HomeMy WebLinkAbout1991-003912 - 13x13 pool equip hov ' PERMIT . .
� �ITY OF ORONO PERMIT TYPE:
�,.35 Brown Rd. South • P.O. Box 66 �jE i�;�'���°���
Permit Number:
:,ystal Bay, Minnesota 55323 Date Issued: t���!k=��,_�f
�612) 473-7357
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APPLICANT/PE TEE SIGNATURE ISSUED BY:SIGNATURE
, , CITY OF ORONO - BIIILDING PSRMIT APPLICATION
Total Fee : $ �.� � � �� Date Received: �'e�/� ���
/' �'.
- Date Approved: ` -�� ' /�
Entered By: � �
� Permit#: �� `�i��
ALL INFORMATION MDST BE SIIBMITTED IN FIJLL BEFORE PLAN RFVIS''W ieIILL B$ STARTED
(See Check-off List Enclosed)
THB APPLICANT IS: (circle one) OWNER o CONTRACTOR
Jos sz� �nnx�ss: ZE,S� N o� S�alzE l�� zIp: S�s 39 I
(work)
NAME OF OWNER: J a,r.n�s M ti-r-C,F}ts.lr�- PHONE: (home) �7� 251�
MAILING ADDRESS: �'�S� NoRt1} S� Of� CITYs OQbNO ZIP: �S3`�I
CONTRACTOR: Gu STDM GN J( P_pNlb(2I►lT�S� � NL PHONE: �Q�-- .38 �
MAILING ADDRESS: �Z2� S p.4� G��fc Gr— CITY: MN1'-KA ZIP: �� 3 �
TYPE OF WORK: New� Addition Accessory Structure � Move
Demo Remode /Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : R�nlove... �xi5r(Nl� �X�.O Pc�oc. tf��SE
C1�h�S'�'Qv cT /�G w / 3 X 13 t��,o�. �u 1 P MC/uT /-�o�S G-
STORIES:�_ SQ. FEET OF EACH FI�OOR: � 49
iJO. OF BEDROOIrIS: r '� GFii2F��E STAI.LS: ATT. NI�Q- �ET. NJ�4 .
�
ESTIMATED CONSTRDCTION VALIIATION (egcluding land) : $ SO�� �"
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 SIGNATORE. � DATE: 8
, . , �
� �
CI'�Y of-ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� - � � 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 wou3.d 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 license requested.
2. You may refuse to supply data, but refusa]. may require that
the City deny the permit or license.
3. The information may be shared with other Iocal, state or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or 3.icense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to process this application or
permit.
J A�•5 C.l�M) 1 �Fw �TT CpN7�f1G'Tb Q, o�'�C�GE�
First Middl.e Last �„g��e GN✓lRONMWL�
�.z29 Fi2���+DS►��� L�
Address
t3v M N Ss33 7
City State Zip
R 44 38 Z3
Phone �
I understand my rights as stated above.
ure
BUILDING&ZONiNG-473•7357 • ADMINISTRAT70N&EINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING
• , . .
- �. _
513.04 RIGH'1'S OF SIIB.TECTS OF DATA � � .
gubdivision L Tppe of data- The rights e tion.viduels on whom the data is
stored or to be stored shall be as set forth in th�s S An.individuel asked to
Subd; 2. Information re9ui�'�d
to be given individuel-
� ' su 1 rivate or confidential date concerning amWi�in the collecting state 8g n y,
PP Y P uested da v refuse or is legally
purpose and intended use of the req tem; (b) whether he ma„ from his
political subdivision, or statewide sys . �own consequence arising
required to supply the requested dats, (c) �y
1 in or refusing to supply private or confidentiel data; end (d� the identity of
supp y g state or federal law to rece��ee�e at ve da a
other persons or entities authorized by
requirement shall not apply when en individuel is esked to supply g
pursuant to section 13.82, subdivision 5, to e law enforcement officer.
The
commissioner of revenue ma lace the no�a�tructi nsuinsteadhos
subdivision in the individuel income tax or ro ert tax re
on those orms. • - � --- - - .
Ac� tp �� � ����, Upon request to a responsible
Subd. 3. �
authority, an individuel shall be infcrmed whe b� h ri`rateeor confidentisl.e�P°n�
individuels; and whether it is classified as p � P ublic data on
to him and, if he desires, shall
further request, an individual wt►o �s the subject of stored private or��u� � been
individuels shell be shown the date witho of�hat dat�a. After an indi
�e informed of the content and meaning � �� need not be disclosed to
shown the private dats and informed of Its u���action pursuant to this secticT�e
him for six months thereafter unless a �P n request by
� ending or additional data on the individuh h�8teeor public datarupoe8ted.
t P ovide copies of t p require the
responsible authority shall pr The responsible authority may
the individual subject oft�e actual costs of making, certifying, and compiling the
requesting person to pay -
copies. if ssible, with any request
The responsible authority shall comply immed'iately, po
or within five days of the date of the request,
made pursuant to this subdivisi�d le holidays, if immediate complisnae is not
excluding Saturdays, SundaYs �
ossible. If he cannot comply with the request within that time, he shall so inf�olr h the
h ave a n a d d i t i o n e l f v e d a Y S Within which to comply
individual, and may �d le al holidnys-
request, exeluding Sa tur d a y s, S u n d a Y s g
d i a�e w h e n d a t n i s n o t acciu'ate or complete. An indi`►idual m8y
. Subd. 4. p� ublie or private data concerning h i m s e l f. T o
contest the accuraey or completeness�of p in �� the responsibie 8uthority
exercise this right� an i���� $� notify nsible authoritq shall within 30
describing the nature of the disagreemen� �e r�P°
da either: (a) correct the data found Lo be inae��ei°�uding reec pients namedt by
�
notify past recipients of inaccurate or incemPle �
the individuel; oc (b) notify the individual t��au��st8tementof disagreement is
if the indi
Data in dispute shall be disclosed only '
• included with the �isclosed data• �ible authority may be apPesled pursuant to the
' The determination of the respo to contested cases. •
provisions of the administrative procedure act relating
� CHECR OFF LIST FOR ISSIIANCE OF P$RMITS
` FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ��P�'� ,��li k�7�- �/-�l PID: O �- /i7 ' �1,� �� �r��7
DESCRIPTION OF WORR: ��C� � �vc� J�-«-���
ZONING REVIEW BY: DATE APPROVED:
BQILDING REVIEW BY: DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes�V,L No
PLAN REVIEW Yes �/ No SEWER CONNECTION
STATE SURCHARGE Yes� No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECR I,IST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: �
Front (Lake) : Right Side:
�
Rear (Street) : -- Left Side:
Adjacent Structures : � 2 � Wetland:
l
Building Height: Def. Hgt. ,a / Peak Hgt._ /1
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By=
Zoning File: # Resolution #: Resolution Date:
R$MARRS (in house) :
BDII.DING REVIEW CHBQC LIST _ , - .
, .. ..
QBC: �j I "1�_ CONSTRIICTION TYPE: �"'1U
Sq Footage $ Per Sq Ftg ~ �- -
Basement x =
lst Floor x =
2nd Floor � x =
Garage X = .
x =
TOTAL
Sstimated Construction Value: $ ���
Inspections Required: Work Reqniring Separate Permits:
Site Plumbing Grading/Filling
✓�'ooting Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
�all Board (Masonry) Other
inal (Mfg. ) Well State Permit
Other Electrical (State Permit)
RSMARRS (IN HODSE) :
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RLVIEW BY OTHERS: DATE:
Access: Existing New '
Access Approval: Date BY=
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REMARRS (TO B$ NOTSD OP PERMIT) :