HomeMy WebLinkAbout1999-011709 - land alteration � PERMIT
t CITY OF ORONO PERMIT TYPE: - _ - - _ -- _ -
2750 Kelley Parkway- P.O. Box 66 -- ` ..==-�� -� �- -
Crystal Bay, Minnesota 55323 Permit Number: �.:.,��,i;��� �
(612)473-7357 Date Issued: - , _- . _-..
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: ` }�r��°� x�==�.�-��. �'
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APPLICAN %PERMITEE SIGNATURE ISSUED BY:SIGNATURE � B�
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Total Fee: $ .�D � Date Received: �,� ����
Entered By: �:,�_ Permit#: ;� 6�
CITY OF ORONO - BUILDING PERMIT APPLICA'ITION f
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All information must be submitted in full before plan revietiv w-ill be started. .
(please print all information) .
T�-IE APPLICA.I��T IS: (circle one) OtiVNER R CONTI�ACTOR
,
JOB SITE ADDRESS: 3 ZZ�- N • �a�..,� �(��f g z�: 5 S 3�t (
�'AItiiE OF Oti'Y�'ER: ��k'c�AfL� �J PHONE: (home) �[ ( l --���'6�
(work) ��]! --�Z��1...�
MAtI�I�i tG ADDFESS:?G-22�'J �S��Q-� CTI'Y: z� ' ZIP:�,��'
CONTRACTOR: C?J-'�S�- b'((�L►�� PHONE: �-c� � �`�z�5
CONT'ACT PERSON: MOBILE/PAGER:
MAII�I�'G ADDRESS: CITY: ZIP:
STATE LICENSE: # �
ARCHITECT/ENGINEER: V � �•t� PHOti�: 3 �� �J �
��I�TG ADDRESS:L350 V.� EITY: [� L� ZIP:
NAME: Nl'F.�� REGISTRAT v#
TYPE OF tiVORK: New Addition Accessory S�ucture
Move RemodellAlteration Land Alteration
PROPOSED'�'YORK(describe in detai�: � �'�"
STORIES: SQ.�EET OF EACH FLOOR:
NO. OF BEDROONSS: GARAGE STALLS: ATT. DET. �
ESTII�iA,.T'ED CONSTRUCTION VALUATION (excluding land): $ � �
I hereb a 1 for a buildina permit'and I'acknowledge that the information above is co�p1`ete�nc�` �`''
Y PP Y ,
accurate;that the work will be in conformance�ith.the�o�diii��es a.nd Cod�S.�f"the Ciry ant�w�, ,
the State Bu��d�*i�,Code; that I tirnder�tand,this is noC�.permit and work is not to start withoutia
permit; and that the work will be in cor a i e approved plan. •
APPLICAl�'T'S SIGNATURE: % DATE: �I S.
; .
NOTE! Parade Q Home� eve�ts require separate permit approval by Police Departm�ent and
� City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGFTTS OF SUSJECTS OF DATA '
Subd. 1. Type o[data. 71ie righcs of individual on whom the daa is swced or to be swcrd shalt be u sec forch ia ttiis secdoa
� Subd.2. IatormatIoa nqvired to be given tadiv[dual. Art iadividual asYed w suppiy private or confideadal daa coccecniag himself sball
be infocmed of: (a)the purpose aad iacended use of the zsquesred daa arichia the callecdng iate ageccy�polidai subdivisioc,or saoewide rysum•
(b)whec�erlte tnay tefuse o'r is.le3ally requ'tr:d.co supply.the r.quesced dse:(cJ aay�sbwn coasequence uisiag ftvm his supplyiag ot reftuing w supp[y
privac�or eon.sdcr.cai dara;and.(�c4e ideadry o[ocherpecsoas or earides auc�ocized by sri�e or fedeni law to teteive the dam. 'Ihi4 requiremee•s�all
�not apply w�en an iedividuai is asked to dupply iavesrigadve daa putsuaac oo secdon 13.82.subdivisioa S,oo s Izw enfatcemeac ofRee�. .� . •
'he ceramissioner of revenus mav vlace che nodce r�uir.d under diis subdivision in the individual income eaz or orooeccv taz refund
instrueaons inscead of on chose[ocnu. • � �
Subd.3. Aecas to data bp iadivtdual. Upon requac w a responsibte aurhoriry.aa iadividuaI shall be infortned whe�hec he is ehe subjecc
e[stor:d daa on iadtviduals.aad whecher it is elass�ed as pubGc.pcivate occonFdeadal. Upon his tticther request,aa iedividual wko is the subjecc
of sioad privace or public daa on tadividuaIs shal!be shown che daa wichaut any charge oo him and,'if he dairu,shail be infocmed ot the coatenc
aad meaaing o!thu daa. Aher an Individual has 6eep shown the priva�e dan and informed o[tcs meaaiag.the daa aeed not be disclosed oo him for
siz moadu theceahe�nnless a dispute or icdon pursuanc to ehis secdon is pending or addidoeal daa on the individual has beea eollecc:d or crea�sd.
T'he tesponsibie authoriry shall provide eopies ot the privacs or pubtie daa upon request by the individual su�jat o[che daa. 11ie respoasi'bie authoriry
may requice the requesdng pecson oo pay che accual cosu of making,cecdfying,and compiling the copiu.
The nsponsible auchoriry shall eomply immediscety,if possibte,wi�h any cequac made pursuuu m ehis subdivision,ar wi�hin Bve days of
the da�e of the ceques�exdudiag Saturdays.Sundays and legal hotidays,if imcned'uce wmpliaace is not possible. If he eanaot comply widi the cequesc
wiehin that dme,he shall so ictform the individnal,and may have an addidona!fve days�vi[hin�which ro co�npty wich the reques4 exdudin'g Saturdays,
Sundays aad legal hotIdays. ' . , . .
Subd.4. Pzoeedure whw data t�not accurate or eomplete. M tadlvidual tnay eontest the accunry or completeaeu of public or private ,
daa eoncecning tiimsdf. To exercix this right,an ir�dividuai shill nodfy ta wrideg the cespoas►ble authoriry dacdbing the naaice o[the ditagreemeac
The re�poosible auchoriry shall within 30 days eieher. (a)comecc che dan fouad to be inaceucdte or iacomptete aad attempc to nodfy pasc tecipienes of
inaccunce oc incamptece daca,inctuding recipienes named by the individuat:or(b)aoafy the individual tLac he believes[he data to be correct Dan
In dispuce shall be disdosed oaly i!the individaal's stacerrcenc o[disagreemeat is induded wi�the disdosed data.
The decernuJta�io�c'af�tHHt-�spop�'b{�auchoriry may be appealed pursuuu to the pr8;`isions of[he adminisaadve pcocedure ut reladng to
contesred cases. � s �' .. � • �, ,�� r i',�� ; - •
'� �•y`�.�. '=�,--�;�-.i�AT�A PRIVACX�1Ali�ffiQ�t�,�� t. / �.� `�:•�
• � 1 'f: :�!�';' :-��:,��,;�J�1 �
In accordance with M.S. 13.04,Subd.2, "Rir,,hu of subjecu of data",we would lil�to inform yb�t that your request
for a permit or license from the Ciry of Orono or any of ics departments may require you to furnish certain private or
confidential information.
You aze notified t$at:
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1. The infocmai���:u�fii'tmj�sh',w'�tl�b�u�ed�tar�le{erm aepaut�ualfficadon for the permit orlicense requested.
2. You may refuse to suppiy data, but refusal may requ`ire tha�the Ciry deny the permit or license. � �
3. Zhe information may be shared with ocher loeal�state or federal agencies to the extenc necessary to process ',
the permit or license. �
4. If your requested permit or license requires Council actioa to approve, some iaformation may become �
. public. � � . . . . �
5. You have certaia rights under M.S. 13.04�(available upon request) to review private data on.yourself. . '
6. Your full name is required to proc�ss this applicacion or permi�.
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� � CHECK OFF LIST FOR ISSUANCE OF PERMITS �
FOR OFFICE USE ONLY • �!
ADDRESS OR LEGAL: 3 ZZZ �'V'� s H o 2t �O/t,u c �
PID: '
DESCRIPTION OF WORK: C,t2v►1 '
ZO�tING REV�W BY: DATE APPROVED: �-z c.-g g
� BUII�D111G REVIEW BY: DATE APPROVED; -� -zc.• gS
FEES TO BE CHARGED: Misc. Fees Calculated By: '
PERMIT — �R���K,c Yes �/ No I
PLAN REVIEW Yes No SEWER CONNECTION ,
STATE SURCHARGE Yes No WATERCONNECTION �
INVESTIGATION FEE Yes No PARK FEE '�
SAC Yes No STfEINSPECTTON I
Number of SAC-Units OTHER (specify) '
ZONING CH�CK LIST Zoning District: �tan Cr�i4s�r�c.'
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Fire Department: Post Office: School District: � ;
;
Lot Area: Sq.ft. Acres Width DePth i
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Sid
Rear(Street): Left Side
Adjacent Structures: etland:
Building Height: Def. Hgt. ak 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 Setba : Lot Coverage:
Existing Proposed
Hudcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
BUII.,DING REVIEW CHECK LIST
�C� — CONSTRUCTION TYPE: �
: Sq Footage $Per Sq Ftg
Basement x =
lst Floor x = _
2nd Floor x _
Garage x =
x _
TOTAL
Estimated Construction Value: $ �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
F��S Septic Sewer Connection �
� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit)
_�F�� Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Eacisting New
Access Approval: Date By;
RE1I�IARKS (TO BE NOTED ON PERMIT�:
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