HomeMy WebLinkAbout1998-009857 - building PERMIT
• CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 � �������
Crystal Bay, Minnesota 55323 Permit Number: ` "`T�
(612) 473-7357 Date Issued:
SITE ADDRESS:
DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ��p� yV�U�} 2 R�. ( .1�4N�
PID: "
DESCRIPTION OF WORK: �'�r�.�, (L��a�' s ��v
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ZONING REVIEW BY: DATE APPROVED: /�S- 9 7
BUII..DING REV�W BY: DATE APPROVED: i - s'-g 7
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes _� No
PLAN REVIEW Yes �r No SEWER COrtNECTION
STATE SUR�HARGE Yes _�� No WATERCOrfNECTION
INVESTIGAT'ION FEE Yes - No PARK FEE
SAC Y:;s No STTEINSPECTION
Number of SAC Units OTHER (specify)
ZONIlVG CHECB LIST Zoning District:
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:
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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 Dis�ict: ,.
Avg. Setback: Bluff Setback: Lot Coverage:
• Eusting Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARI�S(in house):
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BUII..DING REVIEW CHECK LIST ' � �
UBC: /Z�, � CONSTRUCTION TYPE: Y�
' � Sq Footage $ Per Sq Ftg
Basement x — '
lst Fioor x = �
2nd Floor a =
Gazage x = �
R =
TOTAL
Estimated Construction Value: $ 3�c�o o �
Inspections Required: � Work Requiring Separate Permits:
Site ._�Plumbing Fire
Hardcover Removal Water Connection
Footing Septic Sewer Connection
�_Framing Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
�Wall Board (Mfg.) Well (State Permit)
Final Grading/Filling ��Electrical (State Permit)
Other
REMARI�S (IN HOUSE): '
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMIT�: �
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Total Fee: $ �' �` ' `�� Date Received:
Entered By: Permit#: �' ;1�?
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: �3nG' �'��,��`�-t= �''� ZIP: S5 3 Y!
NAME OF OWNER: d�4���,4A�z S�A�s�� PHONE: (home) =i� �-oE-,a
(work) G:3� - �-�sr 3
MAILING ADDRESS: 3��� .v��.rru� t� CITY: ��n,�z,�;,� ZIP: ST i l i
CONTRACTOR: �( rf� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: "'��,� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration jC Land Alteration �
PROPOSED WORK(describe in detain: s�7��K y�� PA�MTM� , �•,��;�� J e��k +���,
�Q�.-�vvi vL � �����n�� l.�c�l.t Cw�r��sc.��,nt� Tr¢c> > �z.r�c
STORIES: 1- SQ. FEET OF EACH FLOOR: //�'�
NO. OF BEDROOMS: 5 GARAGE STALLS: ATT. DET.�I_
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � 3�'�'. `'�
I hereby apply for a building pemut 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 Ciry 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 will be in acc ce with the approved plan.
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APPLICANT'S SIGNATLTRE: � ��s----�---- DATE: '-���i'7
NOTE! Parade of Homes events require separate permit approval by Police Department 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 D.�.Ta
Subd. 1. Type of data. "Ihe ri¢hcs of individual on whom che data is stored or to be stored shall be as sec forth in this secdon.
Subd.2. Information reqtrired to be given individual. P.n individual asked to supply private or confidenrial data conceming himself shall
be informed of: (a) che purpose aad incended use of the requesced dara within the colleccing'state agency, poliacal subdivisiou,or sratewide rystem;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any k�own coasequence arising from his supptying or refusing to supply
• privare or confidendal data;and(d)che idendry of other peaoos or enriries au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieaave dara, pursuant co secoon 13.82, subdivision 5, to a law enforcemenc o�cer. -
The commissioner of re�•enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund
instrucdons instead of on chose forms.
Subd. 3. Access to data by indi�idual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject
of scored data on individuals, and whecher it is classified as public, privace or confidenaal. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown the data wi�hout any charge to him and, if he desires, shall be informed of the contenc
and meaning of chat data. Afrer an individual has been shown the privace data and informed of ics meaning, the data need not be disclosed to him for
six mon[hs thereafter unless a dispute or acdon pursuant to this secaon is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsib(e autfioriry
may require the requesring person to pay the accual costs of making, certifying,and compiling[he copies.
The responsible authoriry shall comply immediacely, if possible, with any request made pursuant to chis subdivision, or wirhin five days of
the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannot comply with the request
within that time,he shail so inform rhe individual,and may have an addirional five days wi[hin which to comply wich the cequesc,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise�his rieht,an individual shall noafy in writing the responsible auchoriry describing the nacure of the disagreemenc.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempe to noafy past recipienrs of
inaccurate or incomplete data, inc(uding recipiencs named by the individual;or(b)notify the individual that he be(ieves the data to be coaect. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The de[erminadon of the responsible authoriry may be appealed pursuan[to the provisions of the admuustrarive procedure ac[relacin� to
contesced cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like[o inform you tha[your request
for a permit or license from the Ciry of Orono or any of i[s 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 pemut or license.
3. The information may be shared with other local, state or federal agencies to the ex�ent necessary to process
the permit or license.
4. If your requested permi[ or license requires Council action to approve, some information may become
public.
5. You have certain ri�hts 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.
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Addcess
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Ciry State Zip Phone
I underst � ��hts as stated above.
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'`' C'+,ODE REQUIREMENTS
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