP��- �.H CITY: {N�,¢Pc.c.�c�-i�- ZIP: S-,5��
STATE LICENSE: #
:�.RCHITECT/ENGINEFR: PHONE:
iVIAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration�_SKf}�-�s f���..��
PROPOSED WORK (describe in detai�: .�;n � �� � v'>� r ec � � �
:, .
r� c� � c - � c� i`�r �Z, � - c
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �-8-
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
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: Et.M.c, 1,�, � MI�I wc.-- DATE: `�� / �-C�
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 RIGHTS OF SUBJECTS OF DaT.�
Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth ia this secaon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and intended use of the requested dara within the collecting'state agency, polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply[he requesred data;(c)any laiown consequence arising fmm his supplying or refusing to supply
private or confidential data;and(d)the identity of ocher penons or enrides authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesaeadve dara, pursuanc to seccion 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individuai income tax or propectv tax refund
instructions instzad 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 whether 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 shali be shown the data without any charge to hun and, if he desires, shall be informed of the content
and meaning of[hat data. After an individual has been shown[he privace data and informed of its meaning,the data need not be disclosed to hun for
six months thereafter unless a dispure or acrion pursuant to this secdon is pending or addidonal data on the individual has been collzcted or creaced.
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 requesting person to pay the actual cosu of makine, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or wi[hin five days of
the date of[he request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request
within that time,he shall so inforrtt the individual,and may have an addidonal five days within which to comply wi[h the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is no[accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise[his right,an individual shall norify in wricing the responsible authoriry describing[he nature of the disagreement.
The responsible au[horiry shall within 30 days either. (a)correcc the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shali be disclosed only if the individual's sta[ement of disa�reement is included with the disclosed data.
Tfie determination of the rosponsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act relacing 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 furnish 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 pernut or license.
4. If your requested pernut 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 Vliddle Last
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signature
, � • CHECK OFF LIST FOR ISSUA.z'�'CE OF PERII�IITS
_ FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �{,3�� �y-��P� wA C�4N�
PID:
DESCRIPTION OF WORK: �(lp�,� �,�.s G �—orL t c�e (Z��-�
.
ZOr�'G REV�ti� BY: DATE APPROVED: S-z L- o�
BUII.DING REVIEtiV BY: DATE APPROV�D:
<.5 d� G,., s rvo c-� P
FEES TO BE CHARGED: GFU���j Misc. Fees Ca�cu�ated By:
pERMIT Yes ✓ No :�
pLAN REVIEW Yes No SERrER CONNEC'ITON
STATE SURCHARGE Yes No WATF�tCONNEC'ITON
IIV'VESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�G CH�CK LIST zoni.n;Districc: N� C(-r�� �
Fire Department: Post Office: School District: �
I.ot Area: Sq.ft. Acres Width Depth
Surve;� Submitted: Yes No Da[e of Survey:
Proposed Setbacks:
Front (La.ke): 5�-- Right Side: � �
��
Rear (Screet): � � I,eft Side: `'
Adjacent Structures: Wetland: .
Buildin� Heioht: Def. H�[. Peal:H�t.
Lo� Covera�e:
Gradin�: Staff Approval Date: �(— Z(o -c�' By:� Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: � Resolution Date:
Shoreland District:
Av�. Setback: Blufi Secback: LotCovera�e:
E���, Proposed
�
Hardcover: 0-75'
75-250'
ti0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RE�LA_RKS (in house):
7
. � .
BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z =
2nd F1oor x =
Garage z =
R =
TOTAL
Estimated Construction Value: $ �
Inspections Required: Worl:Requiring Separate Permits:
Site Plumbing ' Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_� Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: � DATE:
Access: Existing New
Access Approval: Date By:
REVIARKS (TO BE NOTED ON PERMI'I�:
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