HomeMy WebLinkAbout1998-010278 - antenna PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelle'y Parkway- P.O. Box 66 �;i 1 i':,.C;T��:�
Crystal Bay, Minnesota 55323 Permit Number: t:}1�=;i!;�
(612) 473-7357 Date Issued: . - _ -
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS: '
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FEE SUMMARY:
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CONTRACTOR: OWNER: — �.��=c�i �r�,i;i. —
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APPUCANT/PER ITEE SIGNATURE ISSUED BY:SIGNATUR
CHECK OFF LIST FOR ISSUANCE OF PERMITS
• ' FOR OFFICE US ONLY
ADDRESS OR LEGAL: (,Z� /�c
PID:
DFSCRIPTION OF`�ORK: (�o�,,,Q �o-�
� � --------------------------------------------------------
Z0�1ING REY�W BY: (�� DAT'E APPROVED: �'�2 9� �$
BUII.DING RE'VIEW BY: Nt/L DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓� No
PLAN REV�W Yes No ✓ SEWER COivNECTION
STATE SUR`�IARGL Yes r/ No WATERCONNEC"ITON
INVESTIGA'I'ION PEE Yes No PARK FEE
SAC Y::s No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: - I �
Fire Department:L�� �� ��� {, Post O�ce: (,O�`�G ��C-f� School District: � d�.�l�10
I.ot Area: Sq.ft. Nd CH1�4s�-�Acres Width Depth
Survey Submitted: Yes No_� Date of Survey: �c TLT �(�,�)
Proposed Setbacks:
Front (Lake): _ Or c�+ Right Side: (4� "~
Rear (Street): 140 'f' Left Side: �� �"
Adjacent Structures: /U(�(1 Wetland:
Buildin� Height: Def. Hgt. O „IC Peak Hgt.
Lot Coverage:
Gradin�: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoni.ng File; # Resolution: # Resolution Date:
�� .
� Shoreland Dis�ict: .
Avg. Setback: Bluff Setback: LotCoverage:
• Eziscing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REiI�ZAR�S (in h ous e): ��Ji� �/�''V� S d/�1/� � �ti1 � I �� /� I�(J UI� �/'�.t(1 �
� ��� S i� � , � j � J�11�Y.. ,d� �i ��i�. I° E l�;h'� 1��
• 26
BUII.,DING RE'VIEW CHECK LIST '
usc: itJl�9- CONSTRUCTION TYPE: ���--
' Sq Footage $ Per Sq Ftg
Basement x =
l st Floor � R =
2nd Floor x = �
Garage z =
R =
TOTAL
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Estimated Construction Value: $ 3D1 C9� '—
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_Q�Footing Septic Sewer Connection
Fram.ing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_� F�� Gradin�/Filling Electrical (State Permit)
Other
----------- -
REA�ARKS (ni 1 HOUSE): �-Ns �' - ---------------------------_,__�_�______
� �, �h., ��5..�•�r
----------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DAT`E:
Access: Existing New
Access Approval: Date By; '
REIZARKS(TO BE NOTED ON PERMIT�: � �
27
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Total Fee: ' $ �� �'S Date Received: ,,, �D S l
Entered By: C� Permit#: /�a-� � -------
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CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information) __
--------------------------------------------------------------------- ---��- ----------- --------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTO
JOB SITE ADDRESS: �lGr, /�c'j�f� �,���r' ZIP: �
NAME OF OWNER: ��L��rt ���� ����G�i� PHONE: (home) � l � ����
� (work)
MAILING ADDRESS: ,�-�� � �� Z✓:: l,� � z����,CITY: C��,� � ���� ZIP: �,- ,35C
T23����.
CONTRACTOR: (.� J %�PJ '� l,/ '�C'r r-! � PHO�tE: � �
, .� �ie�.� � ��
CONTACT PERSON: �ti r�,S �G,h/h. i O AGER: 2� � - �-j Z ,�l
MAILING ADDRESS: C:,�G /t�'. �,�,,;v:�-�,,� ,s�a�rCITY: �% �'�� :r� � ZIP:��tl'
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO�TE:
MAILIl�TG ADDRESS: CITY: ZIP:
NAIVIE: REGISTRATION#
TYPE OF WORK: New �/ Addition Accessory Structure
l�love Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �/,�r,��iit� �/������//��j`-il,�,z G�'
l�,/�1�� ��� �1/ _
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROONIS: GARAGE STALLS: ATT. DET.
>
ESTIMATED CONSTRUCTION VALUATION (excluding land): $_�G; U�it%
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 ac � ance with the approved plan.
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APPLICAI�TT'S SIGNATURE: �+=-�' `�� �-- DAT'E: / �� �,/ r���1/�'rS�
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
5
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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 this secaon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecdng state agency,poliacal subdivision,or statewide
syscem;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or
refiuing to supply private or confidential dara;and(d)the iden6ry of other persons or enaaes authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply invesagative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income taz or nrooertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible 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 stored private or public data on individuals shall be shown the data without any charge to him and,if hedesires,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 acaon pursuant to this secrion is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the privare or public data upon request by the individua!subject of the data.
The responsible authoriry may require the requesting person to pay the acmal cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,
excluding Saardays,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 conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurau or incomplete and attempt to notify
past recipients of inaccurare or i�omplete dara,including�recipiena named by the individual;or(b)notify the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pursuanc to the provisions of the admu►istrative p�ocedure 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�iry 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 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.
� /r� �%��� �iG�P� �G�ir►i'r�7
� Middle I.ast
�� /�% ��i-U, ��yr i�v�
Address
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�ry State Zip Phone
I unders y rights as stated above.
Signamre
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