HomeMy WebLinkAbout1997-009078 - mudroom add -�.-
PERMIT
� CIfiY OF ORONO PERMIT TYPE: - - � _
2750 Kelley Parkway- P.O. Box 66 - '"��`���� 4
Permit Number. '�i'.{�::��.�.'�-�
Crystal Bay, Minnesota 55323 Date Issued: �� �
(612)473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: "� � V - � "
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APPUCANT%PERMITEE SIGNATURE - ISSUED BY:SIGNATURE ���_
� Total Fee: $ � ��� � � Date Receiv�: ��%�'� i�<-
Entered By: � Permit#: ��� 7 �'
,
CIT` 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) OWNER OR GONTRAC'I`@R
----
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JOB SITE ADDRESS: �,(*; � � �� �� i r�.�_�' �:�IP: �
NAME OF OWNER: C,E: �,�c c, F= 1�C�-��. S PHONE: (home) �� �{ �- �� ( �
R (work) �,:� t '> `f t r�
MAILING ADDRESS: �:�� �-� � ��, ,�� � ��-��'�ITY: ; f�,,�.-,-.,--.-� ' t,�ZIP:��
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CONTRACTOR: �t-�c�•.,��s� ��- �:�-�"��v ��-"���r(',.� PHONE: ��� ' � � � �—
CONTACT PERSON: MOBILE/PAGER: _
MAILING ADDRESS:�7�-.-'�C� �� i u�.r :z�_ < <. CITY: �.c�-�r�e cI ZIP: S S Y�*�
STATE LICENSE: # G�C,' l ��7
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition � Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�: h,��,{ �- ,; �� ,a:� ���� � .� �
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 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: t b��� �1 ��=� DATE: - I . '�
NOTE! Parade Qf Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
�
Sec.13.04 RIGHTS OF SLIBJECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom the data is stored or co be stored shall be as set fonh in this secdon.
Subd.2. Information required to be given individual. r1n individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)[he purpose and incended use of the requested data wi[hin the collec[ing'state ageocy, polidcal subdivision,or statewide system;
(b)whether he may rEfuse or is leeally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the idendry of o[her persons or enaties authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked ro supply invesrigarive dara, pursuant ro secrion 13.82, subdivision 5, to a law enforcement officet.
The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request ro a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whecher i[is classified as public, private or co�dential. Upon his fur[her request,an individual who is the subjecc
of stored private or public data on individuals shall be shown the data without any charge to him and,'if he desires, shall be infomted of the 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 the:eafter 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 of the privacz or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual costs of making, cerafying, 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 immedia[e compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal 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 of public or private
data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreemen[.
The responsible authoriry shall within 30 days either. (a)correc[the data found ro be inaccurate or incomplete and atcempt to nodfy past recipieots of
inaccurate or incomplete data, including recipients named by the individuat; or(b) notify the individual that he belizves the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data.
Tne determinacion of the responsible authoriry may be appealed pursuant ro 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 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 pernut or license.
3. The information may be shared with other local, state or federal agencies to che 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.
�/._.
L�V,•v�f�� ��v �� F: d—�� � �
First �I�ddle � Lasc
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-�,,� 's � C`� f � ��-- .a r
Address
j� �f � `l �� �_ �,,, Y � ,� �� �1 _ �:� � �
� � � 1
C�ry State Ztp Phone
I understand my rights as stated above.
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Signature
' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: (��o Q t(� ,�5��4iv�
PID:
DESCRIPTION OF WORK: (��� � r�d�
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ZONING REVIE�J BY: � � DATE APPROVED: � - �o-5�
BUILDING REVILW BY: DATE APPROVED: G - � o -4�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes ✓' No SEWER CONNECTION
STATE SURCHARGE Yes _/� No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: R 5
Fire Department: (,on,c, (A��c.� Post Offce: �udn��.s School District: p(I.;e��vU
Lot Area: Sq.ft. /(JO Cl�i4n�j Acres Width /!�/Lt�C�uu-�- Depth
Survey Submitted: Yes �j _ No Date of Survey: i Z-?�-�l.
Proposed Setbacks:
Fmnt(Lake): I�1S� t Right Side: ��' G
I�ear (Street): `1�� �' Left Side: �p� w
Adjacent Structures: I�TTWCI-t�'_� Wetland: N�{R,
Building Height: Def. Hgt. 0 •l� Peak Hgt. D.1�-
Lot Coverage: ����
Grading: Staff Approval Date: N (/� By: Council Approval Date:
Septic: Staff Approval Date: 6 -!� -9 � By: S •w
Zoning File: # ►� l (�r Resolution: # - Resolution Date: —
Shoreland District: y�3
Avg. Setback: o ,t� Bluff Setback: /'V l�-
Existing Proposed
Hardcover: 0-75'
75-250' � � l<-
250-500'
50n-1��0�
Hardcover Variance Required: Yes No� Date of Council Approval:
REMARKS (in house):
10
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BUII.DING REVIEW CHECK LIST
usc: R-3 CONSTRUCTION T'YPE: V►'`�
Sq Foota�e S Per Sq Ft;
Basement x =
lst Floor x =
2nd Floor x =
Garage X =
x =
TOTAL
Estimated Construction Value: $ I���n o oU
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
ec Footing Septic Sewer Connection
oc Framing Fireplace Lawn Irrigation
� Insulation (Masonry) Other
� Wall Board (Mfg.) Well (State Permit)
o� Final Grading/Filling X Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By�
REVIARKS(TO BE NOTED ON PERI�IIT):
27
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��I�D� �9` �O,.AN ���p� '11UV1�E A7TtC V�NTrLA'�FON �QUAL TO
�•1158TM ATTIC AREA. IF 50% OR
��a�-�--�---� k10RE IS Pfi01/i�J��l E�d �9PP�R PORTiON
�a-r� � a��a7�r Na. .,....---. OF NOAF AND R��ll�lf�D�R 13 P��VIDED
�����;', ;:,� p; �,�`a,����"T�,� . fN 1�i�F�f7 V�N7S, 17 f�AY BE REfltK�
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;�<�.5 cor,�nr�ts arw Yor your ?rri�rrn�tion_Ail v�tvrk shall G!O�t � I � Q X �Ocjr c� _�-^- � .
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� 7226 OLIVER AVE. S.
, RICHFIELD, MN 55423
PHONE: 869-5122 LIC 010006017
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RICHFIELD, MN 55423
PHONE: 869-5122 LIC t10006Q17
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