HomeMy WebLinkAbout1991-003730 - see "remarks" on permit . PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Bro3un Rd. South • P.O. Box 66 �'`��L-`�;-''�"��
Permit Number: ;;t�;�;;:_:�
Crystal Bay, Minnesota55323 Datelssued: ��7r,,<<_��,;•���
(612) 473-7357
SITE ADDRESS:
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CONTRACTOR: � OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
a 1..,y
F
. CITY OF ORONO - BOILDING PERMIT APPLICATION
Total Fee: $ ��y. ���� Date Received:
, Date Approved:
Entered By: �-
Permit#: � 7
� �� �7 �,
AT•T• INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN '�'EVIE'�1 WILI. BE STARTED
(See Check-�ff List Enclosed )
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one ) OWNER ^r �'�NTRACTOR
JOB SITS ADDRESS: ( Z�O �Y� CI(L�L- �12�t£ Z IP: ��3� �
(work) 3(�' 2l
NAHE OF OWNER: �l l,�- 1 P� r�C�(�c�t,lt,E PHONE: (home) �'��� 3�S �
MAILING ADDRESS: f Z1 D �/t,Q.�C�F VY�L�I,L, `n f2�t,E CITY: O 1'LO�..j0 ZIP: ��39 I
�CONTRACTOR: WII•1,D50✓L Vt�t1�4Dr7Ga1P�S PHONE: `fgZ'"OZOS
MAILING ADDRESS: ( ��S � KW� 36 CITY: �T. �{ru�� NI ,� ZIP: SS_(O �
TYPE OF WORR: New Addition A cessory Structure Move
Demo Remode�/Alteration Re e Land Alteration
PROPOSED WORR (describe in detail) : c.{7N`��YLUL"r Lo�J 1�L�LAT'i � �i2tc,K_. �
�PNIiS Q N✓) PC�Pr►J't�'tiLS - �v��-D 1.�c:LJ �T'�j5 C��-'F ��(I ST i►a 5 1/Q��k.- Y�, �J�-Ptr-lC.'f� �r'Ll U t�1�t'�'j
- �—
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF B$DROOMS: GARAGE STAI.I�S: ATT. DET.
o-o
ESTIMATED CONSTROCTION VALIIATION (ezcluding land) : $ ��� O�D �
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 work will be in accordance with the approved plan.
APPLICANT'S SIGNATORE: DATE: �"��/ ?J�� �/ /� -
rr7-c21?�2 �'F'�o6Y�9�1ods
..
� • _
CHECR OFF LIST FOR ISSIIANCE OF P$R1►sITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �Z7 U l ILC��K ��/� PID:
�i4-?C� _
DESCRIPTION OF WORR: SC..� G�-t r ���LQ�D�P C,t--i-v4+�c�2�- ��GfL Sn4 ►2 ►2�'�J+5 r ��^� �
------------------ �.---- ----------------------_------`-f--------
-------
ZONING REVIEW BY: '`�'�,{'^, - C°,-a.-.. DATE APPROVED. �,-4 �
BUII�DING REVIEW BY: � "� DATE APPROVED: v- �!
--------------------�j-i—�I,U,.---------------------------�--J--------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � . No
PLAN REVIEW Yes �� No SEWER CONNECTION
STATE SURCHARGE Yes—� No WATER CONNECTION
INVESTIGATION FEE Yes-� No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------------
ZONING CHECR LIST ZoningjDistrict:
Fire Department: Post Of�ice: 1 School District:
�
Lot Area: Width: Depth:
;
Survey Submitted: Yes No Date of Survey:
�
Proposed Setbacks: ,
Front (Lake) : r Right Side:
Rear (Street) : Left Side:
Adjacent Structures : Wetland:
Building Height: Def. Hgt. Peak Hgt.
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75 ' '
75-250 '
250-500 ' ' -
500-1000 `
xardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: 6 - 3-Gf1r By:o�- Q • Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution #: Resolution Date:
REMARRS (in house) :
R
_ _ �
BIIILDING REVIEW CHECR I,IST • _
___
� � 1 CONSTRIICTION TYPE: _ '°Y►'U
IIBC: ��2S I-_
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL
Estimated Construction Value: $ .5;� �v =� �'�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
�,Final (Mfg. ) Well State Permit
Other Electrical (State Permit)
RSMARRS (IN HOUSE) :
------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY�
---------------------------------------------------------------
RSMARRS (TO BE NOTED ON PERMIT) :
,r - F�
..-�-::a. ,� r ,: �i��� O� �����
� �,
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
�
� - � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 . �'�•bd. 2 , "Rights of subjects of
data", we would like to inform yot- �t your request for a permit or
license from the City of Orono or L 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 Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
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 to review pri�at�
data on yourself.
6. Your full name is required to process this application or '
permit.
G�/i��so� G.�/ns���'S
Gv��-� !� �fo��`t��-z-
First Middle Last ,
�/TS � /�✓Y �3�
Address
�7; l-fH�� /�1�✓ �S/D 9'
City State Zip
�d2-02o5
Phone
I understand my rights as stated above.
(�� Ur�2� � D �-n�s
ignature
BUILDING&ZONING—473-7357 � ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS—473J359
ASSESSiNG
513.04 RIGHTS �F SII�CTS �F DATA
Subdivision 1. Type of data- The rights of individuels on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Information require
d to be given in�iv��' An individual esked to
su ply private or confidentigl data concera a tamWi hin the collect ng state gency,
P
purpose and intended use of the req tem; (b) whether he may refuse or is legally
political subdivision, or stetewide sys �oWn consequence arising from his
required to supply the requested date; (c) any �d (d) the identity of
supplying or refusing to supply private or confidential data;
other ersons or entities authorized by state or federal law to receive the data. This.
p 1 when an individuel is esked to supply investigative data,
requirement shall not app y to a law enforcement officer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lert tax re�und instructionsunsteadhos
subdivision in the individual income tax or c� v
on those orms. . - -- � .
Subd. 3. Access to �ata bY �n���' UPon request to a responsible
authority, an individual shall be informed whether h�vgteeor confident alte UP�n his
individuels, and whether it is classified as public, p ublic data on
e to him and, if he desires, shall
further request, an individual who is the subject of stored private or
individuals shall be shown the data withou�fan�y ��g. After an individual hBs been
6e informed of the content and meaning the data need not be �isclosed to
shown the private data snd informed of Its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
� ending or additional data on the individu e h� gte or p bl et dataruP°narequest by
� P rovide copies of th p require the
responsible authority shall p �d compiling the
the individual subject of �e gc��•�o� of mak ng,l cerU{yingy may
requesting person to pay t -
copies. y if ssible, with any re9uest
The responsible authority shall comply immediatel , P� uest,
mgde pursuant to this subdivision, or within five days of the date of the req
excluding Saturda}�s, Sundays and legal hotid�thinithat�t meghe hall so nfo m the _
possible. If he cannot comply with the reques with the
individual, and may have ar► additional five days within which to comply
and le al holidays.
request, excluding Saturdays, Sur►daYs g
te or complete. An individu8l may
Subd. 4. Proced�'e when �� � ubl c o�p ivate data concerning himself. To
contest the eccuracy or completeness of p �n W=iting the responsible authority
exercise this right, an individual shall notify
describing the nature of the disagreement. The responsible authority shall within 30
da either: (a) correct the data f ound to be 1 ete datae including ree�pi�� name t by
YS
notify past recipients of inaccurate or incompl
the individusl; or (b) notify the individual th�V dual'slstatemen tof dis8g�'eement is
Data in dispute shall be disclosed only if the in
• included with the disclosed data• be appealed purs�ant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.