HomeMy WebLinkAbout1993-005081 - driveway/culverts . . PEI�MIT
CITY OF ORONO PE�iMIT TYPE:
27,50 t<'�'lley Parkway • P.O. Box 815 Permit Number: �i`='s�` �-�}����'���s
Orono, Minnesota 55356-0815 f7t=�i;;��
(612) 473-7357 Date Issued: i`���j�,:_;�,�::;
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNAT E
CITY OF ORONO - BUILDING PERMIT APPI.ICATION
L
Total Fee• $ ) ��� �� � Date Received:
Date Approved:
Entered BY: ��"� u. �' Y /
Permit,r.
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILI� BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List EncI.osed)
---------------------------
----- ----------------------
THE APPLICANT IS: (circle one) � 06VN or CONTR.ACTOR
_d�� ���.-�..a�.<�r Z I P:
JOB SITE ADDRSSS: ,r- (�- �'�- '��
�`(-� �• � �---`-�►-_ (wo rk)
NAME GF Gw'N�: �c�vl tt�c�s-'� PHONE: (home)`f"7 vZ -a2.���`�
MAILING Annx�ss: t�-t`f S ��t'�--,�=�``�'�— cITY:,�`'��-''.�`:,� zzP: S$'3�`�
CONTRACTOR: p$��"
MAII�ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PH��'
MAIZING ADDRESS: CITY: ZIP:
NAME: REGISTRATION T
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�
PROPOSED WORR (describe in detail) : -�_ C_'�U�'�'"' 4�� ' ��"""''�'� r�'���(�
L�=��--���� � . i�
STORIES: SQ. FEET OF EACH FLODR:
NO. OF BEDROOMS: GARAGE STAI�LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding 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 _
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 SIGNATUR����'�--'�>�� DATE: -'j - � ��
��-�"�.� � ''� .
�}„��"r �
q-.m.- 44� f? ' _
�-���� � �� � C+I'�I' O� O1��IIeTC�
�-�,�-�-�tg �;:
*4�'r> ��'
� ,�.er' w s:;��' �c
-��I�'�`-s .,;3 Post Office Box 66•Crystal Bay,hlinnesota 55323•Municipal Offices
� �� �� 1 �y�
�-�3
`1�����t ' � On Ehe Nortiz Shore of Lake Minnetonka
,. � � �,°:
DATA PRNACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
Iicense fromri ce tain � r '��vate or conf dent aI e nf rmationmay require
you to furnis P
You ar.e 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 or
license.
4. If your requested permit or Iicense requires Councii ac��o%
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 ful.I name is required to proc�ss this application or
permit.
`��� t t����"�`'�
First
Middle Last
(y-�--{-�� �.����r -�,� �-�-�=�i�
Address
�;�.,�.�..� ,,� �? �5'-�.��f- -
�' State Z1p
City
���r- �.1.5 �c:`�
Phone
I understand my rights as stated above.
� ��,-----S-s�-
S gnature .
BUILDING&ZONING— 473-7357
• ADMINISTRATION&F(NANCE—�173-7358 • PUBLIC WORKS —473-7359
ASSESSIN G
1 c:
CHECR OFF LIST FOR ISSIIANCE OF PF�2MITS
� FOR OFFICE USE ONLY `
�3DDRESS OR LEGAL: SYD 6!/'D/Z77� A�'� /�� PID: � -
DBSCRIPTION OF WORR: D21�w+A�`1 I ��A����j _
-------------------------- -------
ZONING REVIEW BY: DATE APPROV�: �/ - Z�-£'3
3IIII,DING REVIEW BY: _ DATB APPROVSD: �'� -S �
----------------------
gEEg Tp gg CH�RGED: Misc. Fees Calculated By:
�--�-�� G 2�4 d��� �PR.w.�'r IA.�S �'ti4.�1 1A� c�!3�c �A�+O�
PERMIT Yes t� No .
PLAN REVIEW Yes—� No SEWER CONNECTION
STATE SIIRCHARGE Yes No WATER CONNECTION -
INVESTIGATION FEE Yes No PARR FEE
SAC � Yes No SITE INSPECTION
Number of SAC IInits OTHER (specify)
--------------------
ZONING CHECK I.IST Zoning District:
Fire Department: Post Office: Sc ool Distric :
Lot Area: Width: Dept :
Survey Submitted: Y s No Date of Survey:
Proposed Setbacks:
Front (Lake) : R' ght Side:
Rear (Street) . eft Side:
Adjacent St ctures: Wet and:
Building Height• Def. H t. eak Hg .
Ang. Setback: Lot C erage-
Exis ing Pro osed
Hardcover: 0 5 '
75 250 '
25 -500 '
50 -1000 '
Hardcove Variance Requ red: Yes No Date of Council pproval:
Grading: Staff Approval Date: y: Council. Ap oval Date:______
Septic: Staff Approval ate: By:
Zoning ile:# Resolutio #: Resolu ion Date:
RF1�sARRS (in honse) : .
BQILDING REVIEW CHECR LIST .
.
IIBC: �/V `/'� CONSTRIICTION TYP$: N � _ �"`. ;
Sq Footage $ Per Sq Ftg
Basement X .. _ _ _. _
lst Floor X _ : _
2nd Floor x . = • .
Garage X —
x =
TOTAL -
$stimated Construction Valne: $ """�'� �
Inspections Required: Work Reqnirinq Separate Permits: .
Site ' P�umbing Grading/Filling
Footing MechanicaJ. Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
�( Final (Mfg.) Other
Other We17. (State Permit)
Electrica� (State Permit)
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REMARRS (IN HOIISE) :
------------------------------------------------------------------------------
REVIEW BY OTHERS: DAT'S:
Access: Existing ' New
Access Approval: Date BY=
REi�SARRS (TO BE NOTSD ON PERMIT) :
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