HomeMy WebLinkAbout1998-010832 - berm PERMIT
C�.TY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;:_„_�;_ ;;�_�=;;:�;;�;
Crystal Bay, Minnesota 55323 Permit Number: , y _ _
Date Issued: '" - �
(612) 473-7357 i ;�� . ,;;i=,:`_=;;_,
SITE ADDRESS:
�. �G_t::� _ :::� ;=��'s•i r��€��
:��.a
�:: r,v �--i =-- --=i1—i�;ii-
DESCRIPTION: '
f;r t�;;;•i .-_ii; :=:!_�r;;,iw: `;`F,;�°!, �
' i�.-:��;' - ,=+i'[;:i '�. T'�C�;=' _...i•-�f`•?'.�� . ,..._f�=. `;-1':,_1`•.M. I
_.._ I
REMARKS:
I FEE SUMMARY:
� ,,.:: : . -: _ . ...: :.
_ . _ .
I
CONTRACTOR: OWNER: __ �,�,�,� ;s;�},t. —
I ��< !i�;;° `���'=-
� i "�t i [_;I I r: i-:'-;',r+;(� �;`Z)
'._ _ j`l;;� "�._:�=�
, �_�.-. - --:--r.�
-r. ::-- L-i- _.�;�:���._,_. . .: -�:��:?�•-:�r 'p:'.-.:.a�:��:- -.3f}S f>^! !"!='�� � � �-?,_ zt"�-`{-::.y ;.._t,}'._ .
} ;"�,:� . °!> ,^c`:_, �{`%_ `i"'i:`_, I`- . Y i-¢,-; � : ., . ...
`•=�-I,_..._. 1 .� i `tt`_ _ _ 9'._f';+"._Y=�=1 �i i•.`�•.� � i�s' _4���t'..`;'.: '
- - ? :.T, -: _ - _ -, ,. .-. n. . - h,} -_ _ . _. . ;�.`�,: ,
_ . ___. _'" I�Li ,i.Js: .- ._.___ ( ;r ^iiJ€ �,1,.�.. is;`•;_!i;;t:, i f,; �:!, , .(�,:�� s_:t_s;°;:-'i_i i-;(°.ii�:i- i.c _ . . . =`sw_i.� t_�1 � . _.
� M_._ "•tf �;``•`�,!4 fVre.�•_�`t� rii`���` _ . ?`a �i�. _. ��i a.! ��w :_`•_'• . ;� ��- :�-�T±�d!.] 4_�t.:`?�' .i��_f !_. ..rf'?�:�'� s �W . �
_� _ .
� �
� I
APPUCANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� Total Fee: $ Date Received:
Entered By: Permit#: ,�C. �? ���,�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT I5: (circle one) OWNE OR CONTRACTOR
JOB SITE ADDRESS: �� , �� ��/�/�// �� � ZIP: S�3S�o
NAME OF OWNER: �/vt�S��US l� �/Gl.f�� PHONE: (home) f�� �T/�/
(work) �S/ `��/(�
MAILING ADDRESS: ��d N � i�/��%� ��� CITY: �Ci LA'X� ZIP: S 5 3S�
�
---�- � / /- Ji�
CONTRACTOR: �/,�/�l�,�JCS!-� f f'l1���Y PHONE: � .�-�/f� � �Q�,r
CONTACT PERSON: �A,tit�S ��U S i� MOBILE/PAGER:�¢�-/� �3 �� 90/-/6/�
MAILING ADDRESS: /� �4 �.P�fI�iJ � CITY: L.��f ZIP: '�5�3
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: ��1i2�!J � �UU G/1) S �ll��/
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.
l
APPLICANT'S SIGNATURE: � r ��,%^� _ DATE: (�� `� � 9�
�---
NOTE! Parade of Homes events require separate pernzit 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 SLTB.(ECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be scored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial dara concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecdng'state agency,polidcal subdivision,or statewide system;
(b)whe[her he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
priva[e or confidential data;and(d)the idennry of o[her penons or enaaes au[horized by state or fede�al law to receive the data. This requirement shall
not apply when an individual is asked to supply invesd2adve da[a, pursuan[to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or propem tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whecher it is classified as public, private or confidenaal. Upon his further request,an individual who is the subjec[
of stored private or public data on individuals shall be shown che data without any charge to him and, if he desires, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hicn for
six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private 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, certifying, and compiling the copies.
The responsible authoriry shall compiy immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,exciuding Sacurdays.Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request
within rhat time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,exciuding 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[his right,an individual shall nodfy in writing che responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall wichin 30 days either: (a)correct the data found to be inaccueate or incomplete and attempt to norify past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible auchoriry may be appealed pursuant to the provisions of che administrative procedure act relating to
contested cases.
� DATA PRIVACY ADVISORY
�,�,' L,
l.'r ,
� " �� � ` 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 permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shared.with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
$, 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.
First �Iiddle Last
Address
C�ty State Zip Phone
I understand my rights as stated above.
Signature
, CHECK Ok�' LIST FOR ISSUANCE Ok' PERltiIITS
' � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ ( �Zc� �,� �� �.,e.,o .
PID:
DESCRIPTION OF WORK: ,C 5-�-� �,/�I� �.��s
ZOYIiYG REVIE�� BY: � � W DATE APPROVED: /a -(o - �t3
BUII..DTNG REVIEti'Y BY• � . . DA1E APPROVED: . .
. -----__—_----------------------=-
FEE.S TO BE CHA.RGED: - ��o�� Misc. Fees Calculated By:
PERMIT Yes C�' No '
PL� ��� Z'eS No SEWF.R CO�tNEC'ITON
STATE SUR`H�,�G� Yes No �A'I�R CO�NECITON
IivVESTIGATION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units � OTHER (specify)
ZONING CHECK LIST zoning Districc: � � c/ �� � M
!�
Fire Departmenr. Post O�ce: School District: � �
Lot Area: Sq.ft. Acres tiVidth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (La.tie): , Ri t Side: '
Reu(Street): Le Side:
Adjacent S[ructures: tiVetland;
Building Height: Def. Hgt• Peak H�t.
a
Lot Coverage•
Gradin?: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: � gy; • � .
Zoning File: # Resolutio : # Resolution Date: �
St�oreland Dis�ict: � �
Avg. Setback: B uff Setback: Lot Coverage: �
� ' E ' ting Proposed
Hardcover: 0-75'
75-250' . � •
250-SQO' . .
500-1OQ0'
Hardcover Variance Required: Yes No Date of Council Approval:
. �
RE1�ZA.RKS ('Ln house): �
z � _ . - .
: �fi ` 26
. ���.. . .
BUILDING REVIEy� CHECK LIST : •
u�ac: . �-- eoYSTxtrcTTov�E: -- _
. Sq Footage $ Per Sq Ft�
Basement� x . � - . �- .
. . lst Floor . � • X - � . - .. �
2nd Floor � - � x -� . _ . . '
Gara�e _ . . . . . _
- x
x
TOTAL
Estimated Construction Value: $ — •
-- Tnspections Required: • Work Requiri.ng Separate Permits:
Site Plumbin� �
Hardcover Removal Fire . . . _
Mechanical Water Connection
Footin� Se tic � '
Framiu� P Sewer Connection - .
Insulation Fireplace Lawn Irrigation
Wall Board (�'IasonrY) Other � � .
�� . (141fg.) Well (State Permit) �
�Other Gradin�/Fillin� Electricai (State Perm.it)
. RE�iS (IN HOUSE): � ~--_------ . -----
------------------------ DATE
--------
REVIEtiY BY OTHERS: - - ----------
Access: Exiscin� New r
• Access Approval: Date •
------------------------------------------- �y�
REMAR��S (TO BE NOTED ON PERitiIXT): ` '� • �r -
i �
�-- ... .. ..�:� � . . : .. . ......__._ . ._. _ .. . . �� � _�__. . ' ' : . . ._.__.-.. .
._ ._.... •' . . • .
. ._ ."__'_ .. _ . . .. __.._._.. ., , - . ,.
_ .'_.. . .. .__ "....� _._. ..-� . �,
._.,_,___ ...:. ..... ..._.._:_ _.
Z` '._.. . • •
�� .
�' . ' _
°�r
CpT �
��
. a
C �
� NORTH 132.01 -
� o o -.,
i�� �i - - - �- - - - - - - - - - - - - -� ;
O� � '�
O� O�' °��^ �� �
. .� , i
,�4� O� .o �' � io
� , i
� � ;
> , � �
- ,' r ,� i
� � ' ' ` �
� � � i • 0
� � � I � �
0 I � -_,��
� 5� � � I
� ' � � C ^ I
-c�
7 � � O C� � �
� a U = � � �^\
� �
� I \ � �
�� \ � � � �
o , _ � o 0
o , , � , �
�, � � � , .� � � � � -�
o C� � 8 � g � � o
� i a �� � � i m
n � � o � �- � % i Z � � �
j :�,.. T ¢ / i 00 . _ � ��
� _ � ('o�oel 1 e � // i cD � (� � �
2 � 8� ?s � i (n � z / �
1_ ♦ ��012 �` I � � V i
Q� - ' Se.a ;a /
-+ $ i � -\ - - - SJ.2 - -�- � v �
�rl �r' °��(���3 � I j �
O - ` �' � T � � � � z
'�• � z � o
� z
i� �'- , � , f;, i fT1 �
� ' C� � \ � � � � �
� ^ � � \o� /� n n
i � O � N, = i
/ � � 1 -- mC0 � �
� � J r g m (� �D � oi � O O � - �
�N u � mO v �� v D � � O
_�
' � m � f Q � • V /
� � � ^ I
� r � � � ��
� `/ ^ � � _ �
I � �
� , �_ � - , _ D;
� ; , . , �° , Z
.,.� , O � _
�',. �' v� ' � � n �, t� ; Z f�Tl �
j �, ,` „� G�P m 7o-� � � I i � O �
/O V, -� ..� I O
p � �, � '�� � � � O O �
, � � � �-� � • � t..�.1
o) i � � �. CR �"' � �
� I � frl Z � � C" L� Q f,_ �.�� � �
� � � � � o � .' z � � Tl �
� o � �4 � i G.l -��'7 , � D
� . n N �, �1 I , _' �
_�-'� _ '��- Q I � /�
-.i Z '�'Ti
� � G �� � � � � �
�: ^ - �� � � c0
� � o -f; �. ]► �r
�
� v ' �� � � p
� v� `
s, _� -�
m
�� � � � r
�;o , Z „ C
I v `' � � � � `
.�
� � � �.
v I � �
1 �
' , � �
� �'' � c , �,�+ N �'
�y � �
- - - - - � v ��o i �o
Z - � ��� i
� � � � � �
o p�j ,o � `'��a � �
(�,� • I �� C� �
'P 0 i I
I �,,1 i
CJ� '
� � - - - - - - - - - - - - - - - - - - - - - - - - - - - - � - - - - - -� ,
_ o 0
� � ` S ���4� 3��� W 235.22
�1-� e0
\i
�� �
�
� �
\ I�,
�; � �>
� � �
� �,
� �