HomeMy WebLinkAbout1999-011583 - land alteration ' PERMIT
:. CiTY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _1:=,;�.;; :::: - _., __-.
Crystal Bay, Minnesota 55323 Permit Number: _ , , ._:^:_; -
Date Issued: �''` `�"�� �
(612)473-7357 i ii-,;''�':��:':i'.=;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — .-- , _ _�;r,,s:;. --
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APPLICA PERMITEESIGNATURE = ISSUEDBY:SIGNATURE G��
-Total Fee: $ . 'Y"�, c`�:� Date Received: �'- -��- %�
,
Entered By: �� Permit#: %/��'� �3
CITY OF ORONO - BUILDING PERMIT APPLICATION �
All information must be submitted in full before plan review w•ill be started. .
�
(please print all information)
THE APPLICAi�'T IS: (circle one) �I�R CONTRACTOR � .
`- -
JOB SIT'E ADDRESS: )�. j�� ��) ��fti'1 ��� ZIP: �� t
I�'A,I1�IE OF Oti��R: 1 j��,� � ��.-ti1C> > )C-'� PHONE: (home) �--i _ �� �
� � � (WOIk) �� � - :' 7
MAIII�I�i IG ADDF.ESS: �/.�� �C'��,ti���. CTI'Y: �� ZIP: .-�-�_ ��
CONT'RACTOR: /�'�r,��,�+t= '1� PHONE:
COtiT'I'ACT PERSON: MOBILEIPAGER:
MElILING ADDRESS: CITY: ZIP:
STATE LICE�'SE: # �
ARCHITECT/E\'GIi`TEER: . PHOti'E:
�7.AII�Itii'G ADDRESS: CIT'Y: ZIP:
�TAME: REGISTRATION#
TYPE OF '4VORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration_ ,��
PROPOSED tiVORK(describe in detai�: r. I/ �r� `r , t`i l-, ���c�P c� �c'����'.�
��� � -� � � � ` 3 �� � c�F'r i� �� f c c�i c�v��*' SC'C� S(,4 ��t" y�
�. .
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �
ESTIiI�iAT'ED 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 wich the ordinances and codes of the City and with
the State Build�*�� Code; that I understand this is not a permit and work is not to start without a
permit; and thac the work will be in accordance with the approved plan.
i% � / , ; � ' —� C C'�.
APPLICAI�"T'S SIGNATURE: .�/' ����-l� >.l`� DATE: �-���� � � � I
�� � �.
NOTE! Parade of Homes events require separate permit approval by Police Department and
� City Council 60 days prior to the event. Non permitted events wi11 not be allowed.
Sec.13.Q4 RIGFiTS OF SUBJECIS OF DATA '
Suhd. i. Type o[data. The righcs af individual on wham[he data is scoced or ro be scorcd shalI be u set fo�ch in this secrion.
Subd.2. Iatormation reqiured to be given iadivfdual. ?.n individuat uY:d w suppty privare oreoafidendal daa conceraing himself sh3I1
be infor¢:ed o,`: (a)the purpose aad in[eaded use of the requuted dam within the eollecdng 3tate agenty,paliacal subd.ivision,or smmwide rystem;
(b)whewerhe rray rF�se ar is.legally requir.d to suooty 4he r_quesud dara;(cj aay Imown eanscqueece arising from his supplyiag or refusing to supply
privace or con.9deccaI dati;ar.d(d)the ideadry of other persoas oreadries auchocized by su�e or federal law to r_:eive c�e da�. 'Ihis r.quircmeat shall
not appiy when an ir:dividuaI is asked to supply invesdgarive dara,pursuaac ro secdoa 13.82,subdivision 5, rn a law enfactement ofncer. �
"Ihe cenmissioner of revenue mav p1ac� �he nodce r�uir:d under this subdivision in the individual incorrte eiz or orooem t�z refund
inscrucdons inscead of on[hose forms.
Subd.3. Access to daca by indiriduai. Upon requac to a responsible aurhoary,an individual shall be inforraed whether he is�he subjecc
of swr.d daa on individuaLs,aad whechec ic is dass�ed as pubtic,private or conF.denaal. Upoa his furcher reques�,an individaal who is che subjea
of stor.d priva�e or public dara on individuaIs shall be shown ehe daci wichout any charge ro him and;if he desira,shalI be infocmed of the eoacanc
ar.d meaning oC chat data. After an individual has been shown[he privare daca usd iaformed o(ic�meaaing,�he data need not be disclased Do him for
six mondu eher_after unless a dispuw o�acaon punuanc to this secdon is pending or addidona!dan on the individual has been coliec`d or craamd.
The responsibte auehoriry shall provida eopies of che priva�or pubtic daca upon request by the individual subjecc of�he daca. T'he responsible authoriry
may requir_ che rsquesdng person to pay the accual coscs oi making,eerdfying,and eompiling the eopia.
The responsible authoriry shaIl comply immedia�eiy, if possible,wich any request made pursuant to this subdivision,or wi�hin five days of
the da�e oF�he raques4 ezcluding Sacurdays,Sundays and legal holidays,if immediace compliance is noc possible. If he canaot comply wich the requesc
wichin rhat dme,he shall so inform che individual,and may have an addidonal five days within which to comply wich the request,excluding Sacurdays,
Sundays and legal holidays. .
Subd.4. Pracedure when data t�not accurate or complete. An individual may eonGsc�he accurdcy or eompletaness of pubiic or privace
dam conceming himsdf. To exercise chis right,an individual shall nodfy in wridng ehe responsible auctioriry dascribing the nature oF the disagreemeac.
The responsible auchoriry shall within 30 days eicher: (a)correcc�ha data faund to be inaccurer�or incomptete and aa:mpc to norify pasc tecipiencs of
inaccu�ate or incamplece data,induding recipieacs named by che individual;or(b)nodfy the individual thac he believes the dae3 to be carrecc Dars
in dispuce shall be disclosed onIy if the individual's sta[er,sent of disagrcem:nt is includtd with the disclosed data.
'Ihe da�ecminauan of the responsib(a auchoriry may be appealed pursuan�m the provisions of the adminisaaave procedure act relaang to
eoncesud cases. •
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 from the City of Orono or any of its depanments may require you to furnish cercain private or
confidential information.
You are notified that:
i. The information you furnish will be used to determine your qualification for che permit or license requested.
2. You may refuse to suppiy data, but refusal may require that the Ciry deny the permit or license.
3. The information may be shared wich ocher local, stace or federal a�encies to the e�tent necessary to process
the permit or license.
4. If your requested permic or licease requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (availabie upon request) to review private data on yourself.
6. Your full name is required to process this applicacion or perm.i[.
/ ;
C��Ci��� ���,``��/i�/ `v��/��
F'ust �fiddle Last �
��_���� �(_� ��✓��r l��
Addreu �.�
�/i`>G//�I/ r���(__ `7 "xi�� � ��- 5��j�
Ciry St+ce Zip Ptione
I understand my ri�hts as stated abov.e.
� /� �
Sigrucure
{
- ' CHECK OFF LIST FOR ISSUANCE OF PERMITS �
�
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: >>35 lV oRTti-t A�2v� DfZ
PID:
DESCRIPTION OF WORK: (_, �.
ZOrTvi G REV�W BY: DATE APPROVED: (a -Z���9
B JILDI�i tG REVIEW BY: N 1�} DATE APPROVED: �--
FEES TO BE CHARGED: (--��� �•��� Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW . Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNEC'ITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Iv'umuzr uf SAC Units OTHER (specify)
ZONIi�TG CH�CK LIST Zoning District: N'o
Fire Depar[ment: Post Office: School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Da[e of Survey:
Proposed Setbacks:
Front(Lake): Right Si e:
Rear (Street): Left Si e:
Adjacent Structures: Wetland:
Building Heigh[: Def. Hgt. Peal:Hgt.
Lot Coverage:
Gradin': Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # . Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff S back: L,ot Coverage:
Ezisting Proposed
Hardcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes o Date of Council Approval:
RENIARKS(in house):
7
BUII,DING REVIEW CHECK LIST '
�C� � CONSTRUCTION TYPE: —
.• Sq Footage $ Per Sq Ftg
Basement � _ .
lst Floor R =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ '—
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical 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
REMARK.S(IN HOUSE): .
-----------------------------
REVIE`�' BY OT�nS: �ATE:
Access: Existing New
Access Approval: Date gy:
-----------------
RENIARKS (TO BE NOTED ON PERMII�:
� 8
i
�
250' OFFSET TO OHWL LINE l
� � I n T' `
L_V I �� 1 ,
! ' 1-ST�Y \� _ �'^T -' � — — I
m ti � —
� I ;1 � � HpUSE GARAGE I �� � - �-U � .� i � �- �` `� ,9 I
��� � 2� rv {' ----�- o / SFiED T � � 9 ; ' l 'x EDG� CF
' I �" / �� BE REMOVED " �� � �� � 9 �. _ � BiTU�IN�US
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'; '`, `. � �,,�'��� ° � .5 ''' � �z�s'�� � PROPOSE GARAGE (2�x4�) ; °� �'� �_
. �
\ �' � --� _ _9a�' o R i�v� PROPOSED ELEV. FF�9g7.5' ' � � �
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,�,,a �', �PROF',OS DE�K WELL ' — I — � — — 9 � --7 — — — -- — `
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.� , �, �� � �'2 � �g,4 — -�� -- _ _ _ _ __ -g76 310�00 _(PLAT) ' 9 Y CERTIFICAT C
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� �, ,�� �_ � � _ - - � � r„- � ^ ' � for;
1 s�� I L_�/ � ..`tr„� �
� CLAUS VI
� C1T� O� O�RONO F4REST L�
� � SiTE PLAN � GRk�D�1G PU�N
.0 APPROVED -- t��-�
� APPROVED WITN REVISIOIVS
PROPOSED CONSTRUC710N NOTES: ❑ DIS RQV
1. The wa�kout patio will be constructed at ground level off lower level of BY �^ - �������
existing house ond wili be a poured concrete slab with no covering an odaquate �T'� (� Z3 -�1�1
grade to move water away from existing house. AS SHOWN ON SURVEY
2. Decks wtll be of wooden construction and wiil be built off existing first abd — �'1�.�.- ��`^^�TZ-"� � ./ � �Eg 0 51998
second levds of existing house. AS SHOWN ON SURVEY ,���N �J ���
�5 � �1�:f+RY �. JUn���Uiy L�'�
3. Garage will be constructed of block foundation and wood frame construction. )
AS SHOWN ON SURVEY Y/�LL`OS
.� po nroT GH�N�o�
(�f�tntl� (�c�.
LEGEND
� ' �� ���� 1 hereby ceyify thot tPis survey, plan
��� or under m direct su ervision ond ',f
Iron Pipe Found Surveyor under the laws of the State
�� Iron Pipe Set
— —' — — —T�— — — — — Overhead Telephone and Electric �
—_ — — — �— — — — — nVPfF1P('lf� ��car�ri� �' � n.,+o• 12/18/97 %