HomeMy WebLinkAbout1996-008259 - driveway alteration , �� PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 !i��.�� t"���-��;�:�.i
Crystai Bay, Minnesota 55323 PermitNumber: yty;_.��,�
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(612) 473-7357 Date Issued:
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — H���•�, z r n���. —
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APPLICANT/PERMI EE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ - Date Received:
Entered By: Permit#: ✓
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNE�OR CONTRACTOR
JOB SITE ADDRESS: �� s� ti r�tia m A--� ���v� ZIP: � ; 3 � b
NAME OF OWNER: /�g,z-�� �,A-;�.,� PHONE: (home) �17�-�0 7 3 S
(work) �' 3 � -/ �.c�
MAILING ADDRESS: ,�:>� �,a.�o rr�u r����� CITY: 6 r��:: ZIP: ;-s �,;�
CONTRACTOR: /�f��-�� L-�- ��� PHONE: �u.�.�,
CONTACT PERSON: c,�,N,.� MOBILE/PAGER: �Iv;� e
MAILING ADDRESS: ����� CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: : �,n-��, (/YI�,.�� (�+��y ) PHONE: ���M�
MAILING ADDRESS: :; �t�n� CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration�_
PROPOSED WORK(describe in detain: /)'�c� ti�� .� !� ���c'�r,�.'�4 y P ��
��� f� �'z��;i �;� � f�-
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �..�C 0 0 • v c
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 accordance with the approved plan.
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APPLICANT'S SIGNATURE: -1 v DATE: v cP�c �r/5'lo
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.
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Sec.13.04 RIGHTS OF Si1BJECTS OF DATA
Subd. 1. Type of data. The righcs of individual on whom che data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Informatioa reqirired to be givea individual. An individuai asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting�tate agency,poliacal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required co supply the requested data;(c)any irnown consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the idenriry of ocher persons or entides auchorized by sta[e or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesd¢adve data, pursuant to secdon 13.82, subdivision 5,to a law enforeement ofFcer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instructions inscead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individua(shall be informed whether he is tt►e subject
of storod data on individuals,and whether it is classified as public, priva[e or confidenual. Upon ivs further request,an individual who is the subject
of stored private or public data on individuats shall be shown the data wichout any charge to him and,-if he desires, shall be informed of the content
and meaning of[hat data. After an individual has been shown che private daca and informed of its meaning,the data need not be disclosed to him for
siz months thereafter unless a dispute or acdon pursuanc to this secrion is pending or addidonal data on che individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs 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 cequest,excluding Satutdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
wi[hin that time,he shall so inform[he 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 exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement.
The responsibte au[hority shall within 30 days ei[her: (a)correcc rhe data found to be inaccurate or incomplete and attempt to norify past recipients of
inaccunte or incomplete data, including recipients named by the individual;or(b)nodfy the individual that he believes[he data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disciosed data.
The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 fumish 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 pemut 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.
/�!�►Zl�- � . GA-S�h
First Middle Last C7
d s �-A��on� /�2�v�
Address �
O✓c.a,c�� /y(,s� cc�cc„ y7�-�73 S
City Stace Zip Phone
I understand my rights as stated above.
Signa re
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z 5 S L���'4'►�4n-tC /J2
PID:
DESCRIPTION OF WORK: �2�v--e wAti, e4c.^cL'-�iz.e�
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ZONING REVIEW BY: DATE APPROVED: 8 -12- �r L
BUILDING REVIEW BY: �r�r� DATE APPROVED:
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ��''O�
PLAN REVIEW Yes No SEWER CONNECTION
STATE SUR:I-�ARG� Yes No WATER CONNECTION
INVESTIGAZ'ION-FEE Yes No PARK FEE
SAC Y�s No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST zoning District:
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: I O �
Rear (Street): Left Side:
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: # Resolution Date:
Shoreland Dist:ict:
Avg. Setback: Bluff Setback: I.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):
� 26
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BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
^, Basement x =
A ',(� lst Floor x —
�v 2nd Floor x
Garage X =
x =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
ti Final Grading/Filling Electrical (State Pemut)
Other
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
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REMARKS(TO BE NOTED ON PERMITj:
27
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CERTIFICATE OF SURVEY FOR -��w-� ti�':�-� ��;��� '
MARK CASEY
OF LOT 1, BLOCK 1, BAYSIDE LANDING SECOND ADDITION
HENNEPIN COUNTY, MINNESOTA :
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