HomeMy WebLinkAbout1999-011872 - deck � Y PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number:
Crystal Bay, Minnesota 55323 Date Issued: - - - _ -
(612) 249-4600 - -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE Q`�
Total Fee: $ ��: �'` Date Received:
Entered By: i '�'� �' �� �� Permit#: ►����
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �:'ti`��C� ":. c:d�i 1-i 5 J��i= m� ZIP: 5 5 3 � y
NAME OF OWNER: (— �L\C �� 1«�r=��,� PHONE: (home) Li 7-Z- ��o�
(wark) �7�� i - �8 � .z
MAILING ADDRESS: `�'I`�C� N��T�-i S i�K1`_ t�. CITY: U r^�n� ZIp• ���'3� </
CONTRACTOR: �-�R\ci� 1�A �-�-i=.��� �o«t� i PHONE: �G� ' ��� .�
CONTACTPERSON: F,�iC i� MOBILE/PAGER:
MAILING ADDRESS: �i/Yc� �lU���-{ S�fcK;� OQ. CITY: u r'�:�� ZIP: �S'3 ��
STATE LICENSE: #
ARCHITECT/ENGINEER: S�=� i� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: N�w Addition � Accessory Structure
Move Remodel/Alteration Land Alteration
PRUPOSED WORK(describe in detai�: �G�'i 1-�0��� �=o� iDt�_�c�. Pc�� c�
STORIES: _� SQ. FEET OF EACH FLOOR: /.Z a c�
NO. OF BEDROOMS: � GARAGE STALLS: ATT. � DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $
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 Ciry and with
the State Building Code; that I understand this is not a permit and work is not to start without a
pernut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: Fj�,�c� ���� DATE: y�'�/ � �
�
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA .
Subd. 1. Type of data. The rights of individoal on whom the data is stored or to be Stored shall be as set forth in this section
Subd.2. Tnformation required to be gtven indivldual. An individual acked to supply private or coafidemial data conceraing himself
shall be informed of: (a)the purpose and intended use of the requested data widvn 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 l�own consequence arising from his supplying or
refi'cino to supply priva�or confideirtial data;and(cn the ideWicy of other persons or e�ties authorized by state or federal law to receive the data.
This requirement shall not apply when an individual i�asked to supply investigadve data,pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
'I'�le f rnvam,o mav nlarP thP nnfira rnmiirxi nn�ier thic cuhdivicion in the 121tI1V1HU3I i11COII18[8R Ot DLODeItV t3R TCt71IIa
in.ctr«ctions instead of on those forms.
�.3. Access to data by indtvidaal. Upon request to a responsihle authority,an individual shall be informed whe�er he is the
subject of stored data on individuals,and whedier it is classified as public,private or confidential. Upon lris fiuther request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without any charge ro him and,if he desires,shall be informed
of the conte�and meaning of that data. After an individual has been shown die private data and infornned of it�meaning,the data need not he
disclased to him for six mond�s thereafoer unless a dispute or aotion pursuant to this section is pend'mg or additional data on the individual has been
collected or created. The responsible authority shall provide capies of die priva�or public daia upon request by the individual subject of the data.
The respons�le authoritY maY re4uire the requestmg person to pay the actual costs of makin8,certifying,and wmp�ing tr►e copies.
The responsible awhority shall wmply immediaoely,if poss�le,with a�request made p�usua�to this sabdivision,or within five days
of the date of the request,excluding Sawrdays,Sundays and legal holidays,if immediate compliance is not possffile. If he cannot comply wi�
the request within that time,he shall so inform the individual,and may bave an additional five days within which to comply wiUi the request,
excluding Saturdays,Sundays and legal holidays.
5abd.4. Pra�ure when data is not accroste or complete. An individual may contest the accuracy or compl�teness of public or
private data coacerning himself. To exercise�is right,an individnal shall notify in writing the•responsible authority descn'bing the�ature of the
d,����„�* The responsffile audwrity shall wid�m 3D days either. (a)correct d�e data found to be inaccurate or incomplete a�attempt to notify
past recipiems of inaccurate or incomple�data,includin�r�ipie��amed by die individuai;or(b)notify the individual that he believes the data
to be wrrect. Data in dispute shall be disclosed only if the individual's stateme�of disagreement is included wi�the disclosed data.
The determinaflon of the respons�ble autlwrity may be appealed pursua�to�e provisions of the administ:ative procedure act relating
to contested cases.
-DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, °Rights of subjects of data",we would like to inform you that your�
request for a germit or license from the�ity 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 io supply data,but refusal may require that the City deny the permit or license.
3. The information may be shared with other lacal, state 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.
6. Your full name is required to process this application or permit. � •
Fust Middle Last
Address
City State Zip Phone
I understand my rights as stated almve.
signature
� 6
� � � CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY ,
ADDRESS OR LEGAL: y 1 y 0 /Vv/�77�1 �N-o/t� p2 � � -
PID:
DESCRIPTION OF WORK: 0 2 c�-+ t (9-�c,tL
ZONING REV�W BY: DATE APPROVED: 9-�S- 9�
BUILDING REV�W BY: DATE APPiZOVED: q- �s-S�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ✓' No
PLAN REVIEW Yes �i No SEWER COrfNECTTON
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEIN5PECTTON
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: iv n G(�
� Fire Department: Post Office: School District:
�.C-
t Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes� No Date of Survey: po•� r 1l.�
Proposed Setbacks:
Front(Lake): (00 t '� Right Side: �` '�" �
Rear(Street): J b�` + Left Side: 35` f"
Adjacent Structures: A�c hfc� Wefland: �'✓��
Building Height: Def. Hgt. ��� Peak Hgt. �'
Lot Coverage: �—
Grading: Staff Approval Date: By: Council Approval Date:
eptic: Staff Approval Date: By:
� ` oning File: # Resolution: # Resolution Date:
Iv�
horeland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
asasoo�
soo-i000�
Hazdcover Variance Required: Yes No Date of Council Approval:
REI�ZARI�S(in house):
7
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BUII�DING REVIEW CHECK LIST
UBC: �• '� � CONSTRUCTION TYPE: 1/N
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
� 2ndFloorPd2c�c�2�c�Zz1Yy x 22.i5' = 3. i �9.�
Garage Q.e,��c l 5 Z x /v-a� _ �,g zo °d
x =
TOTAL
Estmiated Construction Value: $ Si ����
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
vc Footing Septic Sewer Connection
�Framing Fireplace Lawn Irrigation •
Insulation (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
_�C Final Grading/Filling �Electrical(State Permit)
Other
RF,A�1tKS(IN HOUSE�: - . . .
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
Rr+.NrARizs (TO BE NOTED ON PERMI�:
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