HomeMy WebLinkAbout1996-008275 - decks PERMIT
CITY O� ORONO �
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE: _ . ; I
Permit Number: � '� �� _ =�= �`�`=`
Crystal Bay, Minnesota 55323 �-�:��:=����;�.5 �
Date Issued:
(612)473-7357 .j;;,.•';.�=,,'�=�;-;
SITE ADDRESS:
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DESCRIPTION:
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RENIARK��
FEE SUMMARY:
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CONTRACTOR: - ��F��:,� ��=,a-,t. - �_:�" . �_��.: OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATU
�
Total Fee: $,�Gj�. ,� �j Date Received: %i-'>, %'j,�;
Entered By: ��, Permit#: �')��
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR�
�____----
JOB SITE ADDRESS: � (��`�' � �1r��2�i�� ,�'/�-iL�v� ;�= ZIP:
NAME OF OWNER: �;�;;�-,.,,� �E R e r,J 5 PHONE: (home) y 7 3-- �- 3��
(work) y; � . �3�:�7
MAILING ADDRESS: ��-•�- CITY: �,������ �� ZIP:
CONTRACTOR: ST� �s I"1Z�5 E i7�'S�c�,�- PH01�: `-/ �? _ ' z z i
CONTACT PERSON: i4�-�✓ l-�o�s�77-r- MOBILE/PAGER� `i� '� - �-�S 3
MAII.ING ADDRESS: /S��a v ���>�� �i�p CITY:'- ;,,,'�� :.� ZIP: �-s 3; �
STATE LICENSE: # t �- �; 3 �iS 3�
ARCHITECT/ENGINEER � ;,q Y;� , PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure ✓
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: ; ��c K5 �'�. �:-����J c� �x��%"J�
�� L� 5 i.v��,� rt i.l�P rA/ :i ri�_,i��.c..__� V'/f,/j �c-l��_
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /: ; r;,�'
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 Ciry 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 SIGNATURE: � ���_�.i�----�- DA'I`E: �`l I3� �;r
NOTE! Parade o Homes events require separate pernzit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
�
Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forrh in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)[he purpose and intended use of the requested data wi�hin the coliecting'state agency, polidcal subdivision,or stacewide system;
(b)whether he may refuse or is legally required to supply the reques[ed data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidenoal data;and(d)the idendry of other persons or enades authorized by state or fedecai law to receive the data. This requirement shall
not apply when an individual is asked to supply invesagadve data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the norice required under rhis subdivision in the individual income tax or prooertv tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whethec he is the subject
of stored data on individuals, and whether it is classified as public, priva�e or co�dential. Upon his funher request, an individual who is the subject
of stored private or pubiic data on individuals shall be shown the data wirhout any charge to him and, if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secaon is pending or addirional data on the individual has been collected or creaced.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies.
The responsible au[horiry shall compty immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shail within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, inciuding recipienu named by the individual; or(b)nodfy the individual thac he believes the data to be correcc Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
Tne determination of the responsibie authoriry may be appealed pursuan[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 furnish certain private or
confidential information.
You are notified that:
i. The information you furnish will be used to determine your qualification for the pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut 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.
(, Your full name is required to process this application or permit.
i
,,�-��—if t���c� ���st-�7f
First �tiddle Las[
�-s ��� U ����f1�.� i��s�
Address
�i- z��
�-1 n.' SS '_�`7 t/ % >> - L Z"Z 1
C�� State Zip Phone
I understand my,sights as stated above.
��_ ��-\ �� ,�; _
Signature
1 ' 1
' � CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I b�*9 �llO,CTN ��in ��
PID:
DESCRIPTION OF WORK: d�.t�S
ZONING REVIEV6� BY: DATE APPROVED: d �f 6-2 e
BUILDING REVIEW BY: DATE APPROVED: 8 -re���
FEES 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 PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: �-�A
Fire Department: �� r,c Post Office: �_(�M� School District: D(�-0^�n
Lot Area: Sq.ft. No G/.!�'�5C Acres � Width ' Depth '—
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: .
Front(Lake): /v�l� Right Side: �7�
r
Reaz(Street): (UD ` + Left Side: !S
Adjacent Structures: �4�cc,�-� Wetland: /u(�
Building Height: Def. Hgt. /l� (� Peak Hgt. N��
Lot Coverage: �` (�
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
N� Shoreland District:
Avg. Setback: Bluff Setback:
Ezisting. Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house)•
10
�- �
BUII.DING REVIEW CHECK LIST
UBC: /2� 3 CONSTRUCTION TYPE: ��
� Sq Foota;e S Per Sq Ftg
Basement z =
lst Floor x =
2nd Floor z =
Garage x =
R =
TOTAL
Estimated Construction Value: $ 10�'�U�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
vC Footing Septic Sewer Connection
�( Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_�g�� Grading/Fiiling Electrical (State Permit)
Other
REMARI�S (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
REMARKS(TO BE NOTED ON PERMIT):
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