HomeMy WebLinkAbout1996-007895 - found/flr repair * PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;E;l:;=�}�h•fi:�
Crystal Bay, Minnesota 55323
Permit Number: ,_;,E j;,,;��.�,
(612) 473-7357 Date Issued: f�yN�F i��:,r,�t=.
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — �'����1 i c ar-�t. —
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APPLICANTPERMITEESIGNATURE ISSUEDBY:SIGNATURE �-'��l��
. � DateReceived: j - %�
Total Fee: � ���� 7� C � �
Date Approved:
� Permit#: �7.�;='_7
Entered By: ���
CITY OF ORONO - BUII�DING PERIVIIT APPLICATION
ALL Ti�TF'OR1tiIATION I�fUST BE SUBi�ITTTED IN FULL BEFORE PLAIv REVIEW WILL
BE STARTED
_- ---------------------------------
---- --- - --------
THE APPLIC�i:�T IS: (circle one) OWNER OR CONTRACTOR
JOB SITE �DDRESS: ��.��,���a�� bc�.0 �uac ZII': 5 ���� �
� PHONE: (home) y 1 �-�5��
N�vIE OF O`�YER: �}���`;n ��,1',�L r .��,�_
(work) y 7 3- 3�o(� Ca
�IAILING ADDRESS: �3�1 S l�r�US'� �c�� �� CITY: ,�'/�p't�r'�L ZIP: 5 5 3G �
° PH0�1E: �'� �' lU�'I�
CONTRA.CTOR: L IX1 ' l n'�`
MOB HO�IE/PAGER:
v1AILING ADDRESS: (0�5 �I� CITY: �,�����,v�� ZIP: ��3 r,�-'
ST�TE LICENSE: #
��HI I r,CT/ENGI�tEER: PH^vivr;:
MAILING ADDRESS: CITZ'� Z�'
��y�: REGISTRATION #
TI'PE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration �_ Land Alterauon
P OPOSED�VORK(describeindetail): ���Q�► � � �9�roc�k �nc�. -�.'-1'1��1 'ti'►�
� - ��
STORIES: �_ SQ. FEET OF EACH FLOOR: �10� �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. )C �
ESTL�L-�,TED CONSTRUCTION VALUATION(eYcludingland): �y���
I hereby apply for a buildin� 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 Buildin� Code; that I understand this is not a permit and work is not to start
without a permit; and that the w k will be in accordance with the approved plan.
��� � � �
APPLIC�`TT'S SIG�TATURE: CLu1�.Cu� '��11 DATE: � '�- ��l�'
NOTE! Parade o�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 SLJB.TECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored oc ro be stomd shall be as set forth in this secaon.
Subd.2. Information req�rired to be give°md�v�dual' p'°�ndividual asked to supply private or confidendal data conceining himself sha11
be informed of: (a)the purpose and inrended use of the requested data within the collecdng'state agency,polidcal subdivision,or statewide symm:
(b)whether he may refuse or is legally requiied to supply the ceQuested data;(c)any known coasequence arising from his supplying or refusing co supply
private or confidenaal dara;and(d)che idenary of other persons or entiaes authorized by state or federal law to receive the dara. This requirement shatl
not apply when an individual is asked to supply investigaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav lace the nodce re uired under this subdivision in the individual income tax or rooem taz refund
inscrucaons instead of on those forms.
Subd. 3. Acccss 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 whe[her it is ciassified as public, private or confidential. Upon his further request, an individual who is the subject
of stored private or public dara on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the con[en[
and meaning of that data. After an individual has been shown[he private data and informed of its meaning,the data need not be disclosed to him for
six months thereaf[er uniess a dispute or acrion pursuant to this secaon is pending or addidonal data on the individual has been collected or crea[ed.
The responsible auchoriry shall provide copies of the private or public data upon request by che individual subject of the data. The responsible authoriry
may require the requesang person to pay the actual cosu of making, cerrifying, and compiling the copies.
The responsible auchority shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is no[possible. If he cannot comply with the requesL
within[hat time,he shall so inform the individual,and may have an additional five days wi[hin which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeness of public or privace
data conceming himself. To ezercise this right,an individual shall notify in wridng the responsibie authonry describing the narure of the disagreemen[.
The responsible au[hority shall within 30 days either: (a)correct the data found to be inaccurate or incomp(ete and attempt to nodfy past recipieau of
inaccutate or incomplere data, including recipiencs named by the individual;or(b) noufy 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 determu�ation of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relating to
contesced 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 to furnish certain private or
confidential information.
You are notified that:
1, The information you furnish will be used to detemiine your qualification for the pemut or license requested.
2, You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3, The information may be shared with other local, state or federal agencies to the extent necessary to process
the permi[ or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j, You have certain ri�hts 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.
� l � ` � �-T I�ZTU Y'YYl�C��1
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A�ress �' � 1� ���C� 1 '"l � � " l�� L
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Ciry
u derstand my rights as stated above.
C�,�� � 1..��LK-�'��
Signamre
�
. CHECK OFF LIST FOR ISSUA1tiCE OF PERMITS
FOR QFFICE USE C�NLY /
f1DDRESS OR LEGAL: 3 �/,5� �`'�L�j.�ie-� ���c� ��<it
PID: /7 � ii - .� � �/ �%G /�
DESCRIPTTON OF WORK: i=��-�v��� n a� ,— t=��� '� i'� C;v-�:�1C:�.
ZONING REVIEW BY: �� r'R DATE APPROVID: tf-Z�= `�+�:
BUII.DING REVIEW BY: , � DATE APPROVID: `i- u `r�
------------- ---------
FEES TO BE CHARGED: Misc. Fees Calculateci By:
PERMIT Yes � No
pL�J ��w Yes _� No SEWER CONNECI'ION
STATE SURCHARGE Yes �/'� No WATER CONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTE INSPECTION
Number of SAC Units OTHER (specify)
-- --------------------------
ZO�iG CHECK LIST Zoning District: G./�- ��— Shoreland District : x�=5
Fire Department: Y►�w,=.v.>' Post Office: ������� School District: ✓��-��'
, ' ,4� Width r5�-' Depth
Lot Area: Sq.ft. ('`1�S 3'- Acres �j t;��'
Survey Submitted: Yes �_ No Date of Survey:
����
Proposed Setbacks: �
F�t (Lake): `{5 Right Side: (.�Y��`
�ear (Street): ti'(/F Lefr Side: `f 5� '�
Adjacent Structures: ��`�-�� Wetland:
Building Height: Def. Hgt. /L'� i � Peak H�t.
Avg. Setback�,��� Bluff Setback: /�-� �� Lot Coverage: r�-(.G�
Existin� Proposed �,
' 3� •� (�;
Hardcover: 0-75' -3�
75-250' � L= �c� �"'Z .�`1�
250-500'
500-1000'
Hardcover Variance Required: Yes /� No Date of Council Approval: � - 12-`14:
Gradin�: Staff ?�pproval Date: •'����' By: Council Approval Date:
Septic: Staff Approval Date: IZ•(/1 By�
u -�.-� � Resolution Date: ����—���'
Zoning File: n �-� � � Resolution: #
RE�.'�iARKS (in house):
�
BUII.DPi 1G REV�W CFIECK LIST
usc:
v - 1 co�vsTxuc�o�v �E: �ti
� Sq Footage S Per Sq Ftg
Basement R
lst Floor �
2nd Floor R
Garage c
C -
TOTAL
Estimated Construction Value: � 5 ��'����
Inspections Required: «'ork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Ivlechanical Water Connection
—� Footing Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_� Final Grading/Filling Electrical (State Permit)
O[her
RENI�,RKS (IN I30USE): - �
- ---------------------------- -
��W BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date BY�
- --------------------
REI�iA.RKS(TO BE NOTED ON PERl'�1IT):
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