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Home My WebLink About2003-P06603 - land alteration � � PERMIT CITY OF ORONO Permit Number: 2750 Kelley Farkway - PO Box 66 P06603 Crystal Bay, Minnesota 55323 Pe►'mit Type: User Defined (952) 249-4600 Date Issued: ��30�2003 SITE ADDRESS: 795 Ferndale Rd N Wayzata,MN 55391 PID: 36-118-23-12-0014 DESCRIPTION: Proposed Use: Residential Permit Class: General Pernut Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc DETAILS: Approved per resolution#: Separate permits required: Other-(Minor grading without C.U.P.) NOTICES/REMARKS: Minimum 5'setback to property line without neighbors approval FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: Owner/Self OWNER: Catherine&James Blazier � 795 Ferndale Rd N Wayzata,MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. _` �� 1 �"" l ! � < <, � ��% <'� f% /��' � � APPLICANT PERMITEE SIGNA ISSUED BY SIGNATURE Conies: 1-File(Sienitures Required), 1-Apnlicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 '' Date Received: Total Fee: $ Entered By: /,, Pemut#: ---- - - -- - �� C F ORONO - B G PERNIIT A.PPLICATIOl� ��:�ti�� CITY O �� -►'c�um All information must be submitted in full before plan review �vill be started. (please print all information) ----------------------------------------------------------------- -- THE APPLICANT IS: (circle one) OWNER OR CONTR.ACTOR � � ' 1 �-�%z�/��"X�� / � JOE SITE AD�RESS: ?��T ,� � ��3 � _[-� NAME OF OWNER:_ PH NE: (home) SOZ 1 7� (work) ` /��v MA�Q�ING ADDRESS: CITY: ZIP: CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAII,ING ADDRESS: CITY: Z�: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: Z�: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(descri e in detai�:� C,�G,� C .� �`� �' �� ' � �� '��Gc�.� STORrES: _ � SQ.FE��T OF EAC OOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. > G_G':-" _ 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 per�nit; and that the work will be in cc rdance with the approved plan. APPLICANT'S SIGNAT . DATE: �� 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 SiJB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. � Subd.2. Information reqirired to be�ven individual. An individual asked to supply private or confidenrial data concerning hicnself shall be informed of: (a)the purpose and intended use of the requested data within the collecdng"state agency,political subdivision,or sratewide system; (b)whether he may refuse oT is legally required to supply the requested data;(c)any lmown coasequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the idendry of other persons or enaties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nodce re4uired under this subdivision in the individual income tax or property taz refund instructions instead of on those forms. Subd. 3. Access to data by individuai. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidenual. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wichout any charge to hun and, if he desires, shall be informed of the contenc and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addirional data on the individual has been collected or created. The responsible authoriry 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 cos[s of making,cerafying, and compiling the copies. The responsible au[horiry 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 individuai,and may have an addidonal five days within wtuch to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private data conceming himseif. To exercise this right,an individual shall norify in wriang the responsible authoriry describing�he nature of the disagreement. The responsible authority shall 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 that he helieves the data to be correct. Data in dispu[e shali be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the rzsponsible authority may be appealed pursuant to the provisions of the administrarive procedure act relating to contes[ed 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 deternune your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3, The information may be shared with other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested pernut 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. First Middle Last Address Ciry State Zip Phone I understand my rights as stated above. Signature r � . CHECK OFF LIST FOR ISSUANCE OF PEItMITS FOR OFFICE USE ONLY A.DDRESS ORLEGAL: 1 �5 �1/ . r��2N fJALE � PID: DESCRIPTION OF WORK: �p,�v ' -r�YtA-n�� o - ZO.vI�ti G REVIE�V BY: -�- G3•v . DATE APPROVED: 1- � �� -o � BUII.DING REVIE`� BY: DATE APPROVED; FEES TO BE CHARGED: MiNi2 I�I��Fy LL�a�'culated$y: I isc. ees PERNiIT Yes � No PLAN REVIEW Yes No SEWER COiVNECITO�' STATE SURCHARGE Yes No WATERC0�INECITON INVESTIGATION FEE � Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC�Units OTHER (specify) ZONP1i G CH�CK LIST Zon.ing Districr. iv-o c f+�,p . Fire Department: Post O�ce: School District: • Lot Area: Sq.ft. Acres � Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: � Fron[(Lake): Right Si e: Rear (Street): Left Sid : Adjacent Structures: �Vetland: Building Height: Def. Hgt. Peal:Hgt. Lot Coveraje: 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 Covera�e: Ezisting Proposed Hardcover: 0-75' 75-250' 250-SQO' 500-1d00' Hardcover Variance Required: Yes No Date of Council App:oval: REI�L�RKS (in house): _ �. � . . . � BUILDING REVIEtiy CHECg LIST �C: — CONSTRUCTION TYpE: -� _ Sq Footage $Per Sq Ftg ' Basement . x lst Floor z — 2nd Floor x — . Garage x — � � � z — - TOTAL Estimated Construction Value: $ — Inspections Required: `Vork Requiring Separate Permits: Site PIumbing Fire Hazdcover Removal Mechanical Footing ' Water Connection � Septic Sewer Connection � Framing Fire lace Insulation P �wn Irrigation Wall Board ��0�`� __ O�er �C_Final ' (�'Ifg') ._..__ Well (State Permit) : Grading/Filling �Electrical (State Permit) Other � REl�LARK�S(ni t HOUSE): ___ --------------------------------------------------- RE'VIEW BY OTHERS: DA�: _�__ Access: Ezisting New --__ . Access Approval: Date ---_—_---____---_— By' . � ------------_-------------------- REI�iA,RKS O BE ------�----�-------------------- (T NOTED ON PERivIIT�; �N 5� ��,,� ��— �, �... o� M/J n.o� �� $ '