HomeMy WebLinkAbout1998-0100004 - antenna PERMIT
~ C1TY OF ORONO PERMIT TYP�:
2750 Kelley Parkway- P.O. Box 66 t,t I T�L_i;�;�t;
Crystal Bay, Minnesota 55323 Permit Number: 4{�_ti�:_;:�
(612) 473-7357 Date Issued: ;:�;_r,;�;ys f,_�;Y;
SITE ADDRESS:
.�7i;�. ��::��1_�:r �=`��::i:�Y
��i�-I
F`. . �+i . ��'_.—j, 1 :_— _—�,'�—f_)!i;)f,
DESCRIPTION:
�i'�!�E'.r�f`!#� I'
�.���€! �.r�I i i`l t''�i'(ii I t• �;+�'j? i_.;_I�'I—i-3�.d_. _,��`.'t.Y�.,.'����-�'
`:1�3 �ij1#F'� �:;;•i'i�. i ;`�`�' �.._��i('���;'(._i-j;
_•+.'�tl�L,4:� �..•s�}��;= _._`� !�=_1f+��`•Lt_'�.� ;�f!'?#��_�� .
REMARKS:
r:�'�`��t:�;h,i i Ti f :�:t:��;,ii_JL_F' T;'±'�:!='`d_:(����$�'�� 4�I�H E:��I(��':�T€�°��fE_� `�`�ta 1�`�._�°:_: ��E;�I_:F°�' �.;�v`;' E�;i���E:::
:;rd T�-;� ���i EF° Tiii�+��; �,�t'�ii+l:� . �F`�`+I�=t�tt�T �='a`�'�=� ���i;;i�;_��;s t��� �Ii�!°=�F�r�,:Ti��ttv �_i��`r��°=� .
FEE SUMMARY.-----_______ ..___ _. __
f : - -.
___ . ..._..__.. _.__ ••fiLl 7F;�j f t�y �::,;�.-!, i}t;f!
-- _.__ __..__— t • ��__. - -
�_•���__�;��..___._�_ _ _._ .___. _-- -���'`'.._7`?.._.. _ __
_ __ . __ _ ._ .
°��L�;�r#-;�:,���a,�= _--____ _��'�; c;i; --- -.. _ ._.-
����
�'st.�._a.�,.. .��;.� . _ __. _._ ._ ` ���� -`�
. ..._ �'. _ , _. �.•=----
.
CONTRACTOR:____._ . _. _. . ___.._ --. ... ._..._..---.--_ __ .__ .._----__ _..OWIV�R:_._ ._... .__ ,,4,�;1 i_�y-�t. _
__ ____ _- _._ t�l�;;�'�=L t':,it1i1;!i�1It=TI:�i�?°^�
___--- ---_ _.__.._ __ _ _..__.
- -- . _ _______
-�.7 c 11 __ _ _ .Tt':t�l�'.= �';;_;F.
t`.._s_ti_Ii�`�f Z td��!"f_�:�i (1;`•.1 �.riti._�j,
—..__ ____..__.---._______,---___...--_------------------
;i.;—�:�r-�i t!'7 __
r., w ,�_,_—� ;—� �- �--- • — — _ �;.�:; , _ _ _ t,.� �. _ i t: i� '
��y.,
.�,^ l��`•��!_4.'_��.zlv.��� i�N:l'`.`�4' ?':r���'�sa.__�I '_ i �i�.!°i _ �=3.1_ti�� . '_� �`��-����.�. . P��. 'i�:�'��._ _ -`i''•:�i y..�'1�_�` 1 '•�
--`L"r Z:.. �'t j ':h.!'.� (_i�.•`_�-�- �i t i 11; :-i{ :��� i `�` I ' ' 3^: i; .irv��°i f w;fl�tl.= �,:ji� � F-:*r.�i 6.f i � I;y
_. r...�� �I �_. . .. .t. . . . ..___ � _. _ L .. .F;.��. t•� :�7� `t :T _. ...i .�'�. . . __ .. . . . . . _.
;"t;;�r:i��ji�+ i ih°i�,}t:,.� �'�-. , i,:ti, - - i�#' i°`�,`,f'�:;"_;_.._,_.� tJ i ti: t=i:#�� �
�:�t'-��°_� ;�`�, �; { :�T:� �- sT►{ ��- - I � i�� ����i.t � -� ;���{:.�I�;=t°1�:i��'�°=_ .
� � � � � � ' �
:�
� .���
APPLICANT�PERMITEE SIGNATURE ISSUE BY:SIGNATURE �
, ' .
Total Fee: $ �-���J Date Received: o2�/z.�9 �
Entered By: �. Pernut#: /000
CITY OF ORONO - BiTII�DING PERNIIT APPLI TION
All information must be submitted in full before plan review ' 1 be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
,-�1'7b�' '/
JOB SITE ADDRESS: Z70U K6cc. �,�� ZIP: 55 3S�_
Low�6 LpKt M
NAME OF OWNER: ]�r�c� C�r►�ua,c�r�.aS PHONE: (h me)
(work) `70 3 7l00 c�
MAILING ADDRESS: 9�{0/ JA�tS �✓� CITY: �.00anua w� ZIP: 55
CONTRACTOR: �l�ll (,D�Gr�q-wJ�►- PHONE: 2 Z - 95//
CONTACT PERSON: /1�uc.�c 13�c.u�cr... MO�I.E/PAGER: -0 87 Z� 3to '�G�'�7o f+
MAILING ADDRESS: 70i0� ��x�D CITY: � Con•s ZIP: �Z(v
STATE LICENSE: #
ARCHITECT/ENGINEER: C�'�P��" �2Gt�c7C�T 5 PHONE: � S 12 t�
MAII.ING ADDRESS: Syp� 13a A�a CITY: A��C a ZIP:t�3v
NAME: j� �.d�✓t PA+�.�' REGISTRATION#
TYPE OF WORK: �� Addition Accessory S c
Move Remodel/Alteration Land Alte ation
PROPOSED WORK(describe in detain: rv-r��r� a- Ce>roe -�- ct�i.i
�
STORIES: � SQ.FEET OF EACH FLOOR: ZZC�
NO. OF BEDROOMS: d GARAGE STALLS: ATT. D T. -----
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �u' �v •
I hereby apply for a building permit and I acknowledge that the information ab ve i� complete and
accurate; that the work will be in conformance with the ordinances and codes f the City and with
the State Building Code; that I understand this is not rmit and work is n t to start without a
permit; and that the work will be in accordance ' appro ed plan.
APPLICANT'S SIGNATURE: , DATE: Z 'Z'/-C/
NOTE! Parade Qf Homes events require separate perm' approval by Poli e Department and
City Council 60 days prior to the event. Non permitted events will not be a lowed.
5
� .
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in tkus secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself
shap be informed of: (a)the purpose and intended use of the requested data within the cotlecting state agency,poliacai subdivision,or statewide
system;(b)whether he may refuse or is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidendal daha;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement o�cer.
The commicsioner of revenue mav nlace the norice rewired under this subdivision in the individual income tax or nronertv taz refund
instruceons instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a respoasible 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 confidential.:Upon his further request,an individual who
is the subject of swred private or public data on individuals shall be shown the data without any charge to tum and,if he desires,shall be informed
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafter unless a dispute or a�fion pursuant to this secaon is pending or addirional data on the individual has been
collected or created. The responsible authority shall provide wpies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with-any request tnade pursuant to this subdivision,or within five days
of the dat8 of the request,excluding Saturdays,Sundays and legal holidays,if immediate complianoe is not possible. If he carmot comply with
the request within that time,he shall so inform the individual,and may have an addidonal 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
private data concerning himself. To ezercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the
' disagreemecu. The responsible authoriry shall within 30 days either: (a)correct the data foU�i to be inaccnrate or incomplete and attempt to notify
past recipients of inaccurate or ii►complete data,including recipienu named by the irxiividual;or(b)noafy the individual that he believes the data
to be correct. Data in dispute shall be disclosed oaly if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act relaang
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�ity of Orono or any of its departments may require you to furnish certain
private or confidential information. `
You aze notified that:
1. The information you fumish 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 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(available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
��� /��u �.�X-- �ra 2 6(�r.�l ��'rac..rac�t�r�--
First Middle Last ,(� �
`7 �Go 2p '�'� '�St' ��c5 1"'h K.K- JLt,o� 55 �
Address 92 Z�/� �f
City State Zip Phone
I understand my rights stat d above.�,
�
Signa
. 6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z�(�c� Kt.11...� (�Acz l�w�y
PID:
DESCRIPTION OF WORK: �6l u�Pm En�T F3�,p ca
------------------------------------------------------------------------------------------------------------------------
ZONING REVIEW BY: � DATE APPROVED: Z - �5 -�{$
BUILDING REVIEW BY: o DATE APPROVED: 7• �q • �Q
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 � SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: (ZR-l3
�t�,Q Fire Department: Post Office: School District:
G�'pr+J
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No�` Date of Survey:
Proposed Setbacks:
Front (Lake): �Li�� + Right Side: Z�U� �'
Rear (Street): �5 � ± Left Side: �?5 � '�
Adjacent Structures: 'Z�` � Wetland: D.l<
Building Height: Def. Hgt. �• �� Peal:Hgt. --
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: ,St�.ff Approval Date: By:
Zoning File: # Resolution: # Resolution Date: �
(`�'� 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): Na ��5 /�e'T'U/l�✓ � n-� ��� T
t" ��'� K'�.��'�a N� FGsL 5 7`e �e C L-� ��'l I C �
n..�U � ��v � L y � i,��< [�E v � w �M b 4 n,�s P F c 1 «r�� �-E��S
Fh��� 1 � �''��,i �����LG��' �l'�I� tl���th�S.
�3'/ �J., , • i
7
BUILDING REVIEW CHECK LIST
UBC: 5 ' �- CONSTRUCTION TYPE: �/r�!
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
.�
Estimated Construction Value: $ �`�,oc�o —
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)
p�. Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
------------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------------------------------------------------
REMARKS (TO BE NOTED ON PERMIT�: :r-�(pJ�(;l 1 U �t 1����(1„t�'� r h-�t��� r�1- �-'i fi �'�
''/��t�'���l.� ;� �� '>�i ; � �� r���.�- � ' � �/�l�` � r'� ��'D ����f G 1 M t �h..s �nri._ i ,����t; h� ; .'���'���,;
,� L � ✓�� 7C.�' �,�,'��r'i� f��..`�� ;i����.�/ .- .,��� �. .N � l�����._. '� STb 1 � � � fl��
� � 1
YY1p,�v u�'�,cTv(�d ��J co v4-P�,n,pv%K, t�,� , F�'�t,,::,.. �.: �i s (". .�„ ,� S�rt,`.,
f
8