HomeMy WebLinkAbout2000-A02371-voided Total Fee: $ ����. �� Date Received: �'I���1 L��/
Entered By: �^ Permit#: �--,�_���
CITY OF ORONO - BUII.DING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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T'HE APPLICANT IS: (circle one) OWNER O `C�ONTRACTOR
JOB SITE ADDRESS: �(,�.� S /�� ��- Y ,LQ V ZIP: S�5�� .� �
NANIE OF OWNER: Ci-�iQ1,5 Tf} /I��.����H E1...�/� PHOi�tE: (home) �'7 f - 7�//b
(work) if//�-
MAILI�i TG ADDRESS: S'�{M E CITY: O�P o iV U ZIP:
CON'TR�.CTOR: f�OM�jtifP_ SPtC/�1��ST5 PHONE: �{7.Z- y�� Z
COiv'TACT PERSON:�,� /3Dili�d�'V��-� MOBILE/PAGER: ��/- 3�S / .
MAII.I�i 1G ADDRESS:��lTo D t�/Oo)jc',1�E R 1�_CITY: Mi/1��11ETt'/ST.4 ZIP: ,�53� .
STATE LICENSE: # �D/ 7 (n 6 7 3
ARCHI'I'ECT/ENGNEER: s��(t PH0�1E:
l�iAII.L�G ADDRESS: CITY: ZIP:
N��,�: REGISTRATION#
TYPE OF WORK: New � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: ���'«C� �x/S��/�� � .SA'�l�
�L�/���v S�o�v �
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROO�iS: GARAGE STALLS: ATT. DET.
e�
ESTI�i SATED CONSTRUCTION VALUATION (excluding land): $_�_SD 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
pemut; and that the work will be in accordance with the approv d plan.
� �APPLICANT'S SIGNATURE:' DATE: � .�`r� �
NOTE! Parade of Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.0�i RIGH'TS OF SLBJECTS OF DaT?, �
C� N � T-
Subd. 1. Type of data. 'Ihe righ[s of individual on who: � b J ecriou.
Subd.2. Information reqirired to be�ven individual. ?� ng himself shall
be informed of: (a)the purpose and in[ended use of rhe requesud da itewide rystem;
�b)w6erher he may refuse oT is le3ally requiied to supply the cequested �0 fusing to suppty
privace or conndenaal data;and(d)the idandty of ocher pesons or enc �,�j ,��_ quiremen[shall
not appiy when an individual is asked to supply ia�zsaeadve dara, p� (/��" �icer.
The commissioner of re�•enu� mav olsce che nodce rauii ertv taz refur.d
insttucdons inscead of on ehose forms.
Subd. 3. ?.ecess to data b�individual. lipon requesc to a W ,e is the subjecc
of stoced data on individuals,and whe:her it is class�ed as public, pri o is the subject
of scor_d privace or public dan on individuals shall be shown the dara C?� !.of the concenc
> //
and meaning of�hat data. Afrzr an individual has be�n shown che priv r � f � �— �sed ro him for
six mon�hs rhereaiter unless a dispute or acdon pursuanc co ehis secdo l'�� ted or crea�ed.
The responsibie au[horiry shall provide copies of dle private or public d
��'� �sible auchoriry
may requirc the requesring person to pay che accual cosu of makine.c
The responsible auchoriry shall comply immedia[ely, if possibie, wuh any request made pursuant to[his subd•.vision, or wichin five days oi
the dare of[he requesc,excluding Sacurdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannoc comply with the requesc
wi[hin chac time,he shall so inform�he individual,and may have an addidonal five days wichin which to comply with che request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or cotapleteness of public or pri�•ate '
dara conceming himsetf. To exercise chis right,an individual shali nodfy in wriring�he responsibie auchority describing�e nacu:e of the disagreement. ..
The responsible authoriry shall wichin 30 days ei�`:.r. (a)correcc the dara found ro be inaccurate or incomple:e and a�^oc to nodfy past recipien�s of
inaccurate or incomplete da[a, inciuding recipiencs named by the individual;or(b)nodfy [f:e individual thac he believes rhe dara co be correct. Data
in dispu�e shall be disc'.osed only if�he individual's sntemenc of disagreemenc is included wich the disclosed data.
The deserminarion of ehe responsible au�horiry may be appealed punuanc to the provisions of�he administ�;ive procedure act relaang to
contesred cases.
DAT� PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to infor�you that your reauest
for a permit or license from the City of Orono or any of its departments may require you to fumish certain private or
confidencial information.
You are notified that:
1, - The information you furnish will be used to detemune your qualification for the pe:mit or license requested.
2 You may refuse to supply data, but refusal may require that the City deny the permit or license.
;, The information may be shared with ocher local, state or federal ageneies �o the eztent necessary to process
the pemut or license.
4. If your requested permit or license requires Council action to approve, some iniormation may become
public.
�, You have cenain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this applica�ion or permit.
Fint �tiddla Last
�ddress
Ciry State Zip Phone
I understand my ri�hts as stated above.
Signacure
CHECB OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2�z S u..�1 ti �Q,..Q
PID:
DESCRIPTION OF WORK: c.cr� vTPcsacA..ti.n��
ZO�TIl�G REV�W BY: DAT'E APPROVED: 5- 5 -��
BUII.DING REVIEW BY: DATE APPROVED; �-S-vo
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes �/' No
PLAN REVIEW Yes J No SEWER CONNECTTON
STATE SURCHARGE Yes _� No WATF.RCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SIT'EINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CHE.CB LIST Zoning District: iv o L��tr�S.P 7- d• (�
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres dth Depth
Survey Submitted: Yes No ate of Survey:
Proposed Setbacks:
Front(Lake): Right Side: �
Rear(Street): Left Side:
Adjacent Structures: Wetland: .
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: /� Resolution: # R solution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house): s v2 o n! =�C,l� — n�o s �7 L �
� 6��
7
BUII�DING REVIEW CHECK LIST
UBC: IZ 3 CONSTRUCTION TYPEs ��
Sq Footage $Per Sq Ftg .
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x —
TOTAL
Estimated Construction Value: $ `]f 5�0 ��
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connecuon
_�Footing ' Septic Sewer Connection - �
0� Framing Fireplace Lawn Irrigation
Insuladon (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
K F�� Grading/Filling Electrical(State Permit)
Other
REI�ZARKS(IN HOUSE): .
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
ltEl�Z!�RKS (TO BE NOTED ON PERMII�: � N~ ~M
8
STATE OF MINNESOTA
��� DEPARTMENT OF COMMERCE
'�� i3s�c s��n st
St Faul,MN SS101 .
�•., - = (651 296-6319
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��+i�a+ .. BT.TII.DING CONTRACTOR �
ID#20176473
BUILDER
INDIYIDT3AL PR.OP1�tEf OR
BONNEVII I.E MARK D
Fxpirea: 3/31l2041 7 Hrs CE due by 3l31/2001
DBA:HOME IMPROVIIv�'�FT SPECIAL,ISTS
6700 W�ODIDGE RD
MINNE.TRISrA MN 55364-0000
QP:MARK DAVID BONNEVILLE
CM-00543
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