HomeMy WebLinkAbout1995-007108 - addition & remodel a PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 - < - -
Cr stal Ba , Minnesota 55323 Permit Number: � � �� ' _
y y Date Issued: '�-�-'�?'�'-'�_
(612) 473-7357 - - - -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: -- . , _. _. _ -:�: - - - _. : _ OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �.-C�,-
, - � CITY OF ORONO - BUILDING PERMIT A.PPLICATION
Date Received: � � `� �����
Total ree: $ � .� 5�, � � `'
Date P.pproved:
yntered By: � � A:
` � Permit tt ��� �
ALL INFORMATION MIIST BE SIIBMIT'�� IN FIILI. BEFOR.E PLAN REVIEP7 WILL B$ STARTED
(See Check-aff List Enclosed)
---------------.�_--------------------------------
------------------------------- - ------.�
THE APPLICANT IS: (circle cne) OWNER or�NTRACTOR �
Jos sz� �Dx$ss: i �,�( 5 �'�o��-S (�o,.,.�- �. o<�� zzP:
(work)
?'1� OF OWNER- ,� �">L � � o.-.�.�; �}- ���^c, ��=��.�1 .;rc PHONE: (home)
�� �o ; k-} '�c�. CITY: C-i: c...o ZIP:
MATLING ADDR.ESS: \G��-�� �a��� �
CONTRACTOR: �c>�' ... �«�w.�r �r S�~� �= �. � � PHONE: `'4`t� - o c 3`7
MAII�ING ADDRESS: \�'�Z_O � (�•:..-���5 � - c�-�.E?- CITY: ��r=�-- �'� �= r�, E- ZIP: `>>�3�1�7- 5���`-{
STATS LICENSE: � �� C `S
ARCHI�ECT�ENGINEER: ���C � c.E= ��� � S c��.,.v..-� d (�`-,._o C'_ PHONE: � 1��1 �� l- ��z
!�ILING ADDR$SS: 3"���> �'t �,.�.�-t «v���. A. �F- � CITY: �, t��_�� �_w-��: ZIP: SS3�il
N�,r� RSGISTRATION A
TYPE OF WOR.R: New Addition x Accessory Structure Move
Demo Remodel/Alteration�_ Renovate Land r�lteration
PROPOSED WORR (describe in detail) : (,c;��' � �- �=`��� F ""���� � �`"�s�1 ��`}`'J -
��� � ,� ��, � ��� ,,� �. -� � �1 �- ��- - !� \�a ��� ,_;_� � ti. �� _
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STORIES: L�{ SQ. FEBT OF EACH FLOOR:
2�i0. OF BEDROOMS: � G�RAGB ST1�IJ�S: ATT. � DET. L
�STIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ \`�� c` �`�' . ��`
T 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
�hat the work wil 1 be in acco dance with the approved plan.
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-- DATE: � 13--��
P�PLICANT'S SIGNATIIREs � ��— .
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�� �.:�� . �p.�.�.��� CITY o� �RON(�
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'�n`�.� � `� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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fi��- �'���t?�' On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
Iicense 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 3.icense.
3. The information may be shared with other �ocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii a�tion
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 Lo review pri�at�
data on yourself.
E. Your full name is required to process this applicaticn or
permit.
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First Middle Last
�o2�S (-� �-� \��� �--� ����
Address
�� ��.. pcc.: � :-�_ � '1�! `� SS�t� - Sc �y
City State Zlp
`"1 `�-� - ��C��'-7
Phone
I underst nd my rights as stated above.
_ _ �
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\ � -- .
ignature�
BUILDING&ZONING—473-7357 • AD!�iLtiISTRATIOti&FIti.a.VCE—473-7358 • PUBLIC WORKS —473-7359
ASSESSING
� � �
513.04
�Gg►� Og �gJECTS OF DATA
S
ubdivision L Type of da�- The rights of individuels on whom the data is
stored or to be stored shall be as set forth in this section. An.individuel asked to
Subd. 2. Information required
to be given in�ivi�uaL
1 rivate or confidentiel data concsrning �am 1 hin the collect ng state gency,
supp y p uested da
purpose and intended use of the req tQm� �b� Whether he may refuse or lfromhis
political subdivision, or statewide sys �c� any �own consequence arising
required to supply the requested datg3 �nd (d) the identity of
supplying or refusing to supply private or confidentiel date;
�• state or federal law to recenvest gat ve data,
other persons or enti�ies authorized by
requirement shall not epply when an individual is asked to supply
pursuant to section 13.82, subdivision 5, to a law enforcement office:.
The commissioner of revenue ma lace tgX re°una i�tauctionsunsteadhoS
subdivision in the individuel income tax or oropertV
on those orms.
t� �� by ����. Upon request to a responsible
Subd. 3. Access
thorit an individugl shall be informed whe blic h rivateeor confident al.e Upon his
gu y' ublic data on
individuaLs, and whether it is classified as p �
e to him and, if he desires, shall
further request, an individu� �L8 Without any chargtored private orvidual has been
individuals shall be shown the of that data. After an indi
�e informed of the content and mearung the data need not be �isclosed to
sh�wn the private data and informed of its u��o�action pursuant to this section is
him for six months thereafter unless g �Sp n request by
' 'n or additional data on the individuel has gteeor p buc datarupoeated. The
, pendi g rovide copies of the pr require the
responsible authority shall p The responsible authority maY ilin the
the individual subject of the data• certif n and comp g
requesting person to pay the actual costs of making, Yi g'
copies. ssible, with any request
The responsible authority sha.11 comply immediatesY�ff� date of the request,
made pursuant to this subdivision, or with lida e �f immediate compliance is not
excluding Saturdays, Sundays and legal Y5�
ible. If he cannot comply with the request within that time, he shall so in�or h the
P°� }�ve sn additional five days within which to comply
individual, and mgY S�� �d legal holidays.
request, excluding Saturdays, YS
te or complete. An individual may
Subd. 4. Proce�re '�►hen da.ta is not accura �mself. To
contest the accuracy or completeness of public or private data concerning
ht, an individusl shall notify in writing the responsible authority
exercise t� �g eement. The responsible authority shall within 30
describing the nature of the disagr
da either: (a) correct the data found to be i ete datae including ree�Pi�� nam dt by
�
notify past recipients of inaccurate or incomp
the individual; or (b) notify the individual that he believes the data t° beementcis
Data in dispute shall be disclosed only if the individual's statement of �a� t to the
• included with the disclosed data• ealed pursuar►
° The determination of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases•
� CHECR OFF LIST FOR ISSIIANCE OF PERMITS
- �' ' FOR OFFICE USE ONLY
'/ , ,1") � �, '< �f ��lY PID: �7- // 7 - '.:�� / / �c';'C:`'7
ADDR�:S S OR LEGAL:/( y 'l C >
TJESCRIPTION OF WORK: ���I �'�' ��//�=�Lu�C(--
--------------------- ----- ------ -
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ZONING REVIEW BY: DATE APPROVED: fo - Z?-Gi S
BIIILDING REVIEW BY: DATS APPROVED: �' ' 2� '`t 5�
------------------------- -------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �" �o
PLAN REVIEW Yes f�N� SEWER CONNECTION
STATE SURCHARGE Yes�� No WATER CONNECTION
INVESTIGATION FEE Yes No 4�' PARK FEE
SAC Yes No .,� SITE INSPECTION
Number of SAC Units OTHER (specif y)
------------------------------
ZONING CHECR LIST Zoning District:
Fire Department: Post fic • ch�istrict:
Lot Area: Width
Survey Submitted : Yes_�C No Date of Survey: 3 '
ilo -95
Proposed Setbacks : � ' -�.
Pre•r�t (Lake) : � p 3 � Right Side: 7� — 5
�-(Street) : IU/i'a- Left Side: Z5 � �
Adjacent Structures : /�'���i1fC-� Wetland: /v��"
Bui�.ding Height: Def . Hgt. � •�� Peak Hgt. �- �-
� Lot coverage: /V��i
Avg. Setback: C� • - pro osed
Existing P
Hardcover: 0-75 ' �" ° G�{
75-250 ' 2"7. �� Z Y• g�'�°
250-500 '
500-1000 ' --
Hardcover Variance Required: Yes NoQ Date of Council Approva�.:
Grading: Staff Approval D C uncil Approval Date:
Septic: Staff ApprovaJ� at : B '
Zoning File: # solution �- Resol.ution Date:
REMARKS (in house) .
BIIII,DING REVIEW CHECR LIST ' .
. ... _
IIBCs � "3 CONSTRIICTION TYPE: �L/"
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x -
2nd Floor x -
Garage X -
X -
TOTAL
c�
Estimated Construction Value: $ 1�f5/0 00 —"
Inspections Required: Work Requiring Separate Permits:
Site �P�umbing Grading/Fi�J�ing
�Footing o�Mechanical. Fire
Framing Septic Water Connection
�TInsulation _�Fireplace Sewer Connection
Wall. Board (Masonry) Lawn Irrigation
�Fina 1 (Mf g.) Other
Other Wel 1 (State Permit)
�E�ectrical (State Permit)
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�_F.MARR$ (IN HOIISE) :
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REVIEW BY OTHERS: DATE:
Access : Existing New
Access ApprovaJ� : Date BY=
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REMARRS (TO BE NOTED ON PERMIT) :