HomeMy WebLinkAbout2000-P03113 - land alteration PERMIT
CI�Y -�F ORONO
2750 Keliey Parkway - PO Box 66 Permit Number: Po3113
Crystal Bay, Minnesota 55323 Permit Type: UserDefined
(612) 249-4600 Date Issued: ioit�i2o
SITE ADDRESS: 224o Fox st
LONG LAKE, MN 55356
PID: 03-117-23-32-0009
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICESIREMARKS:
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: JYLAND DEVELOPMENT OWNER: J R&H L JOHNSON
150 SOUTH BROADWAY 2240 FOX ST
WAYZATA, MN 55391 LONG LAKE MN 55356
THE UNDERSIGNED I�REBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE O INNESOTA BUILDING CODE REQUIIZEMENTS.
; �,�,,�/� .�'< <��/���� ��;,,,��, ���
A L CANT PERMITE I 11 RE ISSUED BY SIGNATiJRE \ '-�
\-
Copies: City,Applicant,Assessor,Finance Pag�
. Tot�l Fee: $ =��% . ��« _ Date Received: )�` �1�`'�`�
Entered By: � �, Pernut#: �"C� -�lt ��
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: �2K� �ox Sn2�cr ZIP: sS3s(�
NANIE OF OWNER: �'R,�ES !h�'p �E�.F,�1 �ol�k�smnc PHONE: (home)
(work)
MAILING ADDRESS: 22�{0 Fo,X S�zE�r- CITY: L,an�(T L�9-k,� ZIP: Ss3sCo
CONTRACTOR: S'y�►�r,,a �E��c.o(�,n�N7- PHONE: C95z) 404 • 0�00��>--�i )
CONTACT PERSON: Ricic �r��So�c! MOBILE/PAGER ��t z) S�'o• �(ao Z. �S
MAILING ADDRESS: �,So s. t32 aA,�wrw./ ,/�-iJL� CITY: (,u hy t��t- ZIP: ss39 l
STATE LICENSE: # Zoo s��t z�(
ARCHITECT/ENGINEER: f.Jf} PHONE:
iVIAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move ✓ Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: I� f�Q c�� 1�mv�w n�1 .
STORIES: � SQ. FEET OF EACH FLOOR: �
NO. OF BEDROOMS: � GARAGE STALLS: ATT. � DET. �
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ r- o �
I hereby apply for a building pernut 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
pernlit; and that the work will be in acc rdance with the approved plan.
APPLICANT'S SIGNATURE: �r DATE: f'� // Z�xaC�
,
NOTE! Parade of Homes everits 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 SUBJECTS OF DaTA
Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secrion.
Subd.'_. Information required to be given individual. An individual asked to supply privace or confidenrial data conceming hirnself shall
be informed of: (a)the purpose and intended use of the requested data within the collecang"state agency, political subdivision,or statewide system;
(b)whe[her he may refuse oY is legally required ro supply the requested data;(c)any frnown consequence arising fmm his supplying or refusing ro supply
private or confidenaal data;and(d)the identity of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall
no[apply when an individual is asked to supply invesrieaave dara, pursuant to seccion 13.82, subdivision 5, to a law enforcement ofFicer.
The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund
inscructions insrezd of on those forms.
Subd. 3. Access to data by indi�idual. Upon request ro 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 confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown[he data without any charge to him and, if he desires, shall be informed of the content
and meaning of rhat data. After an individual has been shown the private data and informed of irs meaning, the data need not be disclosed to him for
six months thereafter unless a dispute or acaon pursuant to this section is pending or addiaonal data on the individual has been collected or created.
The responsibie auchoriry shall provide copies of the private or public data upon request by[he individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual costs of makine, certifying, and compiling the copies.
The responsible authoriry shall compiy immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sa[urdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform[he individual,and may have an addicional 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 pri�•ate
data conceming himself. To exercise�his rieht,an individuai shall nonfy in writing che responsible authority describing[he nature of the disagreement.
The responsible authoriry shall wi[hin 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
Tfie determination of the responsible authority may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 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 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 permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
��s R �-mKn/s on/
First �fiddle Las[
22Yo Fox 5n2E,�T
Address
l,�.wlr G.�c►E- m N s's3sCo
City State Zip Phone
I understand my rights as sta[ed above.
�
l� --�1 oa
Si a re
CHECK OFF LIST FOR ISSUA.��'CE OF PER1tiIITS
_ � � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2Z.�-1 C� F t�� S<«�_—`
PID:
DES CRIPI�I ON OF W ORK: � (1}�(J(rv Co (�J:c,o c�Z '�2-``��"�--
� _^- ---- --
ZO�TG REVIE`� BY: DATE APPROVED:
BUII,DING REY�ti� BY: �v � � DATE APPROVED:
CofLk+>��Jc w(c�
FEES TO BE CH.4RGED: Misc. Fees Calculated By:
pERMIT Yes � No �
pLAN REVIEW Yes No SEWF�CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
� ZONI:�G CHE.CK LIST Zoning District: _
G� Fire Department: Post Office: School District: �
t Area: Sq.ft. Acres Width Depth
Surve;� Submitted: Yes oc. No Date of Survey: Z - Z-�e�6
Proposed Setbacks:
Fron[(Lake): Right Side:
Rear(Screet): Left Side: �� ��
Adjacent Structures: �Vetland: � .
Buildin� Heioht: Def. H�t. Peal:H�c.
Loc Covera�e:
Gradin�: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
W'� Shoreland District:
Av'. Setback: Blufi Setback: LotCovera�e:
EzistinQ Proposed
�
Hardcover: 0-75'
75-250'
ti0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
I�IAR]KS (in house):
7
� '
BUII.DING REVIEW CHECK LIST
UBC: CONSTRUCT'ION TYPE:
Sq Footage $ Per Sq Ftg
Basement z =
lst Floor x =
2ad Floor x =
Garage x =
R =
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
REI�iARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REVLARKS (TO BE NOTED ON PERMI�:
8
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I hereby cutify U�at lhis survey was prepared by me a uide� my d�recl super- SCALE
���� � rj�Q����j� ��� vision, and lhal I am o duly regislered Civ� Engineer and Land Surveyor �nder 1 "=100'
��Q�,���,� �a�� the laws of lhe State o( Alinnesota. DATE
� 4t1Z TNWt�ICX Al'EH.E . LCt� LN�Yi 55356 2�2��� � ,j
� 6 t2-473-4141 00 02 6 -�.
�lork S. Groi�l�er I�innesoto Licensr, Numbcr 12755
00-02G
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i hereby certi(y that lhis survey was prepared by me or �nde� my d�rect super– scA�E
�R��� � rj�����j� ��� vision, md ll�al I am a duly regislered Civil Engineer and Land Surveyor u�der 1 ,►=100'
�� p�,� ��,� ��� the laws o( the Stale o( Minnesoto. , DATE
� �cn Tnuuuac nvw� ia�c u� � �ss
2/2/00 ( =1
JUU NU. �
612-473-4141 Mark S. Cronher Minnesola Licensr, Numi�cr 12755 ��-026 �
00-02G