HomeMy WebLinkAbout1996-008440 - land alteration � PERMIT
. CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �:`_��.`� ,!:.?`����.��.?�
Crystal Bay, Minnesota 55323 Permit Number: +ii;;,��c��,
(612)473-7357 Date Issued: ��_;i i_};-;l��s=,
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OV�II��.R; � f��E�'�'�- �=`'����� v��
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APPIICA PE ITEE SIGNATURE C ISSUED BY:SIGNATURE �:��"'C`
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Total Fee: $ Date Received:
Entered By: C,e; Permit#: ����
CITY 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 CONTRACTOR
, �, , ZIP: S� '��i �
JOB SITE ADDRESS: � �'�` '� � ?�'�'� . �,E '�. �
�� � � � _� ,,, ��cl:•r�...,PHONE: (home) �}��'UC',��U
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NAME OF OWNER: �C�,�.� ! �
(work) (r� ��.���j - C� `����I
MAILING ADDRESS: �� ,G � �-�-�C_C'��,=• � `_.�`- CITY: ,�_� 's', c` ZIP: ,S�`� �
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CONTRACTOR: � � '� cat .�.L�--�� �.�x �L �'''���PI'IO�
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: Z��
STATE LICENSE: #
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 detain: �% ' '� � - � � '`—
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+ �7����� . '�Y: �L':..i �-� -� / �_l Y\.0 u�.,-y-, GL�C �4,�� � �l.� l-' ,i.� �'���K�-1Ly���
STORIES: SQ. FEE�OF EACH FLOOR: p�
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. h�`_�
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 accQrdance with the approved plan.
�, � CJ `r�
APPLICANT'S SIGNATURE:� ,�E,�c.�.,T _ �-':��-- DATE: C� - / � l '
:� i'
NOTE! Parade Qt'Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
�
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 s[ored shall be as set forth in this section.
Subd.?. Information reqirired to be given individual. An individuai asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecang'state agency, poliocal subdivision, or statewide system;
(b)whether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
privare or contidendal data;and(d)the identity of o[her penons or endaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdeadve dara, pursuant to secdon 13.82, subdivision�, ro a law enforcement o�cer.
The commissioner of re�enue mav pface the nodce reauired under this subdivision in the individual income tax or propem tax refund
instruc[ions instzad of on those forms.
Subd. 3. Access to data by indi�zdual. Upon request to a responsible authority,an individual shall be informed whe[her he is the subject
of stored data on individuals, and whether it is classified as public, private or confidenaal. Upon his futther request, an individual who is the subjec�
of s[ored private or public data on individuals shall be shown the data wi[hout any charge to him and, if he desires, shall be infomted of the conten[
and meaning of[hat data. Aher an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hirn for
six mon[hs thereafter uriless a dispute or acrion pursuant to this secdon is pending or addidonal da[a on[he individuaf has been collected or creaced.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of che data. The responsible auchoriry
may require the requesting person to pay the actual costs of makine, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to[his subdivision, or within five days of
the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot compty with the requesc
within that time,he shall so inform the individual,and may have an additional five days wi[hin which to comply with[he request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest[he accuracy or completeness of public or pm•ate
data concerning himself. To exercise[his rieht,an individual shall notify in wri[ing the responsible authoriry describing the na[ure of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienrs of
inaccurate or incomplete data, including recipients named by [he individual; or(b)notify the individual tha[he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data.
The determina[ion of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act reladng 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 ro 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 agencies to the extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j. You have certain riQhts under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
First :�tiddlz Last
Address
Ciry State Zip Phone
I understand my rights as stated above.
,
, ___.i
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�. -.. ..... ' ��'` Cy� _"__"_..._ .. ...._.
Sign t}�r
� CHECb OFF LIST FOR ISSUr�I�iCE OF PERi1-iITS
FOR OFFICE USE ONLY
�DDRESS OR LEGAI.: I�i�� �`��`'''��r+
PID:
DESCRIPTION OF WORK: ��'_'�l��rv��
ZOY�1G REVIEW BY: ' �,L�� 1��� �''l��'� DATE APPROVID: � - z � - `��:
BUII.DI�'G REVIE��' BY: DATE APPROVID:
�--�`hn'�'7 Misc. Fees Calculated By:
FEES TO BE CHARGED: -
PER'vLIT Yes � No
P�N ��� Yes No .�- SEWER CONNECTION
ST.�TE SL�RCHARGE Yes No � WATER CONNECITON �
INVESTIGATION FEE Yes No �' PARK FEE
SAC Yes No / STI'E LNSPECTION
Number of SAC Units _ OTHER (specify)
--- ------------- —
ZOv .7�ti G CHECK LIST zoning Disuicc:
Shoreland District :
Fire Department:
Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes
No Date of Survey:
Proposed Setbacks:
Fron[ (Lake): Ri,Qht Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
�'� � Building Height: Def. Hgt.
Peak H�t.
�
Avg. Setback: Bluff Setback: Lot Coverage:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500' —
500-1000'
Hardcover Variance Required: Yes No
Date of Council Approval: __
B Council Approval Da[e:
Grading: Staff Approvai Date: Y�
Sepric: Staff Approval Date: BY�
Zoning File: � Resolution: # Resolution Date:
(in house): +n f'l�.�s��ti � ;�i�t'� � � ��c r s'r��� ���-,:�;i� '
��,F� /
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BUII.DI�i 1G REVTE�' CHECK LIST -
�C: CONSTRUCT'ION TYPE:
Sq Footage S Per Sq Ft�
Basemen� �
lst Floor R '
�.'� 2nd Floor z _
Garaoe c
` � _
TOTAL
Estimated Construction Value: �
Inspections Required• �irork Requiring Separate Permits:
Sice Plumbin; Fire
Hardcover Removal �lechanical Water Connection
Foocing Septic Sewer Connec�ion
Framin� Fireplace Lawn Irrigation
Insulacion (Masonry) Other
Wali Board (Mf�,) Well (State Perm.it)
�Final Grading/Filling Electncal (State Perm.it)
Other
P:��IV7(ARKS (IN HOUSE):
- ----------------------- -
REVIEW BY OTHERS: DA'I�E:
Access: Ezistin� �eW
Access Approval: Date BY�
- ----------
RE1l�iARKS (TO BE NOT'ED ON PERII�IIT):
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DATE TIME
CITY OF ORONO CALLED IN !�- i:: i k'
INSPECTION NOTICE SCHEDULED �� " 4 �
PERMIT N0. � ���� COMPLETED
ADDRESS L.rS� �
��e'/- <"'C z ,( ,f�
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OWNER /2.� �.,_, ; :.,� �,� _,�. CONTR.
TELEPHONE NO. �f J l - c. <_' �1
� DESCRIPTION `�/"�-F��C-_'-r-c' 't;�
� 01 FOOTINQ 11 MECHANICAL RI � 18 IXCAV/GRADIN�/FIWNQ
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q .
= 85FINAL_. ' 14 SEWER HOOK-UO 06 PROGRESS
~ ��D7 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d �VORK SATISFACTORY:PROCEED JPROJECT COMPLETE
WL CORRECT WORK 8 PROCEED �� ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONOITION WITHIN HOURS. r pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
��� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Catl for the next inspection 24 hours in advance.473-73�J7
OwnedContractdr����
Inspector. �--�4 ���•
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White Copyllnspector's File Canary CopylSite Notice