HomeMy WebLinkAbout1998-010217 - shed 8x10 PERMIT
: CI`TY OF ORONO PERMIT TYPE:
' �2���Kelley Parkway- P.O. Box 66 �:t.:: �,i��t�;�
Crystal Bay, Minnesota 55323 P e r m i t N u m b e r: �_;�;.;.;f-;
(612) 473-7357 Date Issued: i��;�_;�;�;i
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — �;�,�,I i{�t-�t. —
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APPLICANT PERMIT E SIGNATURE ISSUED BY:SIGNATURE ,.a,,.r��
'
� Total Fee: $ Date Received:
Entered By: .C'� Pernut#: ��2i �
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
ase pnnt all information)
.
����L--�=--�--�-----� ---------- ---------------------------------------------------------
THE APPLICANT IS: (circle one) OWNE OR CONTRACTOR
JOB SITE ADDRESS: �� �� �-����-1�-�c ZIP: S 3 �
NAlV� OF OWNER: �.��.� �- �j�� K.,S PHONE: (home) � 3 " �� y
(work) �
MAILING ADDRESS: � CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILItii TG ADDRESS: CITY: ZIP:
NAIVIE: REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
1�1ove Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�:
STORIES: SQ. FEET 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 �vork 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 ' accordance with the ap r ved plan.
APPLICANT'S SIGNAT `� DATE: � � � 3 — � 0
NOTE! Parade of Homes events require sep rate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS 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 section.
Subd.2. Information required to be given indiridual. An individual asked to supply private or confidenaal data concerning himse(f
shall be informed of: (a)the purpose and intended use of the requested data within the colleccing state agency,polirical 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 confidenual dara;and(d)the identiry of other persons or entiries auchorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigaave data, pursuanc to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav olace the nocice reauired under this subdivision in the individual income tax or orooertv tax refund
instructions instead of on those fornts.
Subd. 3. Access to data by indivzdual. 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 confidendal. 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 hirn 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 iu meanin„ the data need not be
disclosed to him for six months thereafrer uriless a dispute or action pursuant to this secdon is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the privatz or public data upon request by the individual subject of the data.
The responsible authority may require the requesting person to pay the actual costs 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 nodfy 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 individuai;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[he disclosed data.
The deternvnadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 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 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.
First Middle Last
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signawre
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' CHECK OFF LIST FOR ISSUANCE OF PERI�ITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: `��0 FtZN�A c�. C.v�i -
PID:
DESCRIP'TION OF WORK: S l�� p � � I o wv�,��5 PR� ��,( t
------------------------------------------- ------ ------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: s'-(3 -S `�
BUILDING REVIEW BY: DATE APPROVED: 5�- � 3 - S�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No c� SEWER CONNECTION
STATE SURCHARGE Yes �/"No WATERCONNECTTON
INVESTIGATION FEE Yes No PE1RK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: L/�-f�
Fire Department: w A-y�_ Post Off'ice: w.4MZ School District: p�'w�J
Lot Area: Sq.ft. NJ C tfi4ri�,,QAcres Width Depth
Survey Submitted: Yes � No Date of Survey: y- � ' �7
Pro osed Setbacks: '
P Front (Lake}: Zoa� � Right Side: ((��
Rear (Street): �d� �- Left Side: 2 S�r +
Adjacent Structures: ?J� � `�— Wetland: ( 5�
Building Height: Def. Hgt. (��� Peal:Hgt. —
Lot Coverage: �1 �f
Grading: Staff Approval Date: � � ►�- By: Council Approval Date:
Septic: Staff Approval Date: /�(/a- By:
Zoning File: # �` Resolution: # — Resolution Date: —
Shoreland District: ti�S
Avg. SetbackT ��_(C Bluff Setback: L,ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250' v. (c
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): -
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BUILDING REVIEW CHECK LIST
UBC: �J U - ( CONSTRUCTION TYPE: �N
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gara�e x =
x =
TOTAL
Q �
Estimated Construction Value: $ U�
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_ �ooting Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
pLFinal Grading/Filling Electrical (State Permit)
Other
REI�ARKS(Tvi HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REVIARKS (TO BE NOTED ON PERIVII�:
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