HomeMy WebLinkAbout2003-P06355 - land alteration 4 �
CITY OF OR N PERMIT
� � Permit Number:
2750 Kelley Parkway- PO Box 66 P06355
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: 6i2i2oo3
SITE ADDRESS: 1421 North Arm Drive
Mound,MN 55364
PID: 07-117-23-44-0073
DESCRIPTION:
Proposed Use: Residenrial
Permit Class: General
Pernut Type: User Defined Pemut Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Grading pernut-NO C.U.P.
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Thomas Norman OWNER: Thomas Norman
1421 North Arm Drive 1421 North Arm Drive
Mound MN 55364 Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMIT SIGNATURE ISSUED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-Aunlicant 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
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Total Fee: $ -��- ` `�' Date Received: �j������L'�
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Entered By: �'i ' , - Permit#: Q-�-� (o�S� _
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CITY OF ORONO - BUILDING PERNIIT APPLICATIOleT
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 OWNEB,E)R CONTRACTOR
��.__.__ .
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JOB SITE ADDRESS: /�� N . I��M l�� ZIP: �5��
NAME OF OWNER: ���A'S V��. l���A�� PHONE: (home)`�����a-t�'yig
.( (work) �S� _ � .� ._-
MAILING ADDRESS: ��/�� /� ��M �' CITY: /��.d'G�N ZIP: S3�'.�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILII�TG ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration }�
PROPOSED WORK(describe in detai�: —ll�C.- �� � � ��-�r��
�� �lv,9r'�S �� ���
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED 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 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 a�ordance ' h the pproved plan.
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APPLICANT'S SIGNATURE: ��f'��p ��1 %�l�z DATE: r7J=- �� _c--�-
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent 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 S[JBJECTS OF DATA
Subd. 1. Type of data. The rights of individuai on whom[he data is stored or to be stoced shall be as set forth in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal dara concerning himself shall
be informed of: (a)the pucpose and inunded use of the requested data within the collecting rtatc agency,political svbdivision,or staoewide sysum;
(b)whether he may refuse oY is legally required to supply the requesud data:(c)any Imown consequence arising from his supplying or refusing to supply
priva[e or confidendal data;and(d)the idendry of other persoas or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,punuant to secdon 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue mav vlace the nodce te$uired under this subdivision in the individual income tax or proaertv taz refund
instrucdons instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and wher.her it is classified as public,private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown che data wichout any charge to him and;if he desires,shall be informed of the content
and meaning of[hat dara. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of rhe private or public data upon request by the individual subject of[he data. The responsible authoriry
may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible au[hority shall comply immediately,if possibte,with any request made pursuant to this subdivision,or within five days of
the date of the nquesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he caanot comply with the request
within that time,he shall so inform the individual,and may have an addidonat five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compieteness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing[he nature of the disagreemeat.
The responsible authoriry shall within 30 days ei[her: (a)correct[he dara found to be inaccurate or incompleu and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by the individual;or(b)noufy the individual thac he believes the data to be coaect. Data
in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to
contested 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 departments may require you to fumish 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 permit or license.
3. The information may be shared with other local, state or federal agencies to the eztent necessary to process
the pemut 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 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
Fi�� Middle Last
Address
C��, State Zip Phone
I understand my rights as stated above.
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 1 y21 rv,r�� �J/t .
PID:
DESCRIPTION OF WORK: F��.�. '
ZO.�iI�i 1G RE'VIEW BY: DATE APPROVED: 5'• Z� - ° 3
BUII..DING REVIEW BY: DATE APPROVID;
FEES TO BE CHARGED: Misc. Fees CalcuIated By:
.�'PERMIT Yes ✓ No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATIItCONNECTiON
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
ZONING CHECK LIST Zoning District: N o GIfI�N�
Fire Department: Post Office: School District: -
Lot Area: Sq�.ft. Acres � Width Depth
Survey Submitted: Yes No Date of Stirvey:
Proposed Setbacks: �
Front(Lake): `3� Right Side: .5
Rear(Street): � � f Left Side: .�t "'
Adjacent Structures: �Vetland:
Building Hei�ht: Def. Hgt. Peal:Hgt.
Lot Covera�e:
Gradin;: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # ResoluEion: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existino Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
� RE1�Z.A.RKS(inhouse): �(1��nr6 .A-e.���— /�o C � P < s�� �v��t u�f
7
BUII,DING REVIEW CgECx LIST
�C' � CONSTRUCTION TYPE: '—'
_ Sq Footage $Per Sq Ftg
� Basement . . . x _
lst Floor � x . . . _
2nd Floor x � _ .
Gazage x _ .
x =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing ' Se uc
P� Sewer Connection �
. � Framing Fireplace Lawn Irrigadon
Insulation (Masonry) Other
Wall Boazd � (Mfg.) Well(State Permit)
--�F�� Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): .
REVIEW BY OTHERS• DATE: - -------------- -------"______
Access: Existing New .
Access Approval: Date By. �
RE1�ZA►RI�S (TO BE NOTED ON PERi1�IIT�:�--�--- --���_�____ ____
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