HomeMy WebLinkAbout2000-P02924 - land alteration PERMIT
C I TY O F O RO N O Permit Number:
�►2750 Kelle y Parkwa y - PO Box 66 P02924
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(612) 249-4600 Date Issued: 9i�3�2o0
SITE ADDRESS: 2690 Deer Run Tr E
LONG LAKE, MN 55356
P ID: 04-117-23-13-0011
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Pertnit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 500.00
TOTAL FEE: $ 50.00
APPLICANT: JON STERN OWNER:
2813 CASCO POINT ROAD
WAYZATA,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPEC�'IED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII.DING CODE REQUIREMENTS.
i
�� f� I� �����1��� ����
P L N P RM .I TURE IS ED BY IGNAT[JRE
Copies: City,Applicant,Assessor, Finance Page 1
' -� �. .. �^iC�
� Total Fee: $ .��� � Date Received:
. Entered By: Permit#: a�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) WNER R CONTRACTOR
JOB SITE ADDRESS: �(��/U �L ���,., � L ZIP: J J�SCv
�-�a
NAME OF OWNER: S(?1� � �(G�',,� -,�,,,., PHONE: (home) 5'7/- L'�S�/
(work) 1Ls"/�
MAILING ADDRESS: ,.���3 ���, `�-1- � CITY: ��, -�._ ZIP: �3 3�i /
CONTRACTOR: �� (�Q�.t,�,l PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
IIAILING ADDRESS: CITY: ZIP:
r;AlVIE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration_�_
PROPOSED WORK(describe in detai�: � � �,�,� �e�c,� .t�,� �(•�UC� (�lQir.P�C—�
STORIES: SQ. F'EET 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.
APPLICANT'S SIGNATURE: � ��1�-- DATE: �1���<;� L?
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
� ,
Sea13.04 RIGH'TS OF S[JBJECTS OF DaTA
Subd. I. Tvpe of data. The rights of individual on whom the data is stored or[o be s[ored shall be as set forth in this secdon.
Subd.'_. Information reqirired to be given individual. ?.n individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and intended use of[he requested data wi[hin the collecting'state a�ency,polidcal subdivision,or statewide system;
(b)whe[her he may refuse oY is legalty required to supply the reques[ed data;(c)any laiown coasequence arising fmm his supplying or refusing to supply
priva�e or confidenrial data;and(d)the iden�ity of o[her perso�s or enrides auchorized by sta[e or federal law[o receive the data. This requirement shall
not apply when an individual is asked to supply invesdeadve dara, pursuant to seccion 13.82, subdivision�, to a law enforcement officer.
The commissioner of re�enue mav place the notice reauired under[his subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by indi�idual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subjecc
of stored data on individuals, and whe[her 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[he data without any cnarge to him and, if he desirzs, shall be informed of the content
and meaning of that data. Aftzr an individual has been shown the private data and informed of ics meaning, che data need not be disclosed to him for
six monrhs thereafter unless a dispute or acrion pursuan[to this secdon is pending or addiaonal data on the individual has been collected or crea[ed.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subjec[of the data. The responsible authoriry
may require the requesting person to pay [he actual cosu of making, certifying,and compiling the copies.
The responsible au[horiry shall comply immediatzly, if possib(e, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and leeal 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 aceurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate
data concerning himself. To exercise this right,an individual shall notify in writing the responsible auchority describing[he nature of the disagreement.
The responsible au[horiry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipienrs of
inaccurate or incomplere data, including recipients named by the individual; or(b)notify the individual that he believes�e data to be correc[. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
Tlie determination of the responsible authoriry may be appea(ed pursuant to the provisions of the administrarive procedure act relad�g to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "RiQhts of subjects of data", we would like to inform you that your reauest
for a permit or license from the City of Orono or any of its depar[ments 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 Ciry deny the permit or license.
3, The information may be shared with other local, state or federal a�encies 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.
j. 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 applica[ion or permit.
First tiiiddle Las[
Address
City Sta[e Zip Phone
I understand my rijhts as stated above.
��'Y� S�
Signature
� ' CHECK OF'F LIST FOR ISSUAi�tCE OF PER1tiIITS
� FOR OFFICE USE ONLY
� ADDRESS OR LEGAL: Z��C o ,p�.�,2 �2.�N ��L- �== -
PID:
DESCR�'I'ION OF WORK: '',
. ____
ZOrT\'G REV�`V BY: DATE APPROVED: S-/3-��
BUII.DPtG REVIEti� BY: s�(,0 DATE APPROVED:
FEES TO BE CHARGED: (� (��^�� � N� G�
isc. ees Calculated �y:�—��
PERNIIT Yes �/ No :
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNEC"TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONI:�tG CFiE.CK LIST zoning Districc: i►r� G(�?
Fire Department: Post Office: School District: �
I..ot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Righ[Side:
Rear (Sueet): L.eft Side:
Adjacent Structures: We and: .
Buildin� Heigh[: Def. Hgt. Pe •Hgt.
Lot Covera�e:
Grading: Scaff Approval Date: B : Council Approval Date:
Septic: Staff Approval Date: B :
Zoain; File: # Resolution: # Resolution Date:
Shoreland District:
Av�. Setback: Bluff Se[back L,ot Covera�e:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REI�L�RKS (in house)•
7
BUII.DING REVIEW CHECK LIST
UBC: -- CONSTRUCTION TYPE: �'
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd F1oor 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:
RE`�tARKS (TO BE NOTED ON PERMIT�:
8
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