HomeMy WebLinkAbout2004-P07546 - land alteration r � �
' PERMIT
CITY OF O �NO Permit Number:
2750 Kelley Parkway- PO Box 66 P07546
Crystal Bay, Minnesd a 55323 Pe�mit Type: User Defined
(952) 249-4600 Date Issued: 6iisi2ooa
SITE ADDRESS: 3950 North Shore Dr
Mound,MN 55364
P I D: 08-117-23-33-0067
DESCRIPTION:
Proposed Use: Re dential
Permit Class: Ge ral
Permit Type: Us Defined
Pernut Sub-type(s): Land Alterarion(0-500 cu yc
DETAILS:
Approved per resolution#: ,
Separate permits required: �'�
--�-- —
NOTICES/REMARKS:�i
�I
Grading w/out CUP&srn�all retaining wall to block noise
FEE SUMMARY: emut Fee: $ 50.00
Valuation: $ 0.00
i
I
TAL FEE: $ 50.00
APPLICANT: Owner/ elf OWNER: Raoul Booton&Molly Holcombe
M� 3950 North Shore Dr
Mound MN 55364
THE UNDERSIGNED HE REQUESf S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL', RK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND SI'ATE OF
MINNESOTA BUILDING C E REQUIREMENTS.
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LICANT PE EI S[GNATURE SSUED BY SIGNATURE
Couies: 1-File(SiQnitures Rep ired), 1-Aunlicant 1-Monthlv Renorts, 1-Assessins, 1-Finance Page 1
• � cv
Total Fee: $ ��� ` Date Received: 5-1.$-D� �a�4r,.R
Entered By: 1Z�J - �-a��� ���1�� Permit#: /�ib754�lO . �°�'?`��
�en era.(_
CIT� OF ORONO � ��E�pERl'�IIT APPLICATION�s r���oR0
�la�t. NQ
All information must be submitted in full be ore plan review will be started.
(please print al1 iri,formation)
THE APPLICAN'T IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: .S �� � /U o,F'Ti<l�/N�J/�� � � ZIP: J.S'.�G��-
� - -
;�. �
NA..�iE OF OWNER: }j����� [�j o�;'o�i PHONE: (home)95�-�{'7( ,��5 0���
: (work) �I �-7�'7--��-1 i
�I�-iII,ING ADDRESS:,�`�SO !��^TN jiv'n��1i1� CI'�'Y: �2�r�✓o 7IP: �5�;�
CO\�'R.ACTOR: �c���/.E PHOIVTE:
CO1�T'ACT PERSON:��rv!� �<; C.��,L,��'�-- MOBILE/PAGER:
�LAII�ING ADDRESS: _ _---- ----__ --CITY: ZIP:
ST�TE LICENSE: #
ARCHITECT/ENGINEER: (U;,;�;� PHO�tE: _ _
�L�II.,ING ADDRESS: CITY: ZI',F:
�A--��� REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
il�iove tcemodellAlteration Land Alteration_��
�l�; � �����` W i c,�-��
PROPOSED WORK (describ�'n detai�: � ,�� � ,,�' � �, �
� ^ v�
��ir✓1 =� � ( ✓V t�'v :�. ;� LC� �l I��C_K' �'r�a-�-�1!' Y^)n �,� � J•'f_�'., c�C.TI^� c�✓�E�t'� Jf'�'�t 1 �
STORIES: SQ. FEET O�EACH FLOOR:
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.
ES'r�LATE,� CQ�1S'T'RIJ�"I'ION�IAT:?r�TI�N �e�celu�ng Ia.�d): $ 5�S o� � �, 1 c��;�r; ���
"�r-��5 . �/,z�D<� w:tl� �:J-t' i^,�w-�l"��,5 ,
I hereby appl}�for a buildin� 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 Buildin� Code; that I understand this is not a permit and work'is not to start without a
permit; and that the work wilI be in accordance with the approved plan.
� .,-. �i`�-, �
APPLICANT'S SIGNATURE: /�, ,-, .' �' �----,__ DA'�E: �`� C� � n`' '
NOTE! Parade o Homes events require separate permit approval by Poliee Departmenr and
City Council 60 days prior to the event. Non permitted events wi11 not be allowed. �
� �
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3�-,.5�; ;;;�c�2�-� � � r�x�:Z,t� /�c2-
PID:
DESCRIPTION OF WORK: (��,-Y2.w� r�� ,Z,�: z-✓a,�,��,G w�GI
- --- --- - --- ------------------------------------------------�------------�--
ZOV�1G REVIE�V BY: �- �C DATE APPROVED• b i y �
BUII.,DI�tG REV�`V BY: ' — DATE APPROVED;
— _______--_____--____�,�----- -------------------------- ------------------ ----
FEES TO BE CHA.RGED: "�`'��Misc�. Fee Calculated �h
Y=
PER�v1IT Yes ,,-��� No
PLAi�t REVIEW Yes No SEWBR COiVNEC I'ION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes I�'o PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning Districc:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Wid[h Depth
Survey Submitted: Yes No n Date of Survey: � ►-�i•��
Proposed Setbacks: .
�
Front(Lak�): Righ[Side: �
Reaz (Street): - -" Left Side: �
Adjacent Structures: — Netland:
Building Hei;ht: Def. Hgt. _ , Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: �,,By: Council Approval Date:
Septic: Staff Approval Date: 'By:
Zoning File: # Resolution: # Resolutioa Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.otCoverage:
EzistinQ Proposed
0
Hardcover: 0-75'
75-250'
250-500'
500-1Q00'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
�C� ` CONSTRUCTTON TYPE: --
_ Sq Footage $ Per Sq Ftg
Basemen[ x =
lst Floor x =
2nd Floor x =
Garage z =
z =
TOTAL
Estimated Construction Value: $ r�,n� c.�/v C_L, �,=>
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing � Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) We11 (State Perm.it)
'� Final Grading/Filling Electrical (State Permit)
Other
REMA]EtKS(ni T HOUSE): .
____------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
-------------------------------------------------------------
REMARK.S (TO BE NOTED ON PERII�II'1�:
S
Sec.13.04 RIGF3TS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as se[focth in this section.
Subd.2. Information required to be given indiridual. An individual asked to supply private or co�dencial data concerning himself
shall be informed of: (a)the purpose ar.d incer.ded use of the requested data within[he collecting stare agency,po]iIIcal subdivision,or statewide
system;@)whe[her he may refuse or is legaily required ro supply the requested data; (c)any lalown consequence arising from his supplyin�or
retusing to supoly private or coaftdendal dam;and(d)the idendry of ocher persoas or entiaes authorized by sate or federal law to receive the data.
This requiremen[ shall noe apply when an individual is asked to supply investigadve data, pursuant ro secdon U.82, subdivision 5, to a law
enforcement officer.
The commissionerbf reverme mav lace the norice re uired under[his subdivision in the individuaI income hz or �ooem tax refund
instrucdoru ins�ead of on those forms.
Subd. 3. Access to data by individual_ Upon request to a responsible authority, an individual shall be informed whether he is the
SubjecL of stored data on individuals,and whether it is classified as public,private or co�denaal. Upon bis further request,an individual who
is�he subject oE stored priva[e or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed
of[he conte�[and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafter unless a dispute or acnon purs�ant ro tttis section is pending or addirional data on the individual has been
collected or created. The responsible auchority shall provide copies of tfie private or public data upon request by[he individual subject of the data.
Tne responsible authority may require the requesring person to pay the actua(costs of making, cerufying, and compiling the copies.
The resgortsible authoriry shall comp(y immediately,if possible,with aay request made purauant ro this subdivision,or wi[Itia five days
of the date of the request, exctuding Saturdays, Sundays and legal holidays, if immediate com�liance is no[possible. If he cannot comply with
che request within that time, he shall so inform the individual, and may have an addirional five days within which to compiy with the request,
excluding Sacurdays,Sundays and Iegal ho[idays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private dara concerning himself. To exer�ise this right, an individual shall notify in writing the responsible authoriry describing the nature of the
disagreemene. The resporLsible authoriry shail within 30 days either. (a)correct the daCa found to be inaccurate or incomplete and attempt to notify
past recipienu of inaccurate or incomplet�data,ir.ciudin�recipiencs named by the individual;or(b)nocify the individual tha[he believes the data
[o be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determina[ion of the responsible authoriry may be appealed pursuant to the provisions of che adminis�ative p�ocedure act relaan�
to contested cases.
DATA PRIVACY ADVISORY
In accordance w:th M.S. i3.04, Subd. 2, "Rignts 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 fumish certain
private vr confidential information.
You are notified that:
i. Tne inrormation 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 Ciry deny the permit or license.
3. The information may be sha_ed with other local, state or federaI a�encies to the extent necessary to
process the permit or license.
4. If your reauested permit or license requires Council action to approve, some inform.ation�ay beceme
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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bfidd e, Last
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Address
� ����;�r� ,�� �, S 5���`-{ �� � .'�l f �5�� ��
Ciry State Zip Phone
I understand my rights as stated above.
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Signatur
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