HomeMy WebLinkAbout1991-003830 - land alteration � � � � , _ . . ��—
1'ERMIT
� CI'TY OF ORONO PERMIT TYPE: fy:=;��_��_��,,���
1335 Brown Rd. South • P.O. Box 66 Permit Number: !xtj:a,�_;t�
Crystal Bay, Minnesota 55323 Date Issued: �y�%f�'�-��
(612) 473-7357
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
��et1� �C� ___-----�a,(7i�Tf�
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CONTRACTOR: 01�IL�E� —! ��'�'� 1��''{• --
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, . . �.
CHECR OFF LIST FOR ISSIIANCE OF PSRMITS .
FOR OFFICE USE ONLY
ADDR$SS OR LEGAL: /�0 u /I�i�Y�L� /�I'�n'1 !}7/PID:
,� IS �
DESCRIPTION OF WORK: l"b�'L� `� �'�<< ti/�/JS _
---------------------,/- J' --- -----------------------------------------------
ZONING REVIEW BY: O(,�(� DATE APPROVED: 7-I Ft-�j�
I
BUILDING REVIEW BY: DATE APPROVED:
-----------------------------------------------------------------------------
FEES TO BE CEARGSD: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes J No SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No f PARK FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------------
ZONING CHECR LIST Zoning strict:
Fire Department: ost ffice: School District:
Lot Area: Width. Depth:
Survey Submitted: Yes_� No Date of Survey:
`--l�.�c i 5 T//"f p cv (�LL�
Proposed Setbacks: �
Front (Lake ) : Right Side: �jS 2�
!
Rear ( Street) : I 2 5 'f' Left Side: �S � t
Adjacent Structures : � �=�.�.� {�,�us� Hletland: it/r�
Building Height: Def. Hgt Peak Hgt.
Avg. Setback: Lo erage:
E ' stin Prop sed
Hardcover: 0-75 ' -
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date o Council Approval:
Grading: Staff Approval Da C uncil Approval Date:
Septic: Staff Approval D e: By:
Zoning File:# Resol t 'on #: Resolution Date:
REMARKS (in house) :
� a
s'3QII�DING REVIEW CHEC�C LIST
IIBC: � � I l/7" CONSTRIICTION TYPE: � /-1-
Sq Footage $ Per Sq Ftg
Basement X =
lst Floor X -
2nd Floor X =
Garage X -
x =
TOTAL
Bstimated Construction Value: $ �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
�Final (Mfg. ) Well State Permit
Other Electrical (State Permit)
------------------------------------------------------
RBMARRS (IN HOIISE) :
-------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
-----------------------------------------------------------------------------
R$MARRS (TO BE NOTSD ON PERMIT) :
� CITY OF ORONO - BIIILDING PERMIT APPLICATION
� Date Received: �� (�
Total Fee: $
Date Approved: / `� /
Entered By:
Permit#:
ALL INFORMATION MDST BE SDBMITTED IN FIILL BEFORE PLAN REVIgW WI7�L B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THS APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: ' I OO �" � A�� L)�`IV� ZIP: ��`� lD
(work) (p�3 s�q
FAl� OF OWNSR: ��(`� I���1� rl — \ VI PHONE: (home) 7��'b���
MAILING ADDRESS: �1 D� N� A Rm ����� CITY: (��l l�� ZIP:��3t0
CONTRACTOR: S�rI F PHONE: �.b bv�
"MAILING ADDRESS: �b dJ�- CITY: �� Z IP: � �
TYPS OF WORR: New Addition Accessory Structure Movs
Demo Remo��/Alteration Renovate � Land Alteration�
PROPOSED WORR (describe in detail) :SnS�ll G � 1�2�['� 1�t5�J7 �� �.� b�
(t�; d�l-h V A r"+�s � m e� -�o " -�csL..-� • c� S 0 A
5 h�5�p Gu. i n C�e-S �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BBDROO1rLS: GARAGE STALLS: ATT. DET. ,
$STIMATED CONSTRQCTION VALIIATION (eacludinq 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 I
understand this is not a permit and work is not to start without a permit; and
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATORS: . DATS: ('�/'� 7I
1
1
�
�
C��Y o� ORONO
Post Office Box 66•Crystal Bay,Minneaota 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
Iicense from 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 Zicense.
3. The information may be shared with other Iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva��
data on yourself.
6. Your full name is required to process this application or
permit.
�..�� ��ah 1�1o�)cs-F��!
First Middle Last .
��S�Q �l. A�m � �`���
Address
�1�ol�Q �J1 ►i� ��3��
City State Zip
�7�-g�'� 1
Phone
I understand my rights as stated above.
VI
Signa u e ,
BUILDING&ZONTNG—473-7357 • ADMINiSTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
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513.04 RIGSTS OF SIIB�7ECTS OF DATA
gubdivision L Tppe of data- The rights cf individuels on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Information required
to be given in�viduaL An.individual asked to
� ' supply private or confidential data concernina amWi�n the collecti g state agency,
purpose and intended use of the requested
olitical subdivision, or statewide system; (b) whether he ma� refuse or from his
p the requested date; (c) any kncwn consequence arising
required to supply rivate or confidentiel data; snd (d) the identity of
supplying or refusing to supply P state or federallaN► to receive the data. This.
other persons or entities authorized by p �vesti ative data,
requirement shall not apply when an individuel is asked to su ply g
pursuant to section 13.82, subdivision 5, to e law enforcement officer.
The commissioner of revenue ma lert tax re�und uistructio�nsteadhos
subdivision in the individuel income tax or r•
on those orms. . - -- - � .
� A�� � �� � ��yl�. IIpon request to e responsible
Subd. 3.
authority, an individuel shall be informed�he b C�hp=rvateeor confidential.e UPon his
individusls, and whether it is classified p u�u� data on
further request, an inaividuel who is the subject of Se to himrland, if he desires, shall
individuels shall be shown the data witho of�hat da a• After an individual has been
�e informed of the content and meaning t� �� need not be �isclosed te
shown the private date and informed of its u���action pursuant to this section is
him for six months thereafter unless a d�SP
� ending or additional data on the indivf du e h��ate or public datarupon request by
' P require the
responsible authority shall provide eepies o t P �ible authority may
the individual subjeet oft�e actusl�costs of making, certifying, and compiling the
requesting person to pay
copies. 1mmediatelY, if pessible, with any request
The responsible authority shall comply � of the date of the request,
made pursuant to this subdivisi�d le �tholidays, if�immediate compliance is not
excluding Saturdays, SundaYs � -
ossible. If he cannot comply with the request within that time, he shall so inform the
p have an additional five daYS Wititin which to comply with the
individuel, and m Saturdeys, Sundeys and legal holidays•
request, excluding
Subd. 4. Procefiae when data is not accurate or complete. An individual maY
himself. To
contest the accuracy or comQleteness�of public oinritv�at�t�eon����e authority
exercise this right, an ind�v�� s� notify �ible authority shall within 30
describing the nature of the disagresmenL The respe lete and ettempt to
days either. (a) correct the data found to be inaccurate or incomp
notify past recipients of inaceurate or incomp1heRt�'b�e es�the datalto be correct
the individuel; or (b) notify the individuel � eement is
Data in dispute shall be disclosed only it the individusl s statement of disagr
• included with the disclosed data. � 8ppe�ed pursuent to the
' The determination of the responsible authority m o contested ceses.
provisions of the administrative procedure act relating
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