HomeMy WebLinkAbout1996-007897 - pond �
� PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 i_1�-;i=�:_C�F�=T tvF'[}
Crystal Bay, Minnesota 55323 Permit Number: ��r_�j��,,,�_�
(612)473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
F'�::�h�Cy
�.���r �'�rr,�it. Ty��N �Atdl� r�LTE�t�TTi�{�J
REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — �i�=�:��, x r��-�t. --
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L {:��`��tt�l�,€ ii��;i;'�{r"�td�=��'_� ���il� '�=T�TF �r31= i 1?;,�#�,=°���::��'g� �;t.f;L�.3 i t�t� C�i��l?�. F��:�{17 ri�.CS�wt�3 T°=� . �
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APPLICANT/P RMITEE SIGNATURE ISSUED BY:SIGNATURE �•
f (i
s otal Fee: � '�G', �'�' DateReceived: �{ ._:�'_:;- %��-
' Date Approved: _
Entered By: �,�ti�� Permit#: �� 9�7
CITY OF ORONO - BUILDING PERMIT APPLICATION
ALL INFORMATION I�fUST BE SUBil�1ITTED IN FULL BEFORE PLAi�T REVIEW WILL
BE STARTED
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THE APPLIC�i:��'I' IS: (circle one) OWNER OR CONTRACTOR
JOB SITE �DDRESS: 3��� /���/�C G� z�: �'�3 �%
,
Nr�i�ti1E OF OWr�ER: �L�rr� 24 PHOIV�: (home) y���S ��
(wor1:>
NIAILING�DDRESS: 3�0 ��-.� � CITY: �'4�2�-A ZIP: S�3 5'%
CONTRACTOR: ����/t �a� PHONE: ��7/-r��`�a
MOBILE PHO�E/PAGER:
MAII.ING A.DDRESS: �'�� CITY: Z�:
STATE LICENSE: #��,4
ARCH1fiECT/ENGINEER: ��- PHO�tE:
MAILING ADDRESS: CITI'� Z�'
NA�tiLE: REGISTRATION #
TYPE OF WORK: New Addition Accessory Struct�u'e
Move Remodel/Alteration Land Alteration�_
...
PROPOSED`VORK(describeindetail): L9�S�A/�� � /��'��p�`fi�'`� ��y� U`�s� �`r
�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOVIS: GARAGE STAI.LS: ATT. � DET�_
ESTL�I�TED CONSTRUCTION VAI.UATION(escludingland): $
� �00 �3,o v O
I hereby apply for a building permit and I acknowled�e that the information above is complete
and accurate; that the work will be in conformance with the ordinances and codes of the Ciry
and with the State Buildin� Code; that I understand this is not a permit and �vork is not to start
without a permit; and that the work will be in accordance with the approved plan.
A.PPLIC��tT'S SIG�1aT`LTRE: , `�� DATE: � �—
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non-permitted events will not be allowed.
�
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, `
Sec.13.04 RIGHTS OF SIJB.TECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the dara is stored or to be stomd shall be as set forth in this section.
Subd.2. Information reqirired to be�ven individual. An individual asked m suPPlY Private or confidendal data concerning himself shall
be informed of: (a)the pucpose and inrended use of the requestcd data within the collecting�tate agency,poGdcal subdivision,or staoewide sysoem:
(b)whether 6e may cefuse or is legally required to supply the tsquested data;(c)anY known consequence arising from his suPP1Y�8 or refusing to sapply
private or confidenaal daca:and(d)the idendty of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,pursuanc co secdon 13.82, subdivision 5, [o a law enforcement officer.
The commissioner of revenue mav alace the nodce required under this subdivision in the individual income taz or vrocertv ta�c refund
instrucrions instead of on those fortns.
Subd.3. Access to data by iadividual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subjecc
of stored data on individuais,and whe[her it is class�ed as pubiic,private or confidendal. Upon his further request,an individual who is the subject
of swred private or pubiic data on individuals shall be shown the data withouc aay c6arge to him and,'if he desires,shall be informed of the content
and meaning of that data. Afur an individual has been shown the private data and informed of ia meaning,the data need not be disclosed to him for
six mon[hs thereaf[er unless a dispute or acrion pursuant to this secdon is pending or additional data on the individual has been collected or creared.
The responsibie authority shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible aurhoriry
may require the requesting person to pay the actual cosu of making,cerdfying, and compiling[he copies.
The responsible authoriry shall comply immediately,if possible, with any request made pursuant to tivs subdivision,or within five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
within ehat time,he shall so inform the individual,and may have an addidooal five days within which to comply with the request,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or privatc
data concerning himself. To ezercise this right,an individual shall nodfy in wridag the responsible authority describing the nature of the disagreemenG
The cesponsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompleu and attempt to noafy past recipienu of
inaccura[e or incomplete data,including recipients named by the iadividua(;or(b)notify the individual that he believes the data to be correct_ Data
in dispute shall be disclosed only if the individual's staument of disagreement is included with the disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating tn
contested cases.
DATA PRNACY 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 deterniine 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 eztent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
g, 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 perm.it. �
Gq I✓l- % ` �20� -
First M�ddle ��
3 2� �����R�e �H-� _
Addre s
��2.��`�- /`?�y S s�� � %�/�SY
City State Zip Phone
I understan y rights as stated above
Signatu
CHECK OFF LIST FOR ISSUAI�iCE OF PERMITS
� FOR OFFICE USE ONLY
�iDDRESS OR LEGAL: � �S' ; ��C `���f ° � � :� ��--
PID:
DESCRIPTION OF WORK: y-�.� . C
ZONING REVIEW BY: DATE APPROVED: y- z s- 5 �
BUII..DING REV�W BY: /vt/.F DATE APPROVID:
FEES TO BE CHARGED: 6�j0�^'..y M�sc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIE`y yes No ✓ SEWER CONNEC'I'ION
STATE SURCHARGE Yes No WATER CONNEC'TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTE INSPECITON
Number of SAC Units OTHER (specify)
---------------------------
ZO�TING CHECK LIST Zoning District: L2-/�- Shoreland District : 4�P5
Fire Department: Post Of e. chpe�-District:
� ' /J
Lot Area: Sq.fr. Acres
i � �'� Depth
Survey Submitted: Yes �C _
No Date of Survey: � �Z "`1 �3 �N '��
Proposed Setbacks: � 5� '
Front (Lake): G� Right Side: �
�� fi
Rear (Street): I.eft Side:
Adjacent Structures: Z� � � Wetland: N I/}
Buildi.ng Height: Def. Hgt. Peak Hgt.
Av;. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
,� Hardcover Variance Required: Yes No Date of Council Approval:
� Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: BY�
Zoning File: # Resolution: # Resolution Date:
I7��Vl[AgK�S (in house):
BUII.DI�i 1G REVIEW CKECK LIST
UBC: N/i4- CONSTRUCTION TYPE: /✓�/4'
� Sq Foota�e S Per Sq Ftg
Basement z —
lst Floor X —
2nd Floor R —
Garage x —
x =
TOTAL
Estimated Construction Value: $ /V�l�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Sep[ic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_� Final Grading/Filling Electrical (State Permit)
O�her
REiV1ARI�,S (IN HOUSE):
- ---------------
�ZEVJEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date BY�
REI�iA.RKS (TO BE NOTED ON PERNIIT):
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