The URL can be used to link to this page

Home My WebLink AboutMisc. data sheets � • � CHECIi OFF LIST FOR ISSU��CE OF PERI�IITS FOR OFFICE USE ONLY �iDDRESS OR LEGAL: ti3no r'�-�'`'�`� �'k' G'z PID: DESCRIPT'ION OF `VORK: ��J�n a� 'T� � ------------- -------- ZO�tING REVIE`V BY: DATE APPROVED: �- � r- I-�r 5 BUII.DING REVIEW BY: DATE APPROVED: � � - t-�s 5 - -------------------------- FEES TO BE CHARGED: �Iisc. Fees Calculateci By: PERMIT Yes ✓ No PL�'�t REVIE� Yes � No SEWER COi�TiVECTION STATE SURCHARGE Yes ✓ No WATER CONNECTION ________ INVESTIGATION FEE Yes No c/' PARK FEE SAC Yes No � SITE I�i 1SPEC'ITON Number of SAC Units OTHER (specify) Y_N � ---------------------------- ZONING CHECK LIST Zoning District: Shoreland District : /u�_�- Fire Department: Post Office: School District: L��M.,a Acres Width Depth Lot Area: Sq.ft. Survey Submitted: Yes 1� No Date of Survey: C��N 1�=��--�: t � ' Z3`�� Proposed Se[backs: � Front (�a): N �d� Right Side: t �� Rear (�rc�f): lt9o� Left Side: N (A �djacent Structures: I��r�,c..l�e.� Wetland: N l � Building Height: Def. Hgt. � �� Peak H�t. Avg. Setback: Bluff Setback: Lot Coverage: Esistin; Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes �o Date of Council Approval: 1" I� Gradin�. Staff Approval Da[e: By: Council Approval Dace: Septic: Staff Approval Date: By' Zoning File: # Resolution: � Resolution Date: g;�;�y��,S (in house): � BUII�DI�i 1G REVIEW CHECK LIST uBc: � - 3 co�rs�zuc�o�r �E: �� Sq Foo[age S Per Sq Ft� Basement Y — lst Floor c — 2nd Floor � — Gara�e C — � _ TOTAL O,� Estimated Construction Value: S ZS,c�oo Inspections Required: Work Requiring Separate Permits: Si[e Plumbing Fire Hardcover Removal :�iechanical Water Coanection _o� Footing Septic Sewer Connection /\ Framina Fireplace Lawn Irrigation o�Insulation (Masonry) Other 0� Wall Board (Mfg.) Well (State Permit) o'-Final Grading/Filling o� Electrical (State Permit) Other REMARKS (IN HOUSE): - -------------------- REVIEW BY OTHERS: DATE: Access: Existing �eW Access Approval: Date BY� ----------------- REI�iARKS (TO BE NOTED ON PERi�IIT): 27 � s;. £ CITY of OR011eTTO Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices • � - � � On the North Shore of Lake Minnetonka DATA PRIVACY ADVISORY In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of data", we would Iike to inform you that your request for a permit or Iicense 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 wil.l 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 license. 3. The information may be shared with other local , state or federal agencies to the extent necessary to grocess the permit or license. 4. If your requested permit or Iicense requires Councii a�tion to approve, some information may become public. 5. You have certain rights ander M.S. 13.04 to review pri�ate data on yourself. 6. Yaur full name is required to process this apFlicaticn or permit. �I GZ`��'CG�✓l� �/�CtV"r C �C��_%�� _ First Middle Last , �. f l��l�`� � �-�r�t-�� I'-�� "`-� _ Address �un c� � �;�,�,� Gt,lilJ .��S� City State Zip y 7C�- l l l��i Phone I understand my rights as stated above. _--- � /�. /c l�v' Signature BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 ASSESSING f J i �.04 RIGHTS OF SIIBJECTS �F DATA Subdivision 1. �pe of ��- The rights of individuals on whom the data is stored or to be stored shall be es set forth in this section. Subd. 2. Information r�d to be given in�v��' An.individual asked to � supply private or confidentisl data concernina �gmWi�in the collect ng state agencY, purpose and intended use of the requested (b) whether he ma� refuse or is legally political subdivision, or statewide system; �own consequence arising from his required to supply the requested dat8; (c) any su 1 ing or refusing to supply private or confidentiel data; and (d) the identity of PP Y state or federal law to receive the data. This. other persons or entities authorized by �vesti ative data, requirement shall not apply when an individual is esked to supply g pursuent to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue m8 p1ertV tax reound instQuctionsunsteadhos subdivision in the individual income tax or pr�w on those orms. - -- - _ Subd. 3. Access to �ata by in�ivi�uel• Upon request to e responsible authority, an individual shall be informed Wh blic pr vateeor confidential.e Upon his individuals, and whether it is classified as p � ublic data on further request, an individusl who is the subject of e tQ�mrl�v�aae if he desires, shall individuals shall be shown the data withou�t ��Y t�ta. After an individual has been �e informed of the content end meaning the data need not be �isclosed to shown the private date and informed of its meaning, u�uant to this section is him for six months thereafter unless e dispute or action p ending or additionel data on the individu e h� ateQor p bl c datarupon request by P require the responsible authority shall provide copies o t p the individual subject oft�e actual�cos h of mak ng,l�Qrt fYingy 8�d compiling the requesting person to pay - copies. ssible with any request The responsible authority shall comply immediately, if po � made pursuant to this subdivision, or within a8 e'�f,YslT°�e�gteat ompliance eisu not excluding Saturdays, Sundays and legal YS ossible. If he cannot comply with the request within that time, he shall sP in�orth the lndividual, and meY ha�e sn additional five da}'s within which to com ly end le al holidays. request, excluding Saturdays, SundaYS g Subd. 4. Proced�e �►hen data is not accurate or complete. An individual may contest the accuracy or completeness of pub�li f �inrlwriting tthe�responslb e au hor ty exercise this right, an individual shall n y describing the nature of the disagreement be naccura e or incomQlet and att pt to days either: (a) correct the data found to notify past recipients of inaccurate or inuamP�t he believesdthe rdatalto be correct the individual; or (b) notify the individ Date in dispute shall be disclosed only if the individual's statement of disagreement is • included with the �isclosed data• ealed pursuant to the � The determination of the responsible authority may be app provisions of the administrative procedure act relating to contested cases. CHECR OFF LIST FOR ISSIIANCE OF PERMITS ' • � FOR OFFICE USE ONLY ADDRESS OR LEGAL: ��on ��,� C�.t.��2 PID: �G -// 7 V�3 3�Z U U/S DESCRIPTION OF WORR: `t L��L��-� -------------------- -------------------------------------------- ZONING REVIEW BY: c.,�o ��Vw� DATE APPROVED: g'l`{-�I S� BIIILDING REVIEW BY: cy DAT$ APPROVED: �-IS '�S ---------- FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT YesJG No PLAN REVIEW Yes v� 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) --------------------------- -----------------------_------Q------- ZONING CHECR LIST Zoning District IQ� � Fire Department• c,vq�.�'Z Post Office: School District: o�o�rt� Lot Area: Nb GN�rg/vGt: Width: — Depth: — Survey Submitted: Yes� No Date of Survey: to -z3-$7 0� t=��-� Proposed Setbacks : Front (I,a�e) : ��14 a Right Side: o` u Rear (Str�'�t) : �(O` f Lef t Side: S 5 +' C�/ Adjacent Structures: �4�T�e� Wetland: �U��4 Building Height: Def . Hgt. o.(� Peak Hgt. -- Avg. Setback: /V//�' Lot Coverage: � • �- Existing Proposed Hardcover: 0-75 ' 75-250 ' 250-500 ' 500-1000 ' � � •�� - Hardcover Variance Required: Yes No� Date of Council Approval: r Grading: Staff Approval Da e: Bx: Council Approval Date: � Septic: Staff Approval Da �, y: i /, Zoning File:# R �oluti�n #:i%�'� Resolution Date: i REMARRS (in house) : �� - BIIILDING REVIEW CHECR LIST . , IIgC: �-'3 CONSTRIICTION TYP$: � �U Sq Footage $ Per Sq Ftg Basement x - lst Floor X - 2nd Floor X - Garage X - x = TOTAL o> Esti_mated Construction Va].ue: $ �.�, �°" Inspections Required: Work Requiring Separate Permits: Site �Plumbing Grading/Fi�J�ing �Footing _�Mechanical Fire Framing Septic Water Connection �Insu�ation �Fireplace Sewer Connection Wall. Board � (Masonry) Lawn Irrigation ��F'inal (Mfg.) Other Other Wel 1 (State Permit) ;�CElectrica� (State Permit) --------------------------------------------------------- ��FMARKS (IN HOIISE) : -----------------------------�----------------------------- REVIEW BY OTHEFtS: DATE: Access : Existing New Access Approval: Date BY= --------------------------------------------------- FLF.I�ARRS (TO BE NOTED ON PERMIT) : � • � E , /��n'\� � General Information Sheet 2��F<<��f°y Date: � �-� ��/ ��'�ime: � �' � �� -�-{ (,"i'7 �Counter ❑ Called Property Information Property Address: � __ - . --. � -" - v � y_ -� ' _: :�(��C� r c-- -� � � � E-K' �- �1 city, zip � z�� -t �� , �� -' ��-� ��=� r , � �_ Zoning Classification: n �� Map Attached: Yes ❑ No x. � -- � ��'.,��_ Contact Information Name: � �� I �- � I � r-� �� Home Phone: Cell Phone: Email: QUeStIOt1S Handout(s) Given: ❑ Yes ❑ No �Animal Regulations(Type: ) ❑ Hardcover Regulations Building Permit (Type: (–T�g 1�C�csz— ) ❑ Land Alterations (_ Minor/_Major) ❑ Building Permit Status ��-,�,j f-_f 7�.� ❑ Rebuild Questions ❑ CUP Process ❑ Retaining Walls (_<4'/_>4') ❑ Decks ❑ Setbacks � Demo or Teardown Process ❑ Stairway to Lake ❑ Escrow Questions or Escrow Refund ❑ Subdivision Process ❑ Fence Regulations (_Lakeshore/_Non LS) ❑ Variance Application Process ❑ Other/Additional Other/Additional Questions & Staff's Notes/Response �-� ��_� i �,� C.c C '�C�.'�c,� -�__., �� ✓' � � � � . � Mark L. Nesset, AIA � Nesset Architecture, lnc. Y � � .. ,,. . � Fxcelsioi, MN >i�_ i )52 474.1008 office �52-474.0228 fax mark@nessetarchitecture com