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�ERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: ' �."=-
, Crystal Bay, Minnesota 55323 `":��': =�.'��_'��'_ _
Date issued: ;.;�. ;:.,:.,;:�:_;
(612)473-7357 � ' - ' `
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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AP ICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� ' �� ��1 Date Received: .5-%�� %
Total Fee: $ � � • ,� y
, Entered By: ��_ Permit#: //�j�
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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 IS: (circle one) OWNER O ONTRACTOR
JOB SITE ADDRESS: ,�5 C V��/{� T �L /�C',f ZIP:
NAME OF OWNER: ,�/��'� �N f�G/��v�ss y PHONE: (home) 7 y5- 9/o I
(work)
MAILING ADDRESS: S�4-�-<<= CITY: c�< o��o ZIP:
CONTRACTOR U �KLi./� fi�o,�� �•�-,�'����e,��s c���, PHONE: _5 ?-�-/��2v
CONTACT PERSON: /�j���„2�r ��,C�2�LL MOBILE/PAGER: r�5 - �s i �
MAILING ADDRESS: y k 3� ,-�yz ST. �� E . CITY: �1�;s. ZIP: ssy 2�
STATE LICENSE: # Y 7 7,�
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 detai�: �'P.�,,,� ��G'L,4ct s��rF=% r-fs��A to f--�;rN
���Iu1/Ii"✓ /L-r."'-c:.✓c' �cE'y:c.aC2 �ii.' !TF'12
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��/o o . ��r�
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.
APPLICANT'S SIGNATURE: �����.� DATE: as"- o �-% I
NOTE! Parade of Homes events require separate pernzit approval by Police Department and
City Couneil 60 days prior to the event. Non permitted events will not be allowed.
5
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. i. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the coliecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidenual data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigadve data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or proaertv 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 whether it is classified as public,private or co�dential. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this secuon is pending or additional data on the individual has been
collected or created. The responsible authority 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 cosu of making,certifying,and compiling the copies.
The responsible authoriry 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 immediate compliance is not possible. If he cannot comply with
the request within that time, he shall so inform the individual, and may have an additional five days within 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 accuracy or completeness of public or
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients 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 authoriry may be appealed pursuant to the provisions of the administradve procedure act relating
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 to furnish certain
private or confidential information.
You aze 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 permit or license.
4. If your requested permit 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.
/L�.9/ZG,c2� i i,. /1-tr,2R E«
First Middle Last
`/�' 3YL ;iz s i /' �
Address
/t'��^5 ,,,, ,�, SSY�I ��z—S72_-i�=�v
Cih, State Zip Phone
I understand my rights as stated above.
Signature
6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
, FOR OFFICE USE ONLY
ADDRESS OR LEGAL:
PID:
DESCRIPTION OF WORK:
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ZONING REVIEW BY: DATE APPROVED:
BUILDING REVIEW BY: DATE APPROVED:
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L,ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
ist Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical 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)
Other
REMARKS(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 PERMIT�:
8
- THIS OLD HOUSE
Minnesota Statute 273.1 l,subdivisions 16& 17 provide for exemption from property tax for all or a portion of the value of
improvemerits made to homes 35 years of age or older. This law,commonly referred to as"This Old House"is effective for
improvements made through January 2,2003. This program provides for the value of new improvements made to qualifying properties
to be deferred from taxation for up to 10 years. The value of the improvements would then be phased in over a period of 5 years.
To qualify for this exemption,your property must meet thc follorving requirements:
1.The property must be 35 years of age or older at the time the improvements commence.
2. The property must be receiving the homestead classificltion or will be receiving the homestead classification by December
' lst of the year the improvement is begun. This includes property classified as residential homesteads(including duplexes&
triplexes),relative homesteads, disabled homesteads,agricultural homesteads,townhomes,and condominiums.
3. The total estimated market value of the property on January 2nd of the assessment year in which the improvements are
made(residential property=land and shuctures;agricultural property=house,garage,& 1 acre)must not exceed$150,000
unless: the property is located in a city or town in which 50%or more of the homes were constructed before 1960 based on
the 1990 census,and the city or town's median family income based upon the 1990 federal census is less than the statewide
median family income based upon the 1990 federal census. (The cities of Minneapolis,Hopkins,Excelsior,and Spring Pazk
meet these requirements.) Properties with an estimated market value of$300,000 or more on January 2nd of the assessment
year in which improvements are made do not qualify for value exemption. The requirements in#3 apply only to
improvements that werc bcgun,and applications that were made after,July 1, 1994.
You must make application with the county assessor by July 1 in order to qualify your property for exemption from the property
tax.
Once an improvement has been designated for exemption,it cannot be repealed or replaced.
THE DEADLINE FOR MAKING APPLICATION DEPENDS ON WHETHER YOUR CITY OR TOWN REQUIRES
BUII.DING PERMITS. If your city/town requires building permits,you must first obtain a building permit for construction of the
improvement before the work commences. You must complete the application for the exemption and return it to the assessor's office
before July lst of the assessment year in which improvement is first added in order to qualify for exemption in that year.
If your city/town does not require building permits,you must make application for exemption BEFORE the improvement is begun.
If your city/town requires building permits only on certain types of improvements,you must make application for exemption of
those improvements not requiring a building permit BEFORE the improvement is begun.
An application for exemption must be made within 3 years of the date of the permit. The property would then qualify for the
remainder of the 10 year exemption period.
* Only improvements made to the residence and garage,or the construction of a new garage qualify for the exemption.
* Only improvements with a value of$1,000 or more made to the house and gazage of a property receiving a homestead
classification qualify for exemption from property tax.
* The exemption may be applied to no more than three separate improvements made to the house and garage. Improvements
made to the site surrounding the home do not qualify for exemption.
* The value exemption is limited to one two-car garage(600 square feet)per residence. NOTE: If you are converting an
existing garage into living space,you must clearly state on the application your intent to convert the existing garage into living
space.
*A maximum of up to$50,000 of the improvement value added by the assessor may be considered for the program.
* Houses 35-69 years old qualify for 50%of the assessor's improvement amount up to a maximum exemption amount of
'.$25,000. Houses 70 years of age or older qualify for up to 100%of the assessor's improvement amount to a maximum of
$50,000.
" * If a house is moved from its original site and is at least 35 years old,additional improvements done to the property may
qualify.
The following improvements do not qualify for exemption:
*If more than 50%of the square footage of a house is voluntarily razed or torn down,the original house is deemed to no longer
exist;and,as a result,the value of any improvements would not qualify for exemption.
*If any combination of improvements double the size(above grade gross building area)of a structure,any improvement that
further increases the size of the structure will not qualify for exemption.
IF YOUSELL OR OFFER YOUR PROPERTY FOR SALE, YOU MUST DISCLOSE TO PROSPECTIVE BUYERS WNETHER ANY
IMPROYEMENTS MADE TO YO UR HOME ARE EXEMPT FROM THE PROPERTY TA.� YOUARE ALSO REQUIRED TO NOTIFY
B UYERS THAT THE EXEMPTION WILL TERMINATE WHEN THE PROPERTY IS SOLD. INADDITION,IFA PROPERTY LOSES ITS
HOMESTEAD STATUS, THE EXEMPTION EXPIRESAS OF THE NEXT ASSESSMENT DATE. .
Upd9/97 TO APPLY: Call City Assessor at 473-1844