HomeMy WebLinkAbout2002-P05247 - land alteration PERMIT
CITY OF ORONO Permit Number:
2�I�0 Kelley Parkway - PO Box 66 Pos2a�
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: 6�3�2002
SITE ADDRESS: 2801 Fox st
I.ong Lake,MN 55356
PID: 04-117-23-34-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pemiit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y�
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Dan&Maggie Kluth OWNER: Dan&Maggie Kluth
2801 Fox St 2801 Fox St
Long Lake MN 55356 Long Lake MN 55356
THE UNDERSIGNED HEREBY 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 OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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% APPLICANT PERMIT SIG ATURE ISSUED SIGNATURE
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Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
';'otal Fee: $ Date Received:
� Entezed By: Permit#:
CITY OF ORONO - BUII,DING PERMIT APPLICATIOIeT
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� OWNER OR CONTRACTOR
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JOB SITE ADDRESS: - - �
_ �_ ,. ,-�- z�: ��S���-
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, � -; --� �.> �,,�y� �y�9'
NAME OF OWNER: �L j l,��,�-- � .�, ,i� ,,� ��-��E�� PHONE: (home)
,_ (work)�, ; ,'� - �' ��%G L/
MAILING ADDRESS: :�,� � l.�x " �S l
v`�. CITY: Lc,,�, ��r zIP: ��
CONT�tACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAII.ING ADDRESS: CITY: ZIP:
STATE LTCENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAI�iE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration � --'
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PROPOSED WORK(describe in detai�: ,',i y�:�-� ,5't � � �, ,
. �
�t � ; ��:��
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROO�iS: GARAGE STALLS: ATT. DET.
ESTIMATED CC,NSTRUCTION VALUATIOlY (excluding land): $ �,L-�'`
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
pernut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: ; ���1�<_ „ � DATE: ,� ' � � — ���Z
,
NOTE! Parade Qf 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.
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Sec.13.04 RIGH'TS OF S[1BJECTS OF D�TA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secaon.
Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the colleccing'state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse or is legaliy required to supply the requested data;(c)any lmown consequence arising from his suppiying or refusing to supply
priva[e or confidendal data;and(d)the idenriry of o[her persoas or enoaes authorized by state or federal law to receive the data. This requiremenc shall
not apply when an individuai is asked to supply invesrigarive data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re:•enue mav place the nocice rewired under this subdivision in the individual income tax or oropertv tax refund
instrsctions ins[ead of on chose forms.
Subd. 3. Access to data by indi�idual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whecher ic 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 che data wichout any charge to him and, if he desires, shall be informed of the content
and meaning of chat data. Aher an individual has been shown�he private data and informed of its meaning,the data need no[be disclosed[o him for
six mon[hs thereafrer unless a dispute or acrion pursuant to this secrion is pending or addiaonal data on the individual has been collectPd or created.
The responsible auchoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the actual cosrs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediate(y, if possibfe, with any request made pursuant to[his subdivision,or within five days of
the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within rhat cime,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excl�ding 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 concerning himself. To exercise[his right,an individual shall noafy in wridng the responsible authoriry describing[he nature of the disagreement.
The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipienu of
inaccurate or incomplete data, including recipien[s named by the individual;,or(b)nodfy the individual thac he believes the daca to be correcc. Data
in dispuce shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
Tlie determinarion of the r�spensible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing 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 c;etemune 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 permi[ or license requires Council action to approve, some information may become
public.
5. You have certain rights under N1.S. 13.04 �available upon request) to review private data on yourself.
6. Your fuil name is required to process this application or permit.
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First �fiddlz ,��' J Lasc/
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Address , . !
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Ciry State Zip Phone
I understand my rights as stated above.
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Signan.t�e
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
� � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z$� I �o� sT
PID:
DESCRIPTION OF WORK: ( ,4,,,,� �,�y��a,.i
ZO.�tI�1i G REVIE`V BY: DATE APPROVED: ,� • 3 • � 2
BUII.D�G REV�`V BY: DATE APPROVED:
-/------------- �t -----------------------------------------
FEES TO BE CHARGED:��'°t`'�"� � �Ni° �Fees Ca�lcu ted B ��
isc. y:
PERNIIT Yes �/ No
PLAiv REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CH�CK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depch
Survey Submitted: Yes�_ No Date of Survey: -1- �2-�)
Proposed Setbacks:
Fron[(Lake): i o• � � Right Side: �''Jo � �
' , �
Rear (Street): �d � Left Side: z-G a
Adjacent Structures: Sv ` Wetland: �1/>
Building Hei�h[: Def. Hgt. — Peal:Hgt. '—
L.ot Coverage: --
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
^ Zoning File: # Resolution: # Resolution Date:
N �i
Shoreland District:
Avg. Setback: Bluff Setback: L,ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REV�W CHECK LIST
�C� � CONSTRUCTTON TYPE: —
Sq Footage $Per Sq Ftg
Basement x =
lst Floor z _
2nd Floor x =
Garage x =
R -
TOTAL
Estimated Construction Value: $ SQ' SO •U� �G� (=�Zs
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing = Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�Final Grading/Filling Electrical (State Permit)
Other
REMARK.S (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
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REMARKS (TO BE NOTED ON PERivII1�:
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•-•�- " " " Certificate of Survey .for: ; "
Daniel J. Kluth
of Lot l , Bloak 3, FARVIEW
Hennepin County,..Minne.go,ta.. ..
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LEGAL DESCRIPTION OF PREMISES SURVEYED:
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Lo� 1 , Block 3, FARVIEW. •• '� "'
This stirvey shows the boundaries of the above described property, the existing location
of an existing house, and the proposed location of a proposed garage. It does not pur-
�or.t to show any other improvements or_ encroachments.,
"' ' I hereby certify that this survey was pr.epared by me
or under my direct supervision, and that I am a duly
registered Civil En,gin,eer ar}d .Land. Suz�eyor .under. the . .. ... _ ..__._ . _
laws of the State of Minnesota.
.. . ..... ,
• COFFI•�1 & GRONBERG, INC. '
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Mark S. Gronberg MN. Lic. No. 12755 Scale: 1 inch = 50 feet
•.Engineers, Land Surveyors, Pl�nners.. . .Date : July 12, 1991
Long;,Lake,. .Minnesota . . . ., o --: �Iron marker found
. .� .,..._. . 8ea.rin��,,,.�,�gwn aro baead u�on �
assumed datum.
6�5•98' OROGOSED BUiLDINC SrnK60