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Home My WebLink About2001-P04234 - land alteration • PERMIT CITY`OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Poa234 Crystal Bay, Minnesota 55323 Permit Type: User Defined (952) 249-4600 Date Issued: gi2�i2oo� SITE ADDRESS: 1545 Maple Pl MOLJND,MN 55364 PI�: 08-117-23-33-0029 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: G R LANDBERG&M R LANDBERG OWNER: G R LANDBERG&M R LANDBERG 1545 MAPLE PL 1545 MAPLE PL MOLTND MN 55364 MOUND MN 55364 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �- �'/ - p�y,t�``-�`L�� ,1 �� APPLICANT PERMITEE S GNATURE SSLTED BY SIGNATURE Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1 Total Fee: $ J(�•� Date Received: ��7-0� Entered By: � Permit#: /'0 ya3� CITY OF ORONO - BI.TII.DING PERMIT APPLICATION All information must be suhmitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR a JOB SITE ADDRESS: �f S�� J/��C" ��1f`e� ZIP: __��__3� � �4 NAME OF OWNER: ��L,� � �1�,�1��,Q� PHONE: (home)___��l�_�� ,�/�'� (work) -r MAILING ADDRESS:�LF5'"�J,a r' �/3e� CITY:�1�(�Z.�.S ZIP:_�� /� CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAII.ING ADDRESS: CI'TY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION�f TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detain: b , F�w rc ��n STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED 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 permit and work is not to start without a pemut; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: ��rd��l ATE: �F 2 � 2Q�J � 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. � , Sec.13.04 RIGHTS OF S[1B.TECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom ch data is srored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be givm individual. An' ividual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and intended use of the requesud darn ithin the collecting§tate agency,poliucal subdivision,or sratewide system; (b)whether he may refuse otr is legai4y mquired to supply[he requested da ;(c)any(mown coasequence arisiag from his supplying or refusing to supply private or confidenda!data;and(d)the idendry of other persons or enrides authorized by state or federal law to receive the data. This requirement s6a11 not apply when an individual is asked to supply investigadve dare, pursu t to section 13.82,subdivision 5,to a law enforcemenc o�cer. The commissioner of revenue mav lace the noace re uired nder this subdivision in the individual income tax or ro m tax refund instructions instead of on those forms. Subd.3. Access to data by individuai. Upon request to a re onsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is cfass�ed as public,priva or confidenaal. Upon his further request,an individual who is[he subject of stored private or public data on individuals shall be shown the data w' out any charge to him and,-if he desires, shall be informed of the content and meaning of rhat data. Aftec an individual has been shown ehe private data and informed of its meaniag,the dara need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to this secdon i pending or addidonal data on the individual has been collected oc created. The responsible authoriry shall provide copies of the privace or public da[a upon request by the individual subject of the data. The responsible authority may require[he requesdng person to pay the actual costs of making,ce 'fying,and compiling rhe copies. The responsible authoriry shall compiy immedia[ely, if possibl , with any request made pursuant to this subdivision,or within five days of the date of the requesc,excluding Saturdays,Sundays and legal holidays,i immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additi nal five days within which W comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete.iAn individual may contest the accuncy or completeness of public or private data conceming himself. To exercise this right,an individual shall nodfy wriang the responsible authoriry describing�he nature of the disagreement. The responsible authoriry shall wichin 30 days either: (a)correct the da[a found to be inaccurate or incomplete and aaempt to nodfy past recipients of inaccurate or incomptete data, including recipients named by the individ al; or(b)notify the individual that he believes che data to be correct. Dara in dispute shall be disclosed only if the individuai's sta[ement of disagre ment is included with the disclosed data. The determinarion of the responsible au[hority may be appeal d pursuant to the provisions of the administradve procedure act relating to contested cases. DATA PRIV CY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of s bjects of data", we would like to inform you that your request for a pemut or license from the City of Orono or any of ts departments may require you to fumish certain private or confidential information. ; You aze notified that: 1. The information you furnish will be used to d�termine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal y require that the City deny the permit or license. 3. The information may be shared with other lo�, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license require� 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 plication or permit. First Middle Last Address I City State Zip Phone I understand my rights as stated above. ,I Signaare ` � � CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: I S`f S W1 F4pt�. P tAc.� PID: DESCRIPTION OF WORK: � �.L � Ga�� -r �-rv cAu� Q�a.� ZO�Il�TG REVIEW BY: DATE APPROVED: �-Z�-�c BUII.DING REVIEW BY: DATE APPROVED; FEES TO BE CHARGED: ��'��+�� Misc. Fees Calculated By: �PERNIIT Yes _� No � PLAN REVIEW � Yes No SEWER CONNECITON STATE SURCHARGE Yes No WATERCONNECTTON INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTION Number of SAC�Units OTHER (specify) ZONING CH�CK LIST Zoning District: �.2•�L �6 �-�� . Fire Department: Post Office: School Districr. Lot Area: Sq.ft. Acres Width Dep Survey Submitted: Yes No�_ Date of Survey: Proposed Setbacks: Front(Lake): Right Side: Reaz(Street): Left Side: Adjacent Structures: Wetland: Building Height: Def. Hgt. Peal:Hgt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Dat : Septic: Staff Approval Date: By: Zoning File: # Resolution: # Resolution Date: Shoreland District: Avg. Setback: Bluff Setback: Lot Coverage: Existing Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Appro . RENIARKS(in house): 7 , I � ` BUILDING REVIEW CHECK LIST UBC: CONSTRUCTIdN TYPE: Sq Footage $Per Sq Ftg � Basement x �� _ �yP ' lst Floor x 2nd Floor x _ Garage x _ z — TOTAL j F.stimated Construction Value: $ Inspectioas Required: Work Requiring S�parate Permits: Site Plumbing Fire Hazdcover Removal Mechanical j , Water Connection FO°�g � Septic j Sewer Connection Insu�laton Fireplace � Lawn Irrigation (Masonry� Other Wall Boazd (Mfg.) Well(State Permit) —!�.F� Grading/Fil ' g Electrical (State Permit) Other REMARKS(1N HOUSE): ' . ; REVIEW BY OTHERS• ' DATE: ----------------------------------------------- Access: Existing New j —t— Access Approval: Date gy; "" - — ---------+----------------------------------------------------------- RENIARKS (TO BE NOTED ON PERivII�:'� i I i 8 � � �� 1 � aU ��i i� �� i � _ -�q ; � ��p�ti� � � � � , � �- �'LLJ�' �� ca��coc�-h� r- , ( u - � � � � � � � �✓�2 � -� 1 J �,� C1TY OF ORDNfl � SiTE PLAN GRADING PtAN �.APPROVED � APPROVED INITH REVISIONS 0 DISAPPR V D BY �- DATE - 2 -�� f3 G4 uc D�R-� �ti Co�.ivCt�s �tw� � r-,�c.►,�� N sT� ��s — N O mJ�V�r,� C=��'�e� G 2' ` Q�l��v A 44� C�'r°oN'�C�S