HomeMy WebLinkAbout1195-007011 (Shed) PERMIT
CITY �F ORONO { '
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE: - ,:-: �;_r:.,,_;
Permit Number: �`s+��;';�-�! �
Crystal Bay, Minnesota 55323 = = = _
(612) 473-7357 Date Issued: . _.. _ _ . .
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: O_yUNER:. :
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, _ , ' CITY OF ORONO - BIIIZDING P�R�LIT APPLICATION
Date Received:
Total �ee: S �
Date Approved:
��tered By: � "`'� � '� �
1
Permit?: �
AT•T• INFORMATSON MIIST BR SLTBMIT'�ED IN FffI�I' BEFOR.E PI,�N RES7IEW WII�L BB STAR�ED
( See Check-eff List Enclosed}
--------------------------
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THE A.PPLICANT IS: ( circle one) OWNER ar CONTRAC�OR �
S'�D ZIP:
JOB SITE ADDRSSS:
(warx)
'�A� OF OWNER- � (MO��,�1 '� �`C�-Pe-`� ��'" PHONE: (home) �"7�-�3 S
MATI,ING ADDRESS� `��� �f�2� �_ CITY: W�� ZIP: � S3`'( �
PHONS:
CONTRACTOR:
2��SLSNG ADDRESS: CITY: ZIP:
STATS LICENSE: n
�CHSTECT/ENGINEER: PHONE:
:dAII,ING ADDP,.ESS: CI�: 2��:
x�: RBGISTRATION ;=
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TYPE OF WORR: New Addition Accessory Struct�are .o Te_
DP�o Re.*nodel/Alteration Renovate Land Alterat�on
�ROPOSED WORR (desc ibe 3.n deta�l) :
! � �t�fl.� L°
STORISS: SQ. FEET OF EACH FZOOR:
,,�Q_ OF B�gpp�: GARAGS STALLS: ATT. DET. !�
�STIMATED CflNSTRIICTION VALUATION (eaclnding Iand) : $
� hereby �DL71Y for a building permit and I acknow].edge that the informatio=
above is complete and accurate; that the work will be in conformance with thE
�rdinances and codes of the City and with the State Building Code; that �
•�nderstand this is not a permit and work is not to start without a Fermit; anc
�'�at the work wil.l be in accordance with the approved plan. �
A.PPLICANT'S SIGNATURE:
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Post Office Box 66•Crystal Bay, Minnesota a5323•Municipal OfSces
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� _ e � On the North Shore of Lake Minnetortka
DATA PRNACY 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
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 iicense requested.
2. You may refuse to supply data, but refusa3. may require that
the City deny the permit or Iicense.
3. The iniormation may be shared with oth=o esscthe p rmit or
federal agencies to the extent necessary to p
license.
4, If your requested permit or Iicense requires Council action
to approve, some information may become publ.ic.
5, You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Your full name is required to process this applicaticn o�
permit.
��y �U�. .�`
First Middle Last
� � C� �rz-cz�--r-�' �v�s
Address
r �,�.r��,�ar ����.( �-i � J�"[ �
���r�
City State Zip
�2 c� ` ��3 S
Phone
I understand my rights as stated abcve.
�
Signature
BUILDING&ZOMNG—4�3-�357
• ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —��3-�359
ASSESSING
` , .
�.� �G� �g ��TECZ'S OF DATA
Subdivision L 'ryPe
a f �t,a, The rights of in�vl�u� on whom the data is
stored or to be stored shall be es set forth in this section. An.individual esked to
Subd. 2. Informatioa required to be given in�vi�uaL
� 1 rivate or confidentiel data concerning himself shell be informed of: (a) the
suop y p
P
urpose and intended use of the requesm d �b�t whether he maverefusesort is eg�S
political subdivision, or statewide syste , �oWn consequence arising from
required to supply the requested dat8;
(c) ar►Y
su 1 in or refusing to supply private or coo=1 fe�ef� agw to reaeive he data.itThis_
pP y g 1 investigative data,
other pe:�sons or entities autWhen a bndi idual is asked to supp y
requirement shall not apply to a law enforesment officer.
pursuant to section 13.82, subdivision �,
The commissioner of revenue mav olac�V �Ex re�und instauctionsu nsteaahoi
subdivision in the individu8l income tax or Rroper
on :�`�ose orms. � --- � .
tQ �� by ����. IIpon rec}uest to a responsible
Subd. 3. Accffi
authorit , an indivfdusl sha11 be informed whetbh�ec h r vate�or confident al.e Upon his
y ified as p -1 � P ublic data on
individuels, and whether it is class
e to him and, if he desires, shall
further request, an individual who is the subject of stored private or
individugls shall be shown the data withou�f an�y ��a. �ter an individual h� been
6e informed of the content and meaning the data need not be �isclosed to
shown the private data and inf ormed of i� ute or$action pursuant to this section is
him for six months thereafter unless a �SP n request by
� endin or additional data on the individual h� gte or p blic datarupoeated. The
� P g. reauire the
responsible authority shall provide copi�The hres onsible authority maY �in the
the individual subject oftrie actual.costs of making, a�rtifying, and comp g
requesting person to pay -
copies. ssible with any request
The responsible authority shall comoly immediately, if po � uest,
made pursuant to this subdivision, or �th liday5,�f Simmediateatcompliance e� the
excluding Saturda�5, Sundays and leg
possible. If he cannot comply with the request within that time, he shall s linV°ith the
individual, and meY hs�e er► 8dditionai five deys within which to comp y
and le al holidays•
request, excluding Saturdays, Sundays g
�e when �ata is not accurate or complete. An individuel maY
Subd. 4• P� rivate data concerning himself. To
contest the accuracY or completeness of public or p the responsible authority
exercise this right, an individu8l shall notify in ti"�'��e authority shall within 30
describing the nature of the disagreement. The respo lete and attempt to
days either: (a) correc: the data found to be inaccurate or incflmp
notify past recipients of inaccurate or incomple t�he beI eviesdth rdatalt° be cor ect
the individu8l; or (b) notify the individual tha eement is
Data in dispute shall be discl ta d only if the individual's statement of �8� t to the
• included with the �sclosed da ealed p�u�
' The determination of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases•
. CggCR pFF LIST FOR ISSIIANCE OF PERMITS
' + • 'FOR OFFICE USE ONLY
a�,� � PID:
�-�DDRESS OR LEGAL: ��Q _
D$SCRIPTIaN OF WORR: ------------------------------
-------
--------
-------- DATE APPROVEDs
ZONING RE�7IEW B`I'
DAT$ APPROVED:
BIIILDING REVIEW BY: -------- ------------
-----------------
-----------
FEES TO BE CHARGF.D• Misc. Fees Calculated By:
PERMIT Yes� No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes�
�o WATER CONNECTION
Na pARK FEE
Ii1VESTIGATION FEE `�eS Na SITE INSPECTION
SAC YeS OTHER ( specify)
�Tumber of SAC Units --------------------'-
-----------------
---------
-- Zoning District:
ZONING CHECR LIST
Fire Department:
Post Office• School District:
Lot Area:
Width: Depth:
y G No Date of Survey:
Survey Submitted : e-
Proposed Setbacks : Right Side-
Front (Lake ) :
Rear (yi�'��: ��t Left Side: �� �
Adjacent Structures :
Q� Wetland:
Buil.ding Height: Def . gt•
Peak Hgt.
Lot Coverage:
Avg. Setback: proposed
Existin
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes NO
ate of Council Approva).:�_
Grading: Staff Approval. Date: By�
Council Approval Date :
Septic: Staff Approval Date: '�y=
File• # Resolution # : Resolution Date:
Zoning -
gEMARRS (in house) : �
BQILDING REVIEW CHECR LIST , � • .
IIgC: CONSTRIICTION "1'YpE:
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor x
2nd Floor X -
Garage X -
x -
TOTAL
Esti_mated Construction Value: $
Inspections Rern,;red: Work Requiring Separate Permits:
Site Plumbing Grading/Fil.ling
Footing
Mechanica� Fire
Framing Septic Water Connection
Insul.ation Fireplace Sewer Connection
Wa�l. Board (Masonry) Lawn Irrigation
Final (Mfg.) Other
Other Wel 1 (State Permit)
. _ _ Electrical (State Permit)
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�F.MARKS (IN HOIISE) :
---------------------------------------------------
R�?VIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
------------------------------------------------
RF.MARKS (TO BE NOTED ON PERMIT) :
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CERTIFICATE OF SURV�Y fOR �
DRAPER M. JAFFRAY "'�;��' � �4 { �
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• OF LOTS 18.17,18,19,20521 BLOCK 14,MINNENTONKA Bl„�tF(� �' . e i�
�:� S �; ,
IHENNEPIN COUNTY,MINNESOTA
60�
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_ •: Iron Marker Found
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— '—" '—' De�rings stiown nro
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I LEGnL DF.SCRIPTION:
�� �y� Lo[s 16,17,18,19,20and21, Block 14, Minnetonke Dluffs
This s�rvey showa che location of an existing house,dock
and qarage nnd proposed addition and garnge, It docs
not purport to show any othcr imprbvements or •
cncroachments.
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