HomeMy WebLinkAbout1998-010098 - pool PERMIT
CITY'OF ORONO PERMIT TYPE: i � �� �: ��
�150 Kelley Parkway- P.O. Box 66 �"Y�•`'�-�'��''�;'
Crystal Bay, Minnesota 55323 Permit Number: �_`!:_'t�'_:�_; �
(612)473-7357 Date Issued: ���:'�'�.�!t'=%_�
SITE ADDRESS:
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APPLICANT- MITEE SIGNATUR ISSUED BY:SIGNATU E
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Total Fee: $ Date Received:
Entered By: -� Permit#: '• ; :,
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER CONTRACTOR
JOB SITE ADDRESS: �� �-�L� �0�t�.1 e��. ZIP: S? 3 s�
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� NAME OF OWNER: 1 � '�� � PHONE: (home) �"'C L" D� L�
(work
• MAILING ADDRESS: '� j��� CITI': � .��ta ZIP: 3 ��
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CONTRACTOR: l �O l PHONE: � �-'���O
CONTACT PERSON: II,E/P G�R: � Q�- o�
MAILING ADDRESS: S t�J C CITY: ZIP: � �
STATE LICENSE: # O
����f�]���, c
ARCHITECT/ENGINEER: ''���' PHONE: CZ��"'"Z"Z�'F�'
MAII.ING ADDRESS: � CITY: ZIP:
NAME: �� �`�?�S REGISTRATION#
1
TYPE OF WORK: New � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
� `
PROPOSED WORK(describe in detai�: `�1�� �(.r-tc� G �•c��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � Ot��O ---
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 accor ce with the approved plan.
APPLICANT'S SIGNA . DATE: � �_
NOTE! Parade o Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
�
Sec.13.04 RIGHTS OF Si1B.1ECTS OF D�.T�
Subd. 1. Type of data. "Ihe righ�s of individual on whom the data is scored or to be stored shall be as sec fonh in this secrion.
Subd.2. Information reqirired to be given indi�-idual. An individual asked to supply private or confidenrial dara concerning himself shall
be informed of: (a)the purpose and inrended use of the reques[ed dara within the collecting'stace agency,polidcal subdivision,or sta[ewide system;
(b)whe[her he may refuse oY is legally requic�d to supply the requested data;(c)any lmown coasequence arising from his supplying or refusing to supply
• priva�e or confidendal data;and(d)the idenary of ocher persons or enrides au[horized by sta[e or federal law to receive the data. 'Ihis requiremenc shall
not apply when an individual is asked to supply invesdeadve dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav plaee the noace reouired under this subdivision in the individual income tax or prooem tax refund
instrucdons ins[ead of on�those forms. .
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of scored data on individuals,and wherher ic is classified as public, privace or confidendal. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he des'ues, shall be infoaned of the contenc
and meaning of chat data. Afrer an individual has been shown the private data an8 informed of its meaning,the data need not be disclosed to him for
six monchs thereaiter unless a dispute or acrion pursuanc to �his secaon is pznding or addidonal data on the individual has been collected or creaced.
7he responsible authoriry shall provide,copies of[he private or public data upon request by the individual subjecc of�he dara. The responsible authoriry
may require the requesring person to pay the actual costs of making, certifying,and compiling the copies. •
The responsible authoriry shall comply immediately, if possible, with any r�quest made pursuant to this subdivision,or within five days of
the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannot comply with the requesc
within chac time,he shall so info�rn che individual,and may have an addidonal five days within which to comply wi�h the request,exctuding Saturdays,
Sundays and�legal holidays.
t, • .
Sub�S.A. �'rocedure when data is not accurate or complete. An individuat may conrest'the accuracy or comple[eness of public or pm•are
data concerning himsetf. To execcise this right,an individual shall nodfy in writing the responsible authoriry describing the nacure of the disagreement.
The responsible authoriry shall within 30 days either. (a)correcc the data found ro be inaccurate or incomplece and attempt to nodfy past recipienes of
inaccunte or incomplete data, including recipients named by the individual; or(b) notify the individual that he believes the data ro be corcect. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
The decerminarion of[he responsibte auchoriry may be appealed pursu'anc to the provisions of[he admuilscrative procedure act relacing 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 Ciry of Orono or any of its departments may require you to furnish cer[ain private or
confidential information.
You are notified that:
1. The information you furnish will be used to d.e[ermine your qualification for the permit or license requested.
2. You may refuse to supply data, bur`refusal may require that the City deny the permit or license.
3. The information may be shared wich other local, state or federal agencies to the extent necessary to process
the pemut or license.
4. If your requested pernut or license requires Council action to approve, some information may become
public.
5. 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 �tiddle Lasc
Address
City State Zip Phone
I understand my ri�hts as stated above. .
Signature
' CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �S C t�R.�s�ro r o�.s C„�2
PID:
DESCR�'TION OF WORK: no
ZO�TING REV�W BY: DATE APPROVED: �-�� -5�
BUII�DING RE'VIEW BY: DAT'E APPROVED: �(—i S —�t�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes v- No
pLAN REVIEW Yes � No SEWER CONNECTION
STATE SUR`HARGL Yes 1/� No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Y;:s No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZO�TING CHECK LIST Zoning District:
��� Fire Department: Post O�ce: School District:
G
Lot Area: Sq.ft. Acres Width Depth
..
Survey Submitted: Yes �. No Date of Survey: ON �t(.�
Proposed Setbacks: ,
Front (Lake): _ ZS� '� Right Side: �QO�
Rear (Street): 1 ti�, * Left Side: ']S �
Adjacent Structures: V�1T"t 1�►CH�"� Wetland: N/M�
Building Height: Def. Hgt. n1/I'} Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
� � Septic: Staff Approval Date: By:
�• Zoning File; # Resolution: #i Resolution Date:
Shoreland DisL-ict:
Avg. Setback: Bluff Setback: I.ot Coverage:
� Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Vaziance Required: Yes No Date of Council Approval:
REMARKS (in house):
� 26
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BUII..DING REV�W CHECK LIST �
UBC: R'3 CONSTRUCTTON TYPE: '�/'i'�
' - Sq FootaDe $ Per Sq Ftg
Basement R =
lst Floor x =
2nd Floor x =
Garage x =
R -
TOTAL
Estimated Construction Value: $ .3�, ��'��"
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal _c�Mechanical Water Connection
� Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) _T Well (State Permit)
_�CPinal Grading/Filling �c. Electrical (State Perm.it)
Other .
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REIIZARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By;
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REMARKS(TO BE NOTED ON PERMII�: �
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