HomeMy WebLinkAbout1994-005996 - stairway to Lake PERMIT
CI�Y OF ORONO PEl�MIT TYPE:
• 2750 Keiley Parkway • P.O. Box 815 �;tl�_L;i��v�:
Orono, Minnesota 55356-0815 Permit Number:
Date Issued: "�;�_����`
(612) 473-7357 _ ;�r._;;I��;:
SITE ADDRESS:
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CONTRACTOR: OWNER: — :a�=�.��. ; ����t. —
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APPLICANT/PE IT SIGNATURE ISSUED BY:SIGNATURE t�,C�
CITY OF ORONO - BQILDING PERMIT APPLICATION
Total. Fee: $ �D�, �L� Date Received: ��3, �S'�
�, Date Approved:
Entered By: � permit�: � `� '
AT•T• INFORMATION MIIST B$ SIIBMIT'�SD IN FIILL BEFORE PI,AN REVIEW WILL B$ STAR�ED
(See Check-off List Enclosed)
------------------ -------------=----- ------------------- ----------
_ _ - - --------
THE APPLICANT IS: (circle one) �..�_OWN_�Fr-� CONTRACTOR
JOB SITE ADDRBSS: - ZIP: �� � �
(work) � > - 7
- � �� �
N�ME OF OWNER: ��C� PHONE: (home) � Z b�
�iAILING ADDRESS: � �C� /t,� � j cz�: � zzp: S�3 {
CON2'�CTOR: �10 pH��=
IKAILING ADDRESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: PHONE:
MAIZING ADDRBSS: CITY: ZIP:
N�: RSGISTRATION u
TYPE OF WORK: New� Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : S 5 ��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF B$DROOMS: GARAG$ STAI�LS: ATT. DET.
ESTIIriATED CONSTRIICTION VALIIATION (eacluding Iand) : $ � , �(1(1
I hereby apply for a building permit and I acknowledge that the information
above is compl.ete 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 mi and work is not to start without a permit; and
that the work will be ' acc r nce with he approved plan. •
�
APPLICANT`S SIGNA � DATE: � �
�
� . . .
�
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� • � � 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
license 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 Iicense 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, state or
federal agencies to the extent necessary to grocess the permit or
license.
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�at�
data on yourself.
6. Yaur full name is required to process this applicatian or
permit.
/
� � Q c� o
First Middle Las
— � �` �
Address �
�5��
City State Zip
�1� - �-� � i
Phone
I un rst my rights as stated above.
Sign re
BUILDING 8c ZONiNG—473-7357 • ADMINISTRATION dk FINANCE—473-7358 � PUBLIC WORKS—473-7359
ASSESSING ,
513.04 RIGflTS OF SIIBJECTS�F DATA � -
gubdivision L Type of daffi- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section. An.individuel asked to
Subd. 2. Information re9uired
to be given individusl.
1 rivate or confidential deta concerning himself s1�all be informe�a�e 8 e ��
� � �P P Y P u e s t e d d ata within the collecting g
purpose and intende d use o f t�'►e r e q tem; (b) whether he ma� re fus e o r i s l e g a l l y
political subdivision, or statewi de s y s �own consequence arising f r o m his
required to supply the requested date; (�� 8nY �d (d) the identity of
supplying or refusing to supply private or confidentiel data,
ther ersons or entities authorized by state or federal law to rece�veste at ve da a
° P 1 when an individuel is asked to supply g
requirement shall not app y
pursuant to section 13.82, subdivision 5, to e law enforcement officer. �der this
The commissioner of revenue ma
lace the notice re uired
subdivision in the individuel income tax or ro ert tax re und uistructions instea o
on those orms. - � --- - .
Subd. 3.
Access to data bSl i����' �p°II request to a responsible
authorit , an individual shall be informed whe blic h r vateeor eonfidential.e Upon his
y ublic date on
individuels, an d w he t be r i t i s c l e s s i f i e d a s p � P
e to him and, if he desires, shall
further request, an individual who is t�e �b7ect of stored priva te o r�au� � been
individuels shall be shown the data withou�fgn�Y��a. �ter an ind�
6e i n formed of the eontent and meaning t� �� need not be �isclosed to
shown the private date and informed of its u���action pursuant to this section is
him for six months thereafter unless B �P n request by
endin or additioriel data on the individuel hss a�een�r Public�t8ru�eated. The
� P g require the
responsible authority shall provide copies of the P �ible authority may �ln the
the individuel subjeet oftrie actual.cos h of makiriB, aertifying, and comp g
requesting person to pay -
copies. y if ssible, with enY request
The responsible authority she]1 comply immediatel , P� uest,
ursuant to this subdivision, or withia five days of the date of the req
made p S�da� �d legal holideys, if immediate complisnce is not
excluding Saturdays, With the request within that time, he shall so infVorth the
possible. If he cannot comply within which to comply
individuel, and may have �Sundays and legaldho days.
request, exeluding Saturdays,
Subd. 4. Procedure when dsta is not acc�dte or comPlete. An in�ms�. To
notif in writing the respcnsible authori30
contest the accuracy or complet�eenl s��Publicy r private data concerning ittun
exercise this right, en indivi nsible authority shall v+►
describing the nature of the disagreemen� The respe
da either: (a) correct the data f ound to be inae��ae��u�ng pee�ipl��namedt by
�
notify pest recipients of inaccurate or ineemPle �
the individuel; or (b) notify the individuel that he believes the data to be em�t�
Date in dispute shall be disclosed only if the individual's statement of �� the
• included with the disclosed data• � 8ppeeled pursuant to
' The determination of the responsible authority to contested ceses.
provisions of the administrative procedure act relating
�
CHLCK OFF LIST FOR ISSIIANCE OF PERMITS
• FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �'1 S b � �I�Z+dl1 OliQl_�PID: .
DBSGRIPTION OF WORR: LAI�� /�-�Q� 5 S'�7/R�S
--------------------- -------------------------------------------------------
ZONING REVIEW BY:� DATS APPROVED: Y-Y�- cl`�
BIIILDING REVIEW BY: DATS APPROV�: Y-Y"5�
FE$S TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No .
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes—� No WATER CONNECTION
INVESTIGATION FEE Yes No �' PARR FEE
SAC � Yes No �` SITE INSPECTION
Number of SAC IInits OTHER (specify)
--------------------------
ZONING CHECR LIST g i r' t:
Fire Department• Post fice: h rict:
Lot Area: Width: Depth:
Survey Submitted: Yes� No Date of Survey:
Ol� ���r
Proposed Setbacks:
Front (Lake) : yl/a Right Side: 3v �f
Rear (Street) : /`�l�' Left Side: /Ov� -}
Adjacent Structures: /2 � Wetland: /1�//�
� Bui].ding Heig : Def. Hgt. Peak .
Avg. Setback: Lot Coverag :
Existi g Proposed
Hardcover: 0- 5 '
75-2 0 '
250-5 0 '
500-1 00 '
Hardcover Va iance Re uir : Yes No Date of Cou cil Approval:
Grading: Sta f Approv Da e: B : Council Approval Date:_
Septic: Staf Approval Dat : BY:
Zoning File: R soluti n �: Resolut'on Date:
RffirIARRS (in honse) :
�
BQILDING REVIEW CHECR LIST
��: n - 3
CONSTRIICTION TYPE: � �
Sq Footage $ Per Sq Ftg
Basement � X -
lst F7�oor X -
2nd Floor X -
Garage X -
x = �
TOTAL
Bstimated Construction Value: $ Z t^�� o-
Inspections Required: Work Requiring Separate Permits:
S'te ' P�umbing Grading/Fil7�ing
�oting Mechanical Fire
�raming Septic Water Connection
Insulation Firepl.ace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
t�inal (Mfg.) Other
Other WelZ (State Permit)
Electrical (State Permit)
-----------------------------------------------------------
REMARRS (IN HOIISE) :
������_���������������������������������������������������������������r������_
RLrVIEW BY OT�tS: DATE:
Access: Existing New
Access Approval: Date BY=
-------------------------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
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STA[RS
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�7 L�ASi' O�lE HANDRAIL REQUiRED
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�.;��.%;�,=�.���::`l� — CORRECT & RESUBMlT yt' ���. ��'EiVINGS - .
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G� R..�rrr.�.i3.. �r.d�:*�r.; :«*ms nai �eciticeily noted in thts.releif�
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