HomeMy WebLinkAbout1995-006548 - 12x16 menards shed �
� � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _ ���ui;:;
Crystal Bay, Minnesota 55323 Permit Number: - _ _
(612) 473-7357 Date Issued: _ -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: � _
FEE SUMMARY:
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CONTRACTOR: OWNER: - . ; _ _ _ .. .-_ -
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APPLICANT/PERMITEE SIGNATURE ISS D BY:SIGNATURE
* ' CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ ��� �5� Date Received: t/ � �
� i Date Approved:
Entered By: �v r/
Permit�: �� `�3"
ALL INFORMATION MUST B$ SIIBMITTED IN FIILL BEFORE PLAN REVIEW WII.L B$ STARTED
(See Check-off List Enclosed)
------------------------------------ ----------------
THE APPLICANT IS: (circle one) 6VNER r CONTRACTOR
JOB SITE ADDRBSS: �1S � �`'�� �C'. ZIP: ���� �
(work) ���/-G1�`�3
NAN4: OF OWNER: �elT'� �e-�a�� PHONE: (home) ��r—OU��
MAILING ADDRESS: 3S.c�I C v�r����e CITY: � r(G n�-� ZIP: ��c,��
CONTRACTOR: PH��'
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: �
ARCHITECT/ENGINEER: PHONE:
MAILI23G ADDRESS: CITY: ZIP:
N�g� REGISTRATION ,'�r
TYPE OF WORR: New Addition Accessory Structure Niove
Demo Remodel/Alteration Renovate Land lteration
PROPOSED WORR (describe in detail) : �Gti� ��C�e�e s/n� /�X/� ��►e� �`'���� a S��
STORIES: SQ. FEBT OF EACH FLOOR:
NO. OF BSDROOMS: G�GE STALLS: ATT. DET.
��
/�� .
I
ESTIMATED CONSTRUCTION VALIIATION (ezcluding land) : $ S��C ��7�� C-�K��L��^�°��� $�
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work wil 1 be in accordance with the approved plan.
APPLICANT"S SIGNATURE:tYi'��_�i��K�!�`P/LG�./2E'� DATE: ����/ �Y
CH$CR OFF LIST FOR ISSUANCS OF PERMITS
' � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 35�7 LYR I�. A V� PID:
D$SQtI PTION oF woRx: �(t�� t z X� � �M cn,�20 s� _
------------------------ ----------------- . -
ZONING REVIEW BY: DAT$ APPROVED- fQ �-�'tY
BIIILDING REVI�T BY: DATB APPROVED: ( 0 - Z�-�l Y .
-------------------�-------------------------------------------------------
FS$S TO B$ CHARGED: Misc. Fees Ca�culated By:
PERMIT Yes �� No
PLAN REVIEW Yes �' No SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------
ZONING CHECR LIST Zoning DistriCt: C.�`/L
Fire Department: ost fice• ch District: _
�
Lot Area: Width: h=
Survey Submitted: Yes No � Date of Survey:
l�s�� ���!-loi`-'
Proposed Setbacks: ,
Front (Lake) : /'✓�/2 Right Side: z S
Rear (Street) : (D� Lef t Side: 1 0� +
Adjacent Structures: �� � -f- Wetland: /��i4�-
Buil.ding Height: Def. Hgt. d. � Peak Hgt. (�,,�
Avg. Setback: Lo Coverage.
Existing Proposed
Hardcover: 0-75 ' _
75-250 .
250-50 '
500-10 0 '
Hardcover V riance Re uir : Yes N Date of Cou cil Approval:
Grading: S aff Approv J. ate: By: Council ApprovaJ. Date:
Septic: S aff Approva ate: By:
Zoning F ]�e:# Reso], ti # : Resolut on Date:
R�iRRS (in honse) :
BIIILDING REVIEW CHBCK LIST , �
jJgC. �f/j- � CONSTRIICTION TYPE: N
Sq Footage $ Per Sq Ftg
Basement X -
lst F�oor X -
2nd Floor � X =
Garage � �r Z_ X J ( 2Od�t = ?�3 m�
X =
TOTAL
Bstimated Construction value: $ ZF3C�o�"
Inspections Required: Work Reqniring Separate Permits:
Site Plumbing Grading/Fi�J.ing
�Footing Mechanical Fire
Framing Septic Water Connection
Insulation Firep�ace Sewer Connection
Wa�]. Board (Masonry) Lawn Irrigation
�LFinal (Mfg.) Other
Other Wel�� (State Permit)
Electrica]. (State Permit)
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RffiKARRS (IN HOIISS) :
-------------------------------------------------------------------------------
RSVIEW BY OZ'HERS: DATE:
Access: Existing New
Access Approval: Date BY�
RENlARRS (TO BE NOTSD ON P$RMIT) :
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CITY of UR�NO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� _ � � On the North Shore of Lake Minnetonka
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
Iicense f rom the City 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 Iicense.
3. The information may be shared with other Iocal , s�ate or
federal agencies to the extent necessary to process the permit ar
license.
4. If your requested permit or Iicense requires Counci3 action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required �o process this application or
permit.
�e i-�G� /4/a� Qe�a��
First Middle Last
�S�'I ���''�L �vr
Address .
�.e,,�, /V1,�I/ SS3�/ /
City �� State Zip
�-17/—�'Sa7�7
Phone
I understand my rights as stated above.
Signature . .
BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING
�_ .
�.p,� RIGHTS OF SIIB.7ECTS OF DATA �
gubdivision L Type of deta- The rights of individuals on whom the data is �
stored or to be stored shall be as set forth in this section.
S�� Z. �or�a�on �q�ured to be gi�� �divid�usl. An.individuel asked to
� � supply grivate or confidential data conc ed d amwitlhin the collect ng stat gency,
purpose and intended use of the request
political subdivision, or statewide system; (b) whether he may refuse or is legally
required to supply the requested date; (c) any known consequence arising from his
supplying or refusing to supply private or confidentiel data; end (d) the identity of
other persons or entities authorized by s Vadu��e�kedlto supplyeinvest gat ve� da a
requirement shall not apply when an indi
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue me roleft taX re°und instructio insteadho5
subdivision in the individuel income tax •r
on those orms. . --- - -
Subd. 3. Aecess to data bY in���' Upon request to a responsible "
authority, an individual shall be informed�h ublic, pr'veteeor eonfidenL al.e P�n �
individuels; and whether it is classified p ublic data on
further request, an individuel who is the subject of st to himrlande if he desires, shall
individuels shall be shown the data withou�f an�y ��� After an individuel has been
�e informed of the content and meaning the data need not be �sclosed to
shown the private data snd informed of its meaning, u��t to this section is
him for six months thereafter unless a dispute or action p
� pending or additional data on the individ�h h� a eeor public datarupon request by
� responsible authority shall provide copies of P require the
the individuel subject oftrie actuel•costs of making,lcerti yingyand compiling the
requesting person to pey -
copies. immediately, if possible, with any request
The responsible authority shall comply '
made pursuant to this subdivision, or wit olide e dif Simmediate8tcompliance eisunot
excluding Saturdays, Sundays and legal h YS�
possible. If he cannot comply with the requeet �t��i��nt�ch tohcomPlY f�h the
individ u e l, an d m a y h e v e a n a d d i t i o n a l f i v y s
re quest, excluding Saturdays, Sundays and legal holidays•
Subd 4. Procediu'e when data is not acc�te or complete. An individugl maY
contest the accuracy or completeness�of public or private data concerning
himself. To
ht an individual shall notify in writing the responsible authority
exercise this rig , �e r�po�ible authority shall within 30
describing the nature of the disagreement. lete and attempt to
days either. (a) correct the data found to be inaccurate or incomQ
notifp past recipients of inaccurate or incompleterie belie esdthe datalt° be �o�cty
the individuel; or (b) notify the individual tha eement is
Data in dispute shall be disclosed only if the individual's statement of disagi'
• included with the �isclosed data. ealed pursuant to the
' The determinatian of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases•
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❑ D{SAPP,� `� D � ZS,
BY c� � �6�
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The 1c!d�mens,^��s�;a tnken f:om t!;e�eCOrd F��t O�COUnty rec;ords.T'tt(S d��.ving ts tcr tn!omatl�nat furpCS�4 s'zr!!S Shou��not
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