HomeMy WebLinkAbout2000-P02602 - land alteration � PERMIT
� CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: ro26o2
Crystal Bay, Minnesota 55323 Permit Type: user nefined
(612) 249-4600 Date Issued: 6i2�ioo
SITE ADDRESS: 125o Lyman Ave
WAYZATA,MN 55391
P ID: 3 5-118-23-34-0015
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: LAUER HOMES OWNER: MICHAEL BROMME
401 EAST LAKE ST 2165 MAJESTIC WAY
WAYZATA,MN 55391 CHANHASSEN,MN 55317
THE UNDERSIGNID HEREBY REQUESTS PERMISSION TO MAKE Tf�REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII.,DING CODE REQUIREMENTS.
�
,
NA UED BY SIGNATURE � �
Copies:City,Applicant,Assessor,Finance Page 1
� Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII.DING PERMIT APPLICATION
All information must be submitted in fu116efore plan review will he started.
(please print all information)
---------------------------------------------------------------------- -----=—=�---� ------------------------
THE APPLICANT IS: (circle one) OWNER CONTRACTOR
JOB SITE ADDRESS: /.�,� �y/►?f4-� �IIC Z�: SS3`I/
NAME OF OWNER: rnlC�}pt� [�/�j�E- PHONE: (home) 5/7�/- /.���
(work) - �
MAILING ADDRESS: a/(�S MA-J�3T�G t,c�A�/ CITY: C�}��S� ZIP: S�3/'7
��75
COl�TRACTOR: f�/�,E/L �Om�� PHONE: �6-3�3a
CONTACT PERSON: p.� � �{�,� MOBILE/PAGER: 3� - 7� '7S-
MAILING ADDRESS: �►-o i � 1�lKE s�- CITY: W�}y�--�q- ZIP: sss 9 /
STATE LICENSE: # �oo�q p i s-
ARCHITECT/ENGINEER: PHONE:
MAIL�TG ADDRESS: CITY: ZIP:
NA1�IE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration ,/�
PROPOSED WORK(describe in detai�: - H-�� p.o�„��
QCMOV� �f R.T �M S tTE
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTL�IATED CONSTRUCTION VALUATION (excluding land): $
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 permi and work is not to start without a
permit; and that the work will be in acc ance e p ved plan.
APPLICANT'S SIGNATURE: DATE: O�
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.
9
Sec.13.04 RIGHTS OF SCTBJECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning hitnself shall
be infotmed of: (a)the purpose and intended use of the requested data within the col(ecting state agency,polirical subdivision,or statewide system; (b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data; and(d)the idendry of other persons or endaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,pursuant to secrion 13.82,subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav nlace the notice rewued under this subdivision in the individual income taz or arovertv tax refund insuuc6ons
instead of on those forms.
S�bd.3. Access to data by mdividual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of
soored data on individuals,and whether it is classified as public,private or confidendal. 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 hun and, if he desires, shall be informed of the content and meaning
of that data. After an individual has been shown the private daca and informed of its meaning, the data need not be disclosed to him for six months
thereafter unless a dispute or action pursuant to this section is pending or additional data on the 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 authoriry may require the
requesting person to pay the actual 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 Satutdays,S�ndays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within
that time,he shall so infocm the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays
and legal holidays.
S�bd.4. Procedure when data is not accurate or�mpl�e. 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
tesponsible authority shall within 30 days either: (a)correct the dafa found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate
or i�omple�e data,i�luding recipients named by the individual;or(b)notify the individual that he believes ihe data to be correct. Data in dispute shall
be disclosed only if the individual's statement of disagreement is included with the disclosed data.
Tl�e de�ernunaaon of the responsble authority may be appealed pu�suant ro the provisions of the administradve pmcedure 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 aze notified that:
1. The information you furnish will be used to determine your qualification for the pemut 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 ceRain 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
I understand my rights as stated above.
Signature `
1�
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: � �Z �� t- '(vv� ,�4�-�'
PID:
DESCRIPTION OF WORK: ,a /'�� �—E'-�/#y--r �-�-' . v��-,/��%� -�
ZONING REVIEW BY: c �. DATE APPROVED: � Z 7`� �
BUILDING REVIEW BY: DATE APPROVED:
FEES TO BE CHARGED: ' Misc. Fees Calculated By:
PERMIT Yes v'' 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)
------------------------------------------------------------------------------------------------------------------------
ZONIl�i G CHECK LIST Zoning District: /c.v «�,(/
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:
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 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): ('�-r.�y� ,�-c.� �.,� s s ����— s Lc; �=�/_'�,� y��Y1/,�?
�
27
BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ �1/�
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)
_{1�' 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 PERMI�:
28
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