HomeMy WebLinkAbout1996-008026 - docks ��ERMIT'
� � � '�F ORONO PERMIT TYPE:
�y Parkway - P.O. Box 66 �_�:_:�•.� =3��'������,
Permit Number: _ _}_ _._ _
�y, Minnesota 55323 i.;�„�:i,;;�i��
Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - r;�.F:� ;;:.t,-,i_. -
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APPLICANT-PERMITEE SIG ATURE '� ISSUED BY:SIGNATURE
. . �.
� ' � CHECK OFF LIST FOR ISSUAI�iCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �5,-U L71�; [�,•�t.� �;.4-r�:"
PID:
DESCRIPTION OF WORK: �-�+��.� �+-I �' u�
----------------------
ZONING REVIEW BY: � M.--�._ DATE APPROVID: S- }�-`i�-
BUII�DING REVIEW BY: N i tt DATE APPROVED:
FEES TO BE CHARGED: ,� Mi�c. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No f SEWER CONNECTION
STATE SURCHARGE Yes No �" WATER CONNECTION
INVESTIGATION FEE Yes No �' PARK FEE
SAC Yes No `� SITE INSPECITON
Number of SAC Units OTHER (specify)_
ZONING CHECK LIST Zoning District: Shoreland 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: �"e ��d�61��_
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hjt.
Avg. Se[back: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
?�-2s0'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: By: Council Approval Date:
Sepdc: Staff Approval Date: BY�
Zoning File: f# Resolution: # Resolution Date:
P�:��][ARKS (in house): � ����v�-c, /_�:,e�-r ��'�=-� ,l'� s c_����:c< f'�� `� �3� �' _,
. �
BUII.DING REVIEW CHECK LIST
UBC: ,f CONSTR CTION '�YPE: /
!
Sq Footaa� S Per Ftg �� �
Basement i ! x =
lst Floor �� x � _
2nd Floor i x =
Gara�e i x —
x
OTAL
Estima ed Con ction alue: $
Inspections quired: �'ork Re u' 'ng Separate Permits:
Site P ing Fire
Har over Remo �e hanical Water Connec 'on
Fo ing Se,ptic 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):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By�
REVIARKS(TO BE NOTED ON PERMIT):
27 �
� ' v
' ' � Total Fee: � 3 D� �' DateReceived:
DateApproved:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERI�VIIT APPLICATION
AI.L TivFORi1�IATION I�iUST BE SUB�ITTTED IN FULL BEFORE PLAI�i REVIEW WILL
BE STARTED `'YJ��l f21 C l�. ,� T�y�o,�, �
-------------------------------------------------------------------------------------------------------------------
THE APPLIC�'VT IS: (circle one) OWNER R CONTR.ACTOR
JOB SITE ADDRESS: s�d ��S f �vK ��lC� I�' ZIP: S�3 I�' �� 70
►n1 a-c-(Z�-a, �-/ ��l
NANIE OF OWNER: �,�v�u�- q� c�.�-tJV'�_ PHOiV"E: (home) � 7�'�7��v
(work) ,S�3 �So 0
MAILIl�IG ADDRESS: SSD ,� ,Lcx� /�e � � CIT'Y: �il��r,y Z�� �IP: S,S"3�
7"
CONTRACTOR: f����� /� � . �, /� . PHONE: �p/Z 7L '�� ZS
� MOBILE PHO�IE/PAGER:
MAILING ADDRESS: 7gsl /a r���jri�✓�- CITY: �'�ta.�.�cz s�.e�.. ZIP: SS.3� 7
STATE LICENSE: #
ARCHITECT/ENGliYEER: PHONE:
MAII.ING ADDRESS: CITY: ZIP:
N�y�; REGIST'RATION #
TYPE OF WORK New%J Addition Accessory Structure
�
Mov Remodel/Alteration Land Alterarion
PROPOSED�VORK(describe indetail):,S�.So�a..� C%Q-8�� ��� w�fK Sx ��� �1't
w !�/s�
STORIES: le✓e�P SQ. FEET OF EACH FLOOR:
/•i l I�"� NO. OF BEDROOVIS: GARAGE STALLS: ATT. DET.
EST1i��,TED CONSTRUCTION VALUATION(escludingland): $ ,
—�
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 wor will be in accordance with the approved plan.
APPLICANT'S SIGNAT`URE: DATE: `S o2 � � �-p
NOTE! Parade of 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 D�TA
Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private oc confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the coliecting"stace agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidenoal data;and(d)the idenary of other persons or enaries authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigarive data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the no[ice required under this subdivision in the individual income tax or propertv tax refund
instrucrions instead 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 subjecc
of stored data on individuals, and whether it is classified as public, private or co�denrial. 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 thereaf[er unless a dispute or action pursuant to this secdon is pending or addiaonal data on the individual has been collected or created.
The responsible authoriry shall provi�e copies of�he private or pub(ic data upon recluest by the individual subject of the data. The responsible authoriry
may require the requesting person ro pay the actual costs of making, cercifying, and compiling the copies.
The responsible authoriry shall comp(y immediately, if possible, with a�y 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 individuat,and may have an addi[ional 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 i�dividual may contest the accuracy oc complereness of public or private
data conceming hirnself. To exercise this right,an individual shall notify in writing the responsible au[horiry describing the nature of the disagreement.
The responsible authoriry shalt within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b) notify the individual tha[he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's stacement 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 fumish 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 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 pemut 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.
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First �/ / Mi/dd,le- �� Last
SS� �a.S� P�--O ��
Address �� M� SS 3 9/� /6 �� y� / �� ��/ �
C� State Zip Phone
I unde stand my rights as stated above.
� Signature
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N BY REV[SION DATE DESCRII'T10N
I hrreby ccrtify thaf this survcy was prepared by mc ur undcr my direcl superv � , � �
vision,anJ thal I am a duly rcgistered Civil Enginecr and Land Surveyor under
Ihe laws uf Ihe St�te o(htinnesota. 1�
JED BY \ �
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Mark S.Gronberg Minnesota License Number I 5
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