HomeMy WebLinkAbout1995-007373 - shed 1'ERMIT
�' CiTY OF ORONO ' i PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number. `�`-�=��=��:;-'-�'�'s`-�
Crystal Bay, Minnesota 55323 - . ._. . ..
(612) 473-7357 Date Issued: _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: =:U:;;�,.:;:� _ ����
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FEE SUMMARY:
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CONTRACTOR: OWNER: -- . ; _ _ . _ : --
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APPLICANT/PERMITEE SIGNATURE ISSUEO BY:SIGNATURE
Total Fee: S �''i; iS � � DateReceived:^"� i!�>'�
Date�pproved:
- � �
Entered Bv: �!�� P"�t�' �" `� �"
CITY OF ORO�O - BUILDING PER1tiIIT APPLICATION /
�I,L L��'ORtiL�TION�II:ST BE SL�B�iIT'I'ED IN FLZ,L BEFORE PL��1 REVIEtiV ti��II-�-- -�/
BE ST�RTED
---------------- �-- ------------------------------------------
THE �PPLIC:�:`�I' IS: (circ.e one) O`�NER OR CONTR�CTOR
JOB SITE �DDRESS: 2'Z �S ��� `� �` ('��- ZIP: S���'; 1
PHO�IE: (home) ��� �, ��<< Z
�tA.il�1E O F O ti`'�,'ER -C� v��o-T-��� 5�,��� �'�� ��--' , .- ,.
(wor�) �-��-z� �� � Z
l�1ALLL��G ADDRESS: �'z�� �'S�- �:���� � CITY: ���y2 r»,� ZIP: r-�,--��
CONTR�CTOR: �,�-� ti-���� � � _PHO�:
�IOBILE PHONE/PAGER:
1�IAILL�iG�DDRESS: CITY: Z��
STATE LICENSE: �
ARCHI'I�ECT/EtiGI�tEER: PHONE:
�IAILL'�G�,DDRESS: CITY: ZIP:
v�ti1E: REGIS'I'R�TION n
TYPE OF ti�ORI�: �Tew Addition Ac,cessory Structure �j____
1�Iove �emode'J:�lce:ation L��Alterauon
PROPOSED�VORh(describeindetail): SrtG�t��`�
S t-�� t� � 2 �_ � ��
�ti� .:�. � u��,�ti ,--��._ ��, l� �
STORIES: SQ. FEET OF EACH FLOOR:
\'O. OF BEDR001�IS: G�,R�GE ST.-�LLS: :�TT. DET.
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ESTLtiIATED CO�'STRL'CTIOti V:�Lti:�TION(escludin�land): � J� V
I hereoy apply for a buildin� permit and I acknowledQe 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 Buildina Code; that I understand his is not a permit and work is not to start
without a permit; and that woric,�11-b,e. in accordance �vith the approved p1an.
<_�- � �
IC�'V�T'S SIGNA� �-- —" DATE: `� � V `� ��
APPL .
! Parade of Homes events require_�e�arate permit a�proval by Police Department and
NOTE _.
City Council 60 days prior to the event. Non-permiited events will not be allowed.
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Sec.13.04 RIGHTS OF SLBJECTS OF D�T:�
Suod. 1. T}•pe of data. The n�hrs of individual on whom che data is scored or to be stored shall be as set forth in this secdon.
Subd.�. Information required to be�iven indicidual. .-�n individual asked to suppty private or conY�dendal dara concerning'tiimse(f shall
be inrormed of: (a) �he purpose and incended use oi the r:auested da[a wi[hin the collecting"state agency, polincal subdivisioa, or stacewide rys[em;
(b)whethzr he may refuse er is leeally required to suopiy tae:equesced daea:(c)any imown consequence arisin;from his supplying or refusing to supply
priva[e or confiden[ial data:and(d)[he identicy of other�rsons or enades au�horized by state or federal law co receive the data. This requirement shall
not apply when an individual is asked [o suppty invesngsave da[a. rursuan[to secdon 13.82, suodivision�, to a 1aw enforemen[o�cer.
The commissiorer oi rever.ue ma� �lac� •^ �o�ce reauired under �his subdi�ision in !he individual ir.com� caz or orooem �ax refu^d
instructions ins[ead ot on ��ose rorms.
Subd. 3. .�ccess to data by individual. L'oon reouesc to a responsibfe au[honry,an individual shall be iniormed whether he is the subject
ot stored data on individuals, and whether ic is classined�s puolic, pnva�e or conridendal. lipon his Curther request, an individual who is the subjec[
of stored private or public data on individuals shall be snown �he daea wichout any charge to him and, if he desires, shall be informed oi the content
and meaning of that daca. .�fter an individual has be�n shown[he privace daea and informed of ia meaning,the da[a need not be disclosed ro hun for
six months thereafter unless a disouce or aaion oursuan[�o �his sec[ion is pending or additio�al data on the individual has been collected or creaced.
The responsible authoriry shall provide copies of the pnca[e or puolic daea upon request by the individual subject of rhe data. The responsiote aurhoriry
may require the requesvne person to pay the actual cosa of making, ceroiyine, and compilin� rhe copies.
The responsible authoricy shall compty immedia[ely, ii possible, wich any request made pursuant ro this subdivision, or wirhin tive days oi
the date ot the requzst, excluding Sa�urdays,Sundays and l:zal holidays, if immediate compliance is no[possible. If he canno[comply with the request
within eha[time,he shall so iniorm the individual,and r.iay have an additional five days within which to compty wirh the request,exciuding Sa[urdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may con�est the accuracy or completeness of public or private
data concernine himszlf. To exercise�his neht,an individual shall no�ity in wricing the responsible authori[y descnbin3[he nacure of the disagreemenc.
The responsibte au�horiry shall within�0 days eicher: ia)correct the data found to be inaccurace or incomplete and aaempt to norify past recipieats of
inaccurate or incomplete data, includine recipients named by che individuat: or(b) nodfy the individual tha[he beLeves the data to be correct. Data
in dispute shall be disclosed only if the individual's se.:cemen[of disagreement is included witn the disclosed data.
The determinacion of the responsible au�horiry may be appealed pursuanc to �he provisions ot the admuusaadve procedure act rela�ing to
contested cases.
D:�T:� PRIVACY �DVISORY
In accordance with M.S. 13.04, Subd. �, "Ri�h[s of subjeccs of data", we w•ould like to inform you that your request
for a permit or iicense irom the Ciry ot Orono or any of its departments may require you to furnish certain private or
confidential information.
r ou a�e no�ified tnat:
i. The information you furnish wiil be used to de[ermine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license.
3. The information may be shared wirh ocher local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requeste� permit or license requires Council action to approve, some information may become
public.
5, You have certain riohts under �1.5. 13.04 (available upon request) to revie�v private data on yourself.
6. Your full name is required to process this application or pemut.
� � ��, G E �+ �_ - C �,, � , _S � :-
First `iiddle Lasc
ZZ `� � ��LI�� F � i��,�
Address
�� �LL �j�� 1Nl Y' ' � 7 j�I � �'�1 � ��1 �_
C�n, State Zip Phone
I under t y righ� as stated above.
Signa[ure
�--
CHECh OFF LIS OFFICE USE ONLyOF PER�tiIITS
FOR
:�DDRESS OR LEG:�L: �� ' �� �' ����� /�-�%�PID:
DESCRIPTIO\ OF ��'OR�i: s�f�
-----------------------------
DATE APPRO : �; ,al �S 5'
ZO\�G RE���V BY: - , �-=�-- —
BUII.DL\G RE�`�titi BY: � • ���-- DATE A.PPROVED: �s - z� ���5-
FEES TO BE C�L-�RGED: �fisc. Fees Calculated By:
PER�IIT YzS � �o
PL:��t RE`ZE��T Y�s �/' �10 � SE`�'ER C0�1�,�CTION
f/ No WATER COi�tNECTION
STATE StiRCH�RGE Y�S paRK FEE
INVESTIG.�TIOti FEE YzS �o `�
SAC Yes No � SITE INSPEC'ITON
Number of S�C LTnits __________ OTHER (specify) _Y _
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-------------- �'
ZO`�G CHECI� LIST Zonin� District: ��-��-' � Shoreland Distnct : —
-� posc O�ce: 5c�District:
Fire Departmenc: ��
Lot Area: Sq.n.
Acres �� � �Vidth Depth
Survev Submi[ted: Yes X
�ro Date of Survey: Z --'-{- ��
Proposed Setbacks:
Fronc �•�C�): N 1✓� Ri�ht Side: 2-��
;���
Re:r (�` i J` Left Side: �
Adjacenc Structures: /2� �
Wecland: �'���
r Peak Hgi.
Building Hei�hc: Def. Hgt. V• �-
.�vg. Secback: °
Bluif Setback: r ot Covera�e:
Esistin ` Prop sed
Hardcovez: ���
7 -250'
� 0-�00'
� 0-I000'
Hardcover Varian e Required: es No Dat of Council pproval:
Grading: Scaif � proval Da�e: Bv: Council � proval Dace:
Sea[ic: Staif .�p roval Date: B`'� -r---
• I
Zoni.n� Fiie: �
Resolut n: � ?� � Resolution Da e:
_ ,`
��,�5 (inr house):
26
BL�,DL\G RE`�Z�' CHEC� LIST
UBC: v - t CONSTRliCTION TYPE: �°(�L
Sq Footase 5 Per Sq Ft�
Basement z —
lst Floor t —
2nd Floor c —
Gara�e T —
C -
TOT.-�L
Estimated Construction Value: � ��` t"�
Inspections Required: ��'ork Requiring Separate Permits:
Site Plumbin� Fire
Hardcover Removal :�lechanical tiVa�er Connection
Foocins Sepcic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wali Board (Mfg.) Well (State Permit)
D� Final Grading/Filling Eleccrical (State Permit)
Other
REI�I�tKS (L�i HOL'SE):
--------------------
REVIEW BY OTHERS: DATE:
Access: Existin� �eW
Access Approval: Date BY�
REl��1ARKS (TO BE NOT`ED ON PER1tiTI'1�:
27
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CERTIFICATE OF SURVEY
FOR: HUSSMAN INVESTMENT COMPANY
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Wes+ � 96Z.7
,-- 20�.43 Y 6s ;Q sa -- �Y9c3.� x �I
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' ',�y Drain��U��'I;iy %nsemc,rr — — — — — — Y�---o—a , � ', I �
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LEGAL DESCRIPTION ��
LOTS 3 & 4 , BLOCK I , NAVARP,O � ,
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, �
v
vl
c
a
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o Denotes iron monument Proposed lowest floor elev. _
o Denotes offset stake Proposed top of foundation e�ev. _
x 000.o Denotes existing elev. BENCH MARK:
(000.o) Denotes Proposed elev.
Denotes surface drainage
Proposed garage floor elev.=
�evrs�d z/i�(s3
I hereby certify that this is a true and correct representation of a survey of File No.
the bounJaries of e above described land and of the location of all buildings, 3475�A
DEMARS - GABRIEL if any, thereon, d all visible encroach nts, if any, from or on said land.
LAND SURVEYOftS, INC. L1 Y o f e��U�� �9 g3 Book — Page
As surveye b e this ,�
3030 Harbor Lane No. �i ��5 � ��
Plymouth MN 55441 �'�
Phone: (612)559-0908 1 j Scale
\ Minn. Reg No. g��� �r''�O/
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