HomeMy WebLinkAbout1996-007731 - land alteration _ �_ .
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� * PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: �3�=���` ���`� :' ��:.:���'
Crystal Bay, Minnesota 55323 t ti i77:;1
(612) 473-7357 Date Issued: f_}�,��,� f;_;__
SITE ADDRESS:
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L::�V
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DESCRIPTION:
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CONTRACTOR: — r��,�.i a��n�:. — OWNER:
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APPLI ANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
^ CHEC� OFF LIST FOR ISSUA��tCE OF PERI�IITS
FOR OFFICE USE ONL
:�DDRESS OFcLEG:�i.: �Z�S c.Y�_�--
PID:
DESCRIP1ZOti OF jj'ORI�: GR�biNv
DATE APPROVED: Z=z�-S,�
ZO`'L`G REti�v BY: DATE ?�PPROVED: -
BL�II.DL\G REti�tiv BI'� "—
FEES TO BE C�-L�.RGED:
(� � y��F�..s Calculated By:
PERtifIT Yes ✓ �to _�
Yes ti'o c�- SEtiVER COt�NECTION
PL?�N REVIE� �10 v- WATFR CON'�tECITON
STATE SliRCH.-�RGE Yz5 vo �, P°�K �E
INVESTIG:�TIOy FEE Z'�S vo � s� INSpECI�pN
SAC -Yes — pTHER (sPe��Y)
Numoer of S�C Units ___
ZO\�G CHECI� LIST zonin�Discricc:
Shore�and Discrict:
'PostOffice: School Dis�`icc:
Fire Depar[menc: � '
Lot Area: Sq.h. Acres
Width �, eP�
Yes :�To Dac of Surve�:
Survey Submicced: / / �
i �
Proposed Secbacks: Ri�� �de: �
F:ont (L.al:ef:��.r �
i i
Re� (Street�` i I.e Side: �
, � ' ;
. ' '' Wetland: j
Adjacenc S�ructures: i t
� �
' � 1�ot i
Buildiag Heighr. ,Def. Hgt. �I r� Peakr�-I, • .._.._.___._..__..__.._.
�
; � / Lot Covezage: (
_�Bluff etback: i
Avg. Setbacic: , �� (
'' i ` Proposed �
! j Exis � � /
� ' / _ s
Hardcover. � �-�5� ! ---f------- %
% 75-250' ' �.-- �
�50-�00' � �— '
500-1000' rI i
� �
u�, Date of Council �,pprov :
Hardcover Variance Req � '�'�
. / � D roval Dace• By: Council �,pprov Dace:
Grading.�Scarf �._P ' `
Sepcic: Scaii �pP
roval Dace: By:
ZOII7'.IIa File: T 21 O Z
Resoiurioa: : Resolution Daze:
gE�tiiA.RKS (in house):
. � 26
..
BL�ILDL'�G RE«�j' CHEC� LIST .
LTBC. CO�tSTRL�CTION TYPE:
Sq Foo�a�e 5 Per Sa F[s
Basemcnt t
lst Foor t
2r.d Fioor r
Gara�e r
X
TOTaL
Estimated Construction Value: S
Inspections Required• . tiVori: Requirin� Separate Permits:
� P!umoing Fire
Sire Wazer Connection
Hatdcover Removal �teca:nical
Seocic Setiver Connection
Foocins L,awn Irrigacion
Framin� Fireplace
(l�iasonry) Other
Insulation Well (Stace Permic)
Wall Board �f�'�
�C Final Gradin;/Filling Electrical (S[a[e Pezmit)
Other
gEy�gS (�Y HOUSE): ,
gEVIEW BY OT�RS: DATE:
Access: Ezisting �e'� -
Access Approval: Dace BY'
gEyI�iRKS (TO BE NOTED ONPERti1I1�:
27
Total Fee: $ 7SJ DateReceived:
Date Approved:
Entered By: ," : �- Pernut#: ; "/ � %
CITY OF ORONO - BUILDI�i tG PERNIIT APPLICATION
ALL INFORMATION MiTST BE SUBNIIT"TED IN FULL BEFORE PLAi�1 REVlEW WII.L
BESTARTED
------ ----------------- ---------
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR�
JOB SIT'E ADDRESS: ( �-7S L�%M�iv A�=�- ZIP: S53 � �
�,'�'Vi��r O��"+1ER: ��pw�fi,�D�L/u /�cl`�(r�r�N PHONE: (home) �17� -�'(oa�
(work) 37l -��5 �
MAILING ADDRESS: I�1.S L;'M/�rc �v i= . CITY:J�JA;2r4-�`� ZIP: S�g 1
CONTRACTOR: Nadeau utilit�, rp�- PH4�IE: 479-6187
MOBILE PHONE/PAGER:
v1AILINGADDRESS: 5839 Hwy 12 CITY: MaT1A p���� ZIP:55359
STATE LICENSE: # N/A
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z��
vAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory S�ucture
Move RemodeUAlteration Lanci Alteration�_
PROPOSEDWORK(describeindetail): CoND,rioNaz �Ss RNa ��-����L `"'�'� � �l��
STORIES: _ SQ• �ET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONST'RUCTION VALUATION(escluding land): $ 9 0 0 0 .o 0
I hereby apply for a buildin� permit and I acknowledge that the information above is complete
and accurate; that the work will be in conforma.nce 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 wil����}n accordance with the approved plan.
APPLI
CANT'S SIGNATURE: DATE: �'`���19�WH ��1 � ���� •
NOTE! Parade o Homes events require par e permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
� S t-i-�-nr�l l��`�T._� �" a 7 r°� .
Sec.13.04 RIGHTS OF SLIBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the dara 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 confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested dara wirhin the collecting'state agency,political 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 idenary of other persons or entiries authorized by state or federel law ro receive the data. This requirement shall
❑ot apply when an individual is asked to supply investigadve data, pursuant to secaon 13.82, subdivision 5, to a law enforcement off'icer.
The commissioner of revenue may place the notice required under this subdivision in the individual income taz or propertv tax refund
inst7uctions 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 whecher it is dassified 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 hun and, if he desires, shall be informed of the content
and mesning of that data. Afrer an individual has been shown the private data and informed of its meaning,che data need not be disdosed to him for
six months thereafter unless a dispute or acdon pursuant to this section is pending or addidonal data on tne individuai aas oeen coliected o:c:eated.
The responsib!e authority 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 acrual costs of making, cemfying, and compiling the copies.
The responsible authoriry shall compty immediately, if possible, with any request made pursuant co 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 dme,he shall so inform the individual,and may have an addirional 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 individuai may contest the accuracy or compieteness of public or private
data concerning hunself. To exercise this right,an individual shali notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shail within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past rPcipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be cor.'ect. Data
in dispute shall be disclosed only if the individual's statement of disaereement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 furnish certa.in private or
confidential information.
You are notified that:
1. The information you furnish will be used to detemune your qualification for the pemut or license requested.
2. Ye�.: ^:a;� refi�se te st�pply data, but refusal maY require that the City deny the permit or license.
3. The information may be shazed 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.
i�la.d�eQ�. I)�=c-I �� �w�-
First iddle Last
Cl$�� �`�'� U �, �'
Address ��� �� l„� l�� �.�'lj,,, ����—.
1 a,( v� t+�(N `�I ��75`1 ��
C�ry State Zip Phone
I understand my rights as stated above. .
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1275 Lyman Ave.
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