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Home My WebLink About2002-P04935 - land alteration � ' PERMIT CITY OF ORONO Permit Number: � 2750 Kelley Parkway- PO Box 66 P04935 Crystal Bay, Minnesota 55323 Permit Type: User Defined (952) 249-4600 Date Issued: 3�s�2oo2 SITE ADDRESS: 4166 Highwood Rd MOUND,MN 55364 P I D: 07-117-23-44-0027 DESCRI PTION: Proposed Use: Residential Permit Class: General Pernut Type: User Defined Pernut Sub-type(s): Land Alteration(0-500 cu yc DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: *Land Alteration-No CUP-No Engineer Fees FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: Robert Rumsch OWNER: R D&A L RUMSCH M� 4166 HIGHWOOD RD MOUND MN 55364 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 SfiATE OF MINNESOTA BUILDING CODE REQUIREMENTS. .__�,r� ; � ,�� A T PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required). 1-Aunlicank 1-Monthlv Reports, 1-AssessinQ, 1-Finance Page 1 „� � � � , � "� Total Fee: $ _�L� � � Date Received: 3-�-�'� �.1�h� Q� ,,j� ��”Entered By: ,�-' L � '� Permit#: �'1-� `�'� i � i� � r�v� LG��z�f CITY OF OR( �� VIIT APPLICATIOleT ---� /� ��i � � i_.i7 (�.{ , � -- All information musi pe sunmitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: �� L ��'� L�uU L� (�� ZIP: S� 3� � NAME OF OWNER: �hP;�1 f`th�� , �`'�''5�� PHONE: (home) y 5�- Lf 7�_3 c�� ,� (work) MAILING ADDRESS: ��`� l-�/�l-l�,✓v�� ,� CITY: r'�►uviv�7 ZIP: 5'S Jc..� C0�ITRACTOR: � �`�� PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: �� PHONE: l�ZAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: �=;�� r�.�--�� i —S�� STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 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 permit; and that the work will be in accordance with the approved plan. �, APPLICANT'S SIGNATURE: , � `�ATE: -�-� �- � �' NOTE! Parade of Homes events require separate permit approval by Police Deparlment and City Council 60 days prior to the event. Non permitted events will not be allowed. Sec.13.04 RIGHTS OF S[JB.TECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored s6all be as set forth in this secdon. Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidenrial data conceraing himseif shall be informed of: (a)the purpose and in[ended use of the requested data wi[hin the collecting�tate agency,potiucat subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requesud data;(c)any�own consequence arisiag from his supplying or refusing to supply privau or confidendal dara;and(d)the identity of o[her persons or enddes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve dara,punuant to section 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income tax or property_tax refund instrucdons instead of on chose forms. Subd.3. Access to data by individual. Upon request to a respoasible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe�her it is classified as public,private or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and;if he desires,shall be informed of the content and meaning of diat data. After an individua!has been shown che private data and informed of its meaning,the data need not be disclosed w him for siz months thereafter unless a dispute or action pursuant to this secrion is pending or addidonal data on the individual has been collected or created. The responsibie authority shail provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the roquesdng person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addiuonal five days within which to comply with the request,exciuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeness of pubiic or private data conceming himself. To exercise this right,an individual shall noafy in writing the responsible authority describing[he 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 nodfy past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individua!that he believes the data to be correcc. Data in dispute shail be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authority may be appealed pursuant to the provisions of the adminisaacive 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 thar. 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 tnay be shazed with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. j. 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 rstand m t ated above. � �� Signature � CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: �l 1�� t� �t�1-�W�t�� 2�t�+ � PID: DESCRIPTION OF WORK: j� I l . Z0�1G REVIEW BY: DATE APPROVED: 3_ � - o-z BUII.DING REVIEW BY: DATE APPROVED; FEES TO BE CHARGED: Misc. Fees Calculated By: �PERNIIT Yes i/ No PLAN REVIEW Yes No SEWER CONNECTION STATE SURCHARGE Yes No WATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTTON Number of SAC�Units OTHER (specify) ZONING CH�CK LIST zoning District: �/'o c r.�-•4-r/(� Fire Department: Post Office: School District: � Lot Area: Sq:ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: , Front(Lake): Right Side: � Reaz(Street): Left Side: I S � Adjacent Structures: Wetland: Building Height: Def. Hgt. Peak Hgt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # Resotution Date: Shoreland District: Avg. Setback: Bluff Setback: Lot Coverage: Ezisting Proposed Hazdcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS(in house): �►�K (.wN� ��,t�r��,�.�� - No Lu,� - nro c�rrG�rrecra ►=�:`S 7 i BUILDING REVIEW CAECK LIST . . �C� N�� CONSTRUCTION TYPE: /v ��- ' Sq Footage $Per Sq Ftg Basement x = lst Floor x = 2nd Floor x _ Garage x = � a = � TOTAL Estimated Construction Value: $ (,�...,,� �q,�,�-�.�,J �� Inspections Required: `Vork Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connection . F��S ' Septic Sewer Connection Framing Fireplace Lawn Irrigation Insulation (Masonry) Other Wall Boazd � (Mfg.) Well(State Permit) Z F� Grading/Filling Electrical(State Permit) Other REMARI�.S(IN HOUSE): . _---____-- ------------------------------------ REV�W BY OTHERS: DATE: Access: Ezisting New Access Approval: Date gy; -----��--------------------------------- REMARI�.S (TO BE NOTED ON PERNII�: 8