HomeMy WebLinkAbout1998-010704 - entrance monumts/gat PERMIT
CITY OF ORONO PERMIT TYPE: , ;
2�50 Kelley Parkway- P.O. Box 66 `` �-`��` �`"�
, Permit Number: i i i i;!iir�
Crystal Bay, Minnesota 55323 _ _
Date Issued: �;_�;;;i r��-;;;
(612)473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — .���F�� i=�'��� --
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A LICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, Total Fee: $ Date Received:
' 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)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: vZ�o C��. �OR7'/`� �f/�� � ZIP: �,53�/
NAME OF OWNER: �i a�� �� ����E PHONE: (home) �f�"r����`
(work) �3? -oG��-
MAILING ADDRESS: o��.T `�D�T/� �fFi.cE CITY: �yLo.�o ZIP: ,�'"S3 9/
CONTRACTOR: � ���'�- PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAII.ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: E�✓T/l.�Nc:�-�fo.v�..�6.��/�47�S
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
.�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /000
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 SIGNATURE: DATE:
NOTE! Parade Qf Homes ev s require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
�
Sea 13.04 RIGHTS OF SIJBJECTS OF DATA
Subd. 1. Type of data. The righcs of individuat on whom che data is stored or to be swred shall be as set forth in this secdon.
Subd.2. Information nq�rired to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requesred data within the collecting State agency,political subdivision,or stacewide system;
(b)whether he may refuse oti is legally required to supply the csquesud data:(c)any laiown consequence arising from his supplying or refusing W supply
private or confidenrial data;and(d)the idenriry of other persons or enddes auchorized by state or federat law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of rovenue mav place the notice rewired under this subdivision in the individual income_taz or oroDem taz refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown ehe data wi[hout 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 privace data and informed of iu meaning,rhe data need not be disclosed to him for
six months thereaCter unless a dispuu or acdon pursuanc to this secaon is pending or addirional data on the individual has been coliecud or created.
The responsibie 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 tequesting person to pay the actual cosu of making.certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any requesc made pursuant to chis subdivision,or within five days of
the date of rhe request,excluding Saturdays,Sundays and legal holidays,if immediace 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 legat holidays. •
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
dara conceming himself. To exercise ehis right,an individual shall nodfy in writing the responsible authority describing the nacure of rhe disagreement.
The responsible authoriry shall wi[hin 30 days either: (a)correct the data found to be inaccurate or incomptece and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipienrs named by the individual;or(b)notify the individual thac he believes the dara to be correct. Data
in dispute shail be disclosed only if the individual's stacemenc of disagreement is included with[he disclosed data.
The determinaaon of the responsible aurhoriry may be appealed punuanc to the provisions of che administradve procedure act rela6ng to
contesud 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:
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 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 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
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Fint Middle Last
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Address
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City Sta[e Zip Phone
I understand my 'g ts as state bove. .
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Signamre
�
, CHECK OFF LIST FOR ISSUANCE OF PERMITS
` FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ,�c:2'C-r-1 �t.ko.�t.� ��
PID: :
DESCRIPTION OF WORK: ���� �,u�„�.�� � G,�n �
------------------------------------------------ --------------------------------------------------------------------
ZONING REVIEW BY: . �-��-�.L,.�` DATE APPROVED: �l -i -��
BUILDING REVIEW BY. DATE APPROVED.
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes o� No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: /li� C�1-�i4-nk'�0
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes� No Date of Survey: G s� �1,��
Proposed Setbacks:
Front (�aker � � Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By: -
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
UBC: (Z� 3 CONSTRUCTION TYPE: �/V
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
c.rJ
Estimated Construction Value: $ ��U`x'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
�Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wali Board (Mfg.) Well(State Permit)
_�Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS ('TO BE NOTED ON PERMII�:
8
r��..-,. ��"r�. �4 C�R.:��� �F SE�TtoN Z3,-Twp, i��� Rc. .23 — ' . . ' - ��,, O /� .
< � �ot�sz
2b�E =_s�`. ___ '•>c`. . �i/L/�� � '
��E�?`"; . 3- �� - �� � ��..�.�� . l��
� � � � �
�� n�i Q Surve�/ For : ERICKSON ETROLEUI�� �
.,
r �. _S'2L`to 23%� ��� V 1 �110� �� J
: E s _ -� :�C � ' PLAN GRA�I��G P
`�' vf�,� �:_:� �_ � �� � Po�NT �A st�� u �w� 5 Description:
�;� : �'1��t'FhOti�tD ��`
� _+,, �T � 1 � � '` ,
� ❑ ;�p���;�=�WIYH ����S��S � �h That art of Government Lot 4 Section 9 Townshi 1 7 North
C : P , . P 1 ,
����� . , y '' ` ° �? �''��''� �r� Range 23 tiNest of the 5th Principal Meridian, described as
�� r/�/� �� `tir al _ - � �+t
��- �3t �., �;� follo�vs: Commencing at a point in the ��est line of said
� , O ,� �' , ,. s.sQ � Government Lot 4 distant 2878. 55 feet South of the North
� r�f� , ;� ;` �`" 2�`., ���°�;^ °�o quarter corner of said Section 9, said UVest line being assumed�
�,� h �� ^/ ;�"' � ��� J -�. , �to have a bearin of North for urposes of this descriation;
.: / Ic� 9 P
�;. � � ��, \ � � ��
� � ,. �. thence South 70 37 31 East a distance of 838. 42 feet; thence
� . ��' ,' / ,y N S� South 67° 19' 23" East a distance of 266. 25 feet to "Point A",
„ , � �a� i�,i� ,�`,4`� said "Point A" being the point of beginning of the property
_� �E : � _ (O ,, ,�j`;� , ,c �' ,�� ���.\ being described, and also the point of beginning of "Line A";
� : i �\ � `�rE\ o� � � �� �� • ��
= P �, o (� 1° �� �R thence South 32 16 30 West along said Line A to a point
� l � � �
� ,,�� �� � _ � �� � , � � on the shore of Lake N'tinnetonka, and said "Line A" there
? �;' ; � ;j � ending; thence Southeasterly along said shore to a point
v �.. � -��� 300 feet Southeasterly from said "Line.A", said 300 feet being
�� � ' J � —'� � � � \ � - t i i
��� � ��� �� , � � _- A,, , F measured.on a bearing of South 59 � OS 30 East from said
��;� ���' ; �� �° �,�. "Line A" ; thence North 32° 16' 30" East a distance of 370 feet
���������� � �� �� `� to an intersection with a line drawn South 59' 05' 0" East
� � l 3
; - � , �
i � , �,�;'�� from said "Poi nt A"; thence North 59' OS' 30" G�,lest to said
�� � � � "Point A" the oint of be innin EXCEPT that art of said
P 9 9, P
`'' :3 ' '�{ o above described property lyi ng Southeasterly of the follo�ti�i ng
�Rc�y I `Rc�; � •
t, / � , , . � � described line: Commencing at said " Point A"; thence
� ; f o= :s South 59° 05' 30" East a distance of 246. 74 feet to the poi nt
� � � -� � �,, c�o��° ,� ,,�i of beginning of the line being described; thence South 34`
�� �� i�`' n ,�° 54' 30" West to the shore of Lake M;�netonka, a�d there
�\\ `�� � �
'�. ��• o. ending.
��\ \__�,,, � ;� _ � .
- � ''�� � 'R`" L�' �' We hereby certify that this is a true and correct representation of a survey of the
� � ��.-� �;- �•
� .,-� `c- ���; �.. r^ � �, boundaries of the land above described and of the location of all visible encroachments,
.�,,� ���` ,, �-• ,,�� � � � if a�y, from or on said land.
� `���- - ` -� EGAN FI ELD � NO�NAK I NC
�� -'_ 7, / , , .
1 \ "' Dated this 26th da of October 1976. �
� , ,�; , �c/ Y . Surveyors
. �,� � , . .
�Tc r`,. ��� � / - �7 ' . �
�� ��\ �. by �;.� � . . . � : - .� . . .
�. I��in
\ nesota Registration No. 9053
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