HomeMy WebLinkAbout1994-005944 - refurbish PERIliIIT
CITY OF ORONO PERMIT TYPE: �,�;_ � _ �r��
2750 Kelley Parkway • P.O. Box 815 � ' Permit Number: ��t�,�_�,��, �
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: i,:_::�1 ���_;�.
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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APPL ANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
' ' CITY OF ORONO - BUILDING PERMIT APPLICATION
Tatal Fee• $�':�/.3C� � Date Received:
Date Approved:
�
Entered By: � r_.�v Permit�:_ '''c/'��
AT•T• INFORMATION MIIST BE SIIBMITTSD IN FDLL BEFORE PI,AN REVIEW WII,L B$ STAR�ED
(See Check-off List Enclosed)
---------------------------------------------
THE APPLICANT IS: (circle one) �WNER or CONTRACTOR
JOB SITE ADDRBSS. . � ZIP: �j�'1 �
(work) ��� "�
�
� �
N� OF OWNER: Q �� PHONE: (home)
MATLING ADDR.ESS:��' � CITY: ZIP: J�-'� �
CONTRACTOR: 1 �y�f�%� PHONS:
MATI.ING ADDRESS: CITY: ZIP:
STATS LICENSE: �
� C
ARCHI TECT/ENGINEEFt: ��Q��l� �1���l.rj Y��1� PaorrE: l"�--`�'� '" .
MAIZING ADDRSSS: CITY: ZIP:
N�: RBGISTRATION �
TYPE OF WORR: New Addition Accessa�tructure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : f �
� tS�,lV� � � ��. '� � T�-r� /�
�, _ �-,��
��� �`����� , �'�7��✓'1r�:1'.�_� �.,,
STORIBS:�_ SQ. FEBT OF EACH FLOOR: � Zi-'1''
NO. OF B�DROOMS:� GARAGS STALLS: ATT. DET.
✓�,�� ,
�STIMAZ`ED CONSTRIICTION VALIIATION (eacludin� Ia.nd) : $ �• � �
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 ermit d r is not to start without a permit; and
t�at the work wil 1 be in cc d c with the approved plan.
APPLICANT'S SIGNATDRE• DATE: � �
.�
'{ CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 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 Iike to inform you that your request for a permit or
].icense from the City of Orono or any of its departments may require
you -to £urnish 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 license.
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 Councii action
to approve, some information may become public.
5. You have certain rights ander M.S. 13.04 to revzew pri�at�
data on yourself.
6. Your full name is required to process this applicatian or
permit.
� � �� , U ✓1 ��j; ;
�- �
First Middle Last
�
Address
�� ��
City State Zip
_ ��+�
�
Phone
I und stand my ights as stated above.
S ' n tu e
BUILDING&ZOIYING—473-7357 • ADMI[YISTRATION 8c FINANCE—473-7358 • PIJBLIC WORKS —473-7359
ASSESSING
� . .
513.04 RIGSTS OF SIIBJECIS OF DATA � �
Subdivision L Type of dat�- The rights of individuals on whom the data is
stored or to be stored shall be es set forth in this section.
Subd. 2. Information r��
to be gi�ren indihdu8l. An.individuel asked to
� ' su ply private or confidentiel data concer a a BmWithin the collecting stat agency,
P ueste
purpose and intended use of the req tem; (b) whether he may refuse or is legally
politieal subdivision, or statewide sys �own consequence arising from his
required to supply the requesfed date; (�� a�y �d (d) the identity of
supplying or refusing to supply private or confidentiel data;
other persons or entities authorized by state or federel law ta receive the data. This_
1 when an individuel is asked to supply investigative data,
requirement shall not app y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue me lert t8X re°una u structio�nste8dh�s
subdivision in the individuel income taac or r•
on those orms. . - --- � - - .
Subd. 3. �
Access to �a�a bY ����' tiPon request to a responsible
authority, an individuel shall be informed�h b��hp=vateeor eonfident a1.e �7P°n �
individuels; and whether it is elassified p ublic dats on
turther request, an individusl who is the subject of e to�mri��if he desires, shsll
individuels shall be shown the date witho of�hat data. After an individual has b�en
�e informed of the content and meaning t� �� need not be �sclosed to
ahown the private date and informed of its u���8etion pursuant to this section is
him for six months thereafter unless a d�SP
ending or additional data on the individuel h� ate or public dataruponarequest by
' p require the
responsible authority shall provide copies of t e P o�ible authority mgY �n the
the individuel subjeet of the data. The r�P ��rtif n and comp g
requesting person to pay the actual costs of makinB, Yi g�
copies. if ssible, with any request
The responsible authority shall comply immediately, Po
made pursuant to this subdivision, or within five days af the date of the request,
excluding Saturdays, Sundays and legal ho�id�ays�i�h8��m 8he ha]1 so nform the
possible. If he cannot comply with the reques y� �,yithin which to comply with the
individual, cludin Saturdays, Sundays snd legalhoU'days•
request, ex g
te or complete. An indi�id� m8y
Subd. 4. Proced�a'e when de.ta is not acciu'e �mself. To
contest the accuracy or comQleteness�of public or private � the�nrespensibie 8uthority
exercise thi.s right, an indiv�dusl sh� notify � ��e authority shall within 30
describing the nature of the disagreemenL T�e r�P� lete and attempt to
days either. (a) correct the data found to be inaccurate or incomp
notify past recipients of inaceurate or incemPle te dat�eVesdth rdatalto be correct
the individuel; or (b) notify the individuel tha eement is
Data in dispute shall be disclosed only if the individual's statement of disabn'
• included with the disclosed data. ealed pursuant to the
" The determination of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases•
- CHECR OFF LIST FOR ISSIIANCE OF PERMITS '3_!! + �
` FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �.�t�7i �� )���Iw �Q�I Ij� PID: �" I I���.� / ' ��t
D$SCRIPTION OF WORR: � Ul,2P..��S � --
---------------------------------------------
ZONING REVIEW BY: �V �� DATE APPROVED: �
BIIILDING REVIEW BY: v�r— DATE APPROVED: 3 "�� - � �
------------------- ---
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 �/ SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------
ZONING CHECR LIST Zon ng District:
Fire Departm n : Post Offic : Sc ool District:
Lot Area: Width: � Depth:
Survey Submi te \ : Yes Nq Dat� of Survey:
j ; ';
Proposed Set acks ��
Front ( ake) : Rig�t Side:� �
Rear (S reet) :
Le�t Side: � �-
:�
Adjacen Structu es: Wetland:
i
Building Hei ht: Def. g . 1 Peak Hgt. '
Avg. Setbac : � Lo Coverage:
, Exis ing roposed ,
�
Hardcover: 0-75 ' "�.�7-
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approva�:
Grading: Staff Approval Date: By: Council ApprovaJ. Date:
Septic: Staff Approval. Date: BY=
Zoning File:# ResoJ.ution #: Resolution Date:
REMARKS (in house) : L,C�K,AsE%#4.� �il�''�, ,�S c•!'�����-C= - � ��
.�
BIIII�DING REVIEW CHECK LIST - . ,ti . .
IIgC: ��. � CONSTRIICTIO"d TY�E: �
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor 4 X -
2nd Floor X -
Garage X -
x =
TOTAL
$stimated Construction Value: $ �' o�o
�
Inspections Required: Work Requiring Separate Permi.ts:
Site � �Plumbing Grading/Filling
Footing �Mechanical Fire
_<LFraming Septic Water Connection
_�Insulation �Fireplace Sewer Connection
�Wal� Board (Masonry) Lawn Irrigation
�Final �(Mf g.) Other
Other Well (State Permit)
p� El.ectrical. (State Permit)
---------------------------------------------------------
REMARRS (IN HOIISE) :
------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval Date Y=
.
--------------�- ��%rn , ;--
------------------------------------------------------
REMARRS (TO BE NOTED ON PERMIT) : C���'���- _ "��� �� s �'`� U
d�� Z� 7if��i `f
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�7 ���(� r N�� " . ...._�. �y:
i � -��;'�r����
. � ,, Prnvide f2 Layers Of 15LB
jf ' , ` ' �=eit ��lid Mopped Togethet
� "' ��y , � , �,. , ?��" InsrdP EXT. Wali Line
- � - � ' �� � `�-:�" ror �b'o�� Shingles Or Shake
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. _ � PROVIDE TitEATED PLATES�fJHEN
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