HomeMy WebLinkAbout2008-00036 - shed � t
CITY OF ORONO PERMIT NO.: 2008-00036
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssUEn: 07/16/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 210 BIG ISLAND
PIN : 23-117-23-23-0034
LEGAL DESC : MORSE ISLAND PARK
: LOT 000 BLOCK 000
PERMIT TYPE : ACCESSORY STRUCTURE
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SHED
ACTIVITY : 328-OTHER NONRESIDENTIAL BUILDINGS
VALUATION : $ 4,000.00
NOTE: SEPERATE PERMITS REQUIRED: ELECTRICAL(STATE)
APPLICANT pERMIT FEE SCHEDULE 103.25
STRUCTURES UNLIMITED, INC.
5425 CLAYTON DRIVE PLAN REVIEW 67.11
MAPLE PLAIN, MN 55359 STATE SURCHARGE(VALUATION) 2.00
O TOTAL 172.36
Minnesota State License#: 20173396
OWNER
CHAMPL[N,JUD
2643 THOROUGHBRED LANE
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire ecome Il and v id if construction authorized is not
com enced within 0 day f the date of issuance,or if construction is
sus nded for a pe od of 1 days at any[ime after work has commenced.
The pplicant i esponsi for assuring all required inspections aze
requ sted in nforman th the State Building Code.This permit may be
revo d any time due ause.
��� 7 //� IDS�
Applican Permi ure Date Is d y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Total Fee: $ .� Date Received: ���7(b$
Entered By: Permit#: a`�,/`]
CITY OF ORONO - BUILDING PERMIT AP��CA ON T
All information must be submitted in full before plan review will be started.
(please print all information)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) CONTRAC O
2 �D - % �
JOB SITE ADDRESS: j' � ��J ZIP:
Will this be a P�rade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS ����0 If yes, a special event permit is reguired with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
sufficient on-site parking is available. Non-permitted events will not be allowed.
NAME OF OWNER: �t�� �/ � /f�l PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �/'���TL11��E'.S � //jl' �. PHONE: �/Z��`7'" �� �
CONTACT PERSON: - �� . MOBILE/PAGER: �/Z-,.3�'�/ �,�
MAILING ADDRESS: s' L�' ,,, �r„� CITY: �0,� ��h ZIP: S�'3
STATE LICENSE: # Z�%!7 3 9(c� EXPIRATION DATE: ��'-- ��
ARCHITECT/ENGINEER: � s �rrr��A�� PHONE:
MAILING ADDRESS: ITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure��
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detai�:
/Z�/��� ���'��l,e� s � �h 5,�,.
STORIES: � SQ.FEET OF EACH FLOOR: /cj Z �'
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ `�E�I,��`
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate;
that the work will be in conformanc with the ordinances and codes of the City and with the State Building
Code;that I understand tl�is is not a er ' and wo k is not to start without a permit;and that the work will be
in accordance with the approved pl
APPLICANT'S SIGNATUR TE: ��� I�
D.� ���c� ��7�r��i-E�
�D�
,_� ���������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. Infortnation required to be given individuaL An individual asked to supply private or confidential data concerning himselfshall be
informed of. (a)the purpose and intended use of the requested data within the col lecting state agency,pol itical subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state 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 commissioner of revenue ma lace the notice re uired under this subdivision in the individual income tax or ro e tax refund
instructions instead 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
stored data on individuals,and whether it is classified 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 the data without any charge to him and,ifhe desires,shall be informed ofthe content and
meaning of that data. After 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 action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe data. The responsible authority
may.require the requesting person to pay the actual costs of making,certifying,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 ofthe 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 additional five days within 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 contest the accuracy or completeness ofpublic or private data
concerning himselE To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients 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 shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authorit��may be appealed pursuant to the provisions of the administrative 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 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 aeencies 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
ublic.
5. ou have certain rights under M.S. 13.04(available upon request)to review private data on yourseif.
6. our full name is required to process this application or perm't.
�
First Middle Las
� � �� [�., �I��
Address -
14� 1�- ��v -� 6 ��j�r���
City State Zip Phone
I understan y right s stated abo e.
Signature
Reset Form 32
1 �
CHECK OFF LIS7'FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: � j� ���ya,�� �,�,,��
PID:
DESCRIPTION OF WORK.• ti Z x� b 5�� .
ZONING REVIEW BY.• DATEAPPRO i�ED: �_z�-v
BUILDING REi�IEW BY.• DATEAPPROi�ED: 6 • a 3– u c�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓� No
P���E� Y�S—� N� SEWER CONNECTION
STATE SURCHARGE Yes—�� No WATER CONNECTION
WVESTIGATION FEE Yes No � PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (spec�)
ZONING CHECK LIST Zoning District: i2-S �
Fire Department: Post Office: School District.•
Lot Area: Sg.ft. • Acres Width Depth
Survey Submitted: Yes_ c No Date of Survey; p �,e
Proposed Setbacks:
Front(Lake): _ i U e� �' Right Side: _ �0 � +'
Rear(Street): S-t� r "+' Left Side: �U � �.
Adjacent Structures: �
,�b Wetland:
Building Height: Def.Hgt. c'.SG. Peak Hgt.
Lot Coverage: � ,/a
Grading.• StaffApproval Date: N ( �A By: Council Approval Date:
Septic: Staf,�'Approval Date: C� ' � [ �� By. �
Zoning File: # Resolution: # Resolution Date:
Shoreland District:�Z.17 MCWD Permit:
Avg. Setback: _ (�_�c., Bluff'Setback. �./!A Lot Coverage: �.q
Existing Proposed
Hardcover: 0-75'
75-250'
250-50�' O��
500-1000'
Hardcover i�ariance Reguired: Yes No
� Date of Council Approval.�
REMARKS(in house):
33
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