HomeMy WebLinkAboutRe: permit application !' � � `�,�
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���,'����, ,� ���� ���,���� : �, ������ CITY of ORONO c��v►�-
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�� �� �� ��' ����� G�, � Street Address:
���� ���,,,�,;� ,¢�i,� Mailing Address:
���'�gg0 /� 2750 Kelley Parkway � P.O. Boz 66
'---"'" Orono, MN 55356 Crystal Bay, MN 55323-0066
September 25, 2007
Dan Phipps
4064 North Shore Drive
Mound MN 55364
Dear Mr. Phipps:
When you put your project on hold last year, the zoning review had not been completed. Your
application for a building permit for a family room addition is being returned to you because it is
missing information required to complete the zoning review. Please obtain the items noted on
the attached checklist and resubmit the application.
The wetland delineation must be completed by a qualified wetland delineator and accepted by
the Minnehaha Creek Watershed District before it is mapped and submitted to the City. The
setback from the wetland is 70 feet for buildings and 50 feet for driveways, patios and similar
ground level structures.
In addition to the items noted on the enclosed checklist, your project most likely will require a
wetland buffer setback variance (unless the wetland is smaller than the pond that existed in
1994). You may find information about applying for a variance at the City's website
(www.ci.orono.mn.us — select licenses and permits from left hand menu, then permits from left
hand menu, the scroll down to variance application under applications) or you may pick up a
packet at City offices
If you should have any questions feel free to call me at 952-249-4623.
Sincerely,
-'��
�ve n Turner
City Planner
�
Telephone(952)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
«.
.
CHECKLIST FOR APPLICATION FOR PERMIT, Family Room Addition 4064 North Shore Drive
RESIDENTIAL ADDITIONS(INCLUDING DECKS�,ACCESSORY BUILDINGS�AND
ACCESSORY STRUCTURES(INCLUDING POOLS�
EXCEPT FOR APPLICATION AND DATA PRIVACY ADVISORY TWO COPIES ARE REQUIRED.
For more information see the building permit application packet.
Check if Item Required/Not required
Submitted
✓ Application form, completely filled out
/ Data Privacy Advisory
v
Survey of property with proposed Required,to accompany hardcover calculations
structure and setbacks shown. Must be
to scale.
Grading plan Not required
/ Floor plans
v
� E�erior elevations
/ Details and Sections
N
Wetland Delineation Required, must be mapped onto survey. (A 70 foot
setback is required from the wetland.)
Hardcover Calculations for property Required as there are no hardcover calculations on file
for the property.
Lot Coverage Calculations for properties Required
less than 2 acres in size.
Access Permit to County Road for new or Not required
altered driveway to a County Road
Total Fee: $ DateReceived: 8-'��-O�o
Entered By: Permit#: �IO a 3a
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: '�j����/ _�O�.'Th � N-o2.�. l7 t2 ZIP: _ S S 3�y
Will this be a Parade of Homes,Remodelers Showcase I�ome or other Display Home?
❑ Yes �o Ifyes, a special evenl permit is reguired with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be reguired unless appdicant derr�onstrates
suffzcient on-site parking is available. Non perrrzitted eve�zts will not be allowed.
NAME OF OWNER: �(�� ��Qp� PHONE: (home)�S Z-�!7Z �709
� � (work)Cotz -�o3-ZZ S 8
MAILING AI�DRESS: S�A t�E. CI I'Y: C�02 c��o ZIP: S S 3�y
CONTRA.CTOR: � W N� (L PHONE: S�r� �
CON'TACT PERSON: �fl ,� '�� ,�� MOBILE/PAGER:
MAII�ING ADDRESS: � CI'I'Y: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHI'TECT/ENGINEER: Sr4w�.�„ pgp�;
MAII.ING ADDRESS: CI'TY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home odel/Alteration
PROPOSEYi WORK(describe i�detai�: ' �m �A,r�•�. L A ��
�J � � � �x i s-�� s"�2t��t 1.7 1�E�--�
� N tt c�n�a�
S'TO�S: 3Q.�ET O�'E�CH FLOOR:
NO. O�'BEIDROOI��: GAI�AGE S'�"ALLS: �,'TTAC�iED DE'�"AC�D
ac�C�
ES'�Il�'I'ED COI�tST'RLTC'I'��1�T'V�TJA�CIOI�T(ex�tudira�i�rad): S �2 — �'�`
I hereby apply for a building permit and I acknowledge that the inforcnation 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 wor is not to start without a permit;and that the work will be
in accordance with t11e approved plan.
��a��c�rr��s sa�Na��: \ �ax�: � — (� - C��
31
.M
s
Sec.13.04 RIGHTS�F.SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set fotth in this section.
Subd.2.Infortnation required to be given individual.An individual asked to supply private or confidential dataconceming himself shall be
informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shap
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the noNce required under this subdivision in the individual income tax or property tax refund
instructians instead of on those forms.
Subd.3. Access to data by individual.Upon request espons� ority,an individual shall be infortned whether he is the subject of
stored data on individuals,and whether it is classified as public, vate or confid al. Upon his fiuther request,an individual who is the subject of
stored private or public data on individuals shall be shown the da arge to him and,if he desires,shall tse informed of the content and
meaning of that data. After 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 action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the privete or public data upon request by the individual subject ofthe data. The msponsible authority
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible suthority shall comply immediately,if possible,with any request made pursuant to this subdivision or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.Ifhe cannotc with the request
within that Nme,he shall so inform the individual,and may have an additional five days within which to comply with the requ luding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is notaccurate or complete.An individual may contest the accuracy or completeness ofpublic or private data
concerning himsel£To exercise this right,an individual shall notify in writing ttte responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is iacluded with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the sdministcative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S.13.04,Subd.2,"Rights of subjects of da.ta",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 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 da may�i ire that the City deny the permit or license.
3. The information may be sh ther 1 tate 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.
Your full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
nderstand m •ights as sta d above.
\
Sig e
32 .
CHECK OFF LIST FOR ISSUANCE OF�ER1ti.tITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �(C}(�� �—I � • � ��� � � , �
PID:
DESCRIPTIO:V OF W'ORK: OC ' � � �'
--------------------------------------------------j---------------------------------------------------------------------
ZONING REVIE lv B Y: �/ , DATE APPRO VED:
B UILDIrVG.RE V.IE W B Y: � DA TE APPR O ti'ED:
------------------------------------------------------------------------------------------------------------------------
FEES TO BE CHARGED: Nlisc. Fees Calculated By:
PERNIIT Yes No
PLAN RET/IEIV Y"es �Vo SEYVER CONNECTION
STATE SURCH4RGE Yes 1Vo � YVATER CONIVECTION
IIti�VESTIGATI0IV FEE Yes !Vo PARK FEE
SAC Yes tVo SITE NSPECTIO�V
NL�»�ber of SAC U�zits OTHER (specify)
--------------- --- - --------------------------------------------------------------------------------------------------
Z0IVING CHECIi LIST Zar�i�2g District: �� '
Fire Deparhne�rt: Past Office: School District: ___..
Lar.�lrea: Sq.f't. Acres Yt�i�fth Dept{i
Survey Sc�br�iitted: Yes� Na Date of Sccrvey: � � ' �S ,bU��l�I�i'
h�S�
Proposed Setbacics: S�� C�>� i /
Frortt(�= 1�1 oL i�'tgf�t Side: I�11'\ l�
Rear(Street): Left Side:
Adjace�zt Str•uct«r•es: G[�etla�id:
Buildi�rg Height: Def. Hgt, Peak Kgt.
Loc Coverage:
Gr�adi�ig: Staff,4pprovccl Date: By: Cocuicil App��oval Date:
Septic: Staff,4pproval Date: gY,� ��
�
Za�irig File: # Resolutiora: # Resolu[i� � -'�
/ � C
/ �
Slcoreland Dish•ict: \/
Avg. Setback: Bl��ff Setback: t.,,> �
Elistiiig ��
Harcfcover: -8�— �
-�'SO' �
250-500' (�^s 1`�--�`it� -r-� `-c-- (,
500-1000' 5��,"S '�`
' � 1 Karcfcover f/arianceReqc�i�•ed: Yes No � �� ��( `�d� 5__-P , ,.
RE�l�fARKS(i�s lxoccse):
3i
.._
B UI'LD.fNG,REVXEtv C�YECK LIST
UBC: CONSTRUCT70iV TYPE:
Sq Footccge ,S Per Sq Ft,;
Baser�ie�ct 1 =
!st Floor x =
?nd Floor 1 =
Gara;e t =
� _
TOTAL
Estimated Constrccction T�i�lue: �
I�espectiass Required: 6York Reqcririx,;Separate Perneits:
Site Plu�nbing Fire
XaJ•cicauer Rerxoval Mechanical Yl�ater•Go�inection
Footiag Septic SeH�er Connection
Fs•aming Firepface Lmvn!r-r�igcctio�i
tnsccdation (Masonry) Other
LYaI!Board (tl�tfg.) YYell(Sf.ate Pernsit)
Final Gracti�ig/Fillirc� Elech•ical(State Permit)
Oth er
REtVIARI�S(INHOUSE):
REVIEW BY OTHERS: DATE:
.�ccess: Existing tYew
.�ccess Approval: Date By:
REt ~Rh'S (TO BE NOTED OtV PER.ttiIIT):-----aN-�t -M-�-1'►�1 us� �~��_�__��
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