HomeMy WebLinkAbout1994-006187 - land alteration __ _ _ PE�Il�IT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: `-`'''�--� �'`.i�i�'��:�:`
Orono, Minnesota 55356-0815 '=`-'='�'=°`
(612) 473-7357 Date Issued: i:;s:-.E i ;';'°�:.�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - ��,����::_ i c�;����::. -�
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AP T-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
' ' '" CHECR OFF LIST FO1� ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ��5�'I �/a4 K OT�- � U P PID=
D$SCRIPTION OF WORK: �2��N G � ( �� C�� � �- y��S
------------ -- -------------------------_-----`(------------------
ZONING REVIEW BY:_� DATE APPROVED. C� 7`'`�'I
BIIILDING REVIEW BY: Iv I� DATB APPROVED:
-----------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
-- �n�-�n�'�
PERMIT Yes�o
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
--------------------------------------------
ZONING CHECR LIST Zoning District:
Fire Department: Post Office: Schoo� District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake) : Right Side:
( fi 1
Rear ( Street) : Lef t Side: ��
�
Adjacent Structures: S Wetland:
Buil.ding Height: Def . Hgt. Peak Hgt.
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75 ' _
75-250 ' �4,y r�
(J �
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approvalz
Grading: Staff Approval. Date: By: Counci]. Approval. Date:
Septic: Staff Approval Date: BY=
Zoning File• # Resolution # ' Reso]�ution Date:
REMARRS (in house) : .
r ?
BQILDING REVIEFI CHECR LIST �
�C: CONSTRIICTION TYPE:
Sq Footage $ Per Sq Ftg
Basement X -
lst F7.00r X -
2nd Floor X -
Garage X -
x =
TOTAL
Bstimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site � P�umbing Grading/Fill.ing
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Firep�ace Sewer Connection
Wall. Board (Masonry) Lawn Irrigation
�Final (Mfg.) Other
Other Wel� (State Permit)
E�ectrical (State Permit)
-------------------------------------------
F�F.MARKS (IN HOQSE) :
---------------------------------------------
RL7VIEW BY OTHF.RS: DATE:
Access : Existing New
Access Approval: Date By=
-----------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
. � ,
�� �
C ITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data", we would 3ike 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 confidentiaZ information.
You are notified that:
1. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supp3y data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other iocal , state or
federal agencies to the extent necessary to grocess the permit or
license.
4. If your requested permit or Iicense requires Councii. action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review prica��
data on yourself.
6. Yaur full name is required to process this apglicatica or
permit.
�,'� �`�� � � c.ti��� r' _
First Middle Last
�=�� y � . � �
� ��_� �� �� �� �� -� n� e �--� '� --
Address
�' SSsS �
�=� �� �= ,_ � ���t ,�� _
City State Zip
�,,� 7�� �r2 ��i r� y 7�� 7��13 -
Phone
I understand my right_s, as stated above.
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Signature
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BUILDING&ZONING— 473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359
ASSESSING
---- ------ ' t . ,
513.04 RIGHTS OF SIIBJECTS �F DATA
Subdivision 1. Type of da�- The rights af individu8ls on whom the data is
stored or to be stored shall be es set forth in this section. An.individu8l asked to
Subd. 2. Information re9uir�d to be giv� u'����
u pl rivate or confidential data concernina ta�w hin the collect ng state agency,
s P. Y P uested
purpose and intended use of the req �b� �„�hether he ma� refuse or is legally
political subdivision, or statewide syste�c� any �own consequence arising from his
required to supply the requested dat8;
su 1 ing or refusing to supply private or te orlfederal law to receive the data.1tThis-
PP Y
other persons or entities authorized by sta 1 investigative data,
requirement shall not apply when an indt�viaia en orcementuofficer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lart tgX re�und instructionsu nsteadho5
subdivision in the individual income tax or or��e V
on those orms. - - -
t� �� by �����, Upon request to a responsible
Subd. 3. Access
authority, an individuel shall be informed whetbh�c Pr vateeor confidential.e Upon his
individuals, and whether it is classified as p � ublic data on
further request, an ino.ividuel who is the subject of e tr�e�mrl�ae if he desires, shall
individuels shall be shown the data withou�fan�y ��g. �,fter an individual has been
�e informed of the content and meaning the data need not be �isclosed to
shown the private data snd informed of i� ute or�action pursuant to this section is
him for six months thereafter unless a disp
� rivate or public data upon request by
endin or additional data on the individuel has been collected or created. T �
� P g. require the
responsible authority shall provide copies of the p ilin the
the individuel subject of th gc��'cos h of mak ng,l certi yingy and comp g
requesting person to pay the _
copies. y if ssible, with any reQuest
The responsible autherity shall comoly immediatel , Pa
if immediate complisnce is not
maae pursuant to this subdivi.sion, or with lide e,�ys °f the date of the requ�hQ
excluding Saturdays, Sundays end legal � with the
ossible. If he cannot comply with the request within that time, he shall so inform
P have an additional five days within which to comply
individuel, and may S��� �d legal holidays.
request, excluding Saturdays,
te or complete. An individual may
Subd. 4. Procediu'e �►hen �►� � ubI c o��p ivate data concerning himself. To
contest the accuracy or completeness of P the responsible authority
exercise this right, an individual shall notify in writing
within 3 0
describing the nature of the disagreem to beTnaccura e or in omplete and attempt bo
days either: (a) correct the data found lete data, including recipients named y
notify past recipients of inaccurate or incomp
the individuel; oc (b) notify the individual that he believes the data to beementcis
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the disclosed data. be 8ppe�led pursuant to the
" The determination of the responsible authority m o c�ntested cases•
provisions of the administrative procedure act relating
i �� . �
CITY OF ORONO - BUIZDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: %
Permit�:�
ALI, INFORMATION MDST B$ SIIBMITTSD IN FULL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRBSS: �i�'� ��k-��� ��-� �- ZIP: �> ��j�
(work) q�l� -`12,3�
NAME OF OWNER: ���1L' l�� n r-- � ������� � wc. PHONE: (home) y 1(c l�y�
MATLING ADDR.ESS: ��J� ��'��L���� b� �-'`� CITY: �rc., r� c� ZIP: S S 3 S �:
CONTRACTOR: �;� '��� PHONE: t-1`'=� =�" �
M.AILING ADDRESS: --- CITY: � ZIP: :
STATS LICENSE: ,�r
ARCHITECT�ENGINEER: ����� � �r�-��_� � i� � ,. '���-- PHONE:
MATLING ADDRESS: CITY: ZIP:
N�g: RSGISTRATION tt
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�_
PROPOSF.D WORR (describe in detail) : � �� d�" � � � -'�' `�"� c�'-`-= �' '_ �\
\;�L�-� �l c� � "� c.X \5'� , -� � �.ti c� ��.
STORIBS: SQ. FEBT OF EACH FLOOR:
NO. OF BSDROOMS: GARAGB ST1�I.LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding la.nd) : $
_T 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 e approved plan.
APPI,ICANT'S SIGNATORE: � � ' __. .-L,�L DATE: (��" �`�` /S�
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�C��N4 1 �
CITY OF RADING P1�N '
� SITE FLAN G l �
�qpPROVED . �
�� A,ppROVED �DTH REVISIONS � -
❑ DISA P /
BY
DATE____---�'� `5
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BACH�IA(1S B�AE�: / ��� ___a_
DES7GNE0_^"'T^ N / ►LANHO.: D TE: ybI9Y
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OFSIGHEir; r SCnLE: ��.�,. �. C IENTS Wr'y/1/3
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