HomeMy WebLinkAbout2003-P06359 - land alteration CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: Po6359
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: 6/2/2003
SITE ADDRESS: 4140 North Shore Dr
Mound,MN 55364
PID: o�-i i�-23-aa-oos2
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Pernut Sub-type(s): �d Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Sepazate permits required: �h�_���g w/o C.U.P.<500 yards)
NOTICES/REMARKS:
Grading-Minor Land Alteration for Culvert&Water Gardens
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT• owner/Self OWNER• Ted&Carrie Woychick
. MN � 4140 North Shore Dr
Mound,MN 55364
TI�UNDERSIGNID HEREBY REQUESTS PERNIISSION TO MAKE THE REAL IlVIPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CI'fi'OF ORONO ORDINANCES AND STATE OF
MIlVNESOTA BUII,DING CODE REQUIREMENTS.
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LICANT PE ITEE SIGNATURE LSSIJED BY SIGNATURE
Conies:1-File(Si�tnitures Requixed). 1-At�plicant 1-Monthlv Renorts, 1-A�essin�,l-Finance Page 1
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Total Fee: $ ��'� �- DaCe Received: '`�-� �--�
Entered By: � Permit#: _
�C'i.� l� � ;� � �, �- � � ���� � ` i 'I� � ' � ..
( .� �i �
,,�� CITY OF ORONO - BUI�.,�FG PERMIT APPLICATIOIeT `�
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`=`� yJ All information must be submitted in full before plan review will be started.
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u� (please print all information)
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� THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
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�'�� JOB SITE ADDRESS: ���C . ( ' 7 �- � '>ZIP: f! -�
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NAME OF OWNER: �... � �� � _ �,, r . (home)�°��� ��Z_��7��
� �7�,,� (work�
MAILING ADDRESS: ��� I D T I�,e�/•�1�Y: �''/��C ZIP: `�>'� . ���
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CONTRACTOR: )�-/C-��_ PHONE: _�fy�/���
CONTACT PERSON: >�-J�/� MOBILE/PAGER:
MAILING ADDRESS: ���/� CITY: ZIP:
STATE LICENSE: #
ARCI�ITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N�,�; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Altera•ion '
,--,
�- � � �, ;
PROPOSED WORK(describe in detai�: ( �.� ?�-%� ��1� �- � �'��� �� -�"�%--�__
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET._____
___.
r �-. ._: _ ` „___-�\,,
ESTIMATED CONSTRUCTION VALUATION (excluding l�: $ l�(I� �--�
I hereby apply for a building pernut 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
permit; and that the work will be i�n-accordan�e with the approved plan.
''� �`, / �� ,
APPLICANT'S SIGNATUREI,: � , i� DATE: �-��l-��G� '`
- ____
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NOTE! Parade Qf Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF S'�TBJECTS OF DATA �
Subd. 1. Type of data. The righrs of individual on whoai the data is stored or to be stored shall be as set forth in this secaon.
Subd.2. Information req�rired to be given individual. An individual asked to supply private or confideatial data concerning himself shall
be informed of: (a)the purpose and intended use of die requested data widiin the collecting 3tate ageacy,political subdivision,or statewide system;
(b)whether he may cefuse oY 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 idendry of other persons or enrides authorized by"state or federal law to receive the data: This requirement shall
not appiy when an individual is asked to supply investigarive data,punuant to secrion 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav vlace the nouce required under this subdivision in the individual income tax or nroaertv tax refund
instrucdons instead of on those fornvs.
Subd.3. Access to data by iadividual. Upon request W a responsible authority,an individual shall be informed whe[her he is the subject
of stored data on individuals,and whether it is class�ed as public,private or confidential. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data without any charge w him and,'if he desires,shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of its meaniag,the data need not be disclosed to him for
s'vc months thereafter unless a dispute or action pursuant to this section is pending or addiriona(data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
T1se responsible authority shall comply immediately,if possiHle,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding 5aturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within d�at time,he shall so inform the i�ividual,and may tiave an additional five days within wluch to comply with the request,excluding Saau�days,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing rhe 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 noafy past recipients of
inaccunte or incomplete dara, including recipients named by die i�ividual;or(b)nodfy the individual that he believes the data to be correc� Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinadon of the responsible authority may be appealed pursuant to the provisions of the admiaistrative procedure act relating fo
contested cases.
DATA PRNACY 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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You aze 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 data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other local, 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.
First Middle Last
Address
Ciry State Zip Phone
I un and my rigfits as stated above.
D
'g ture
CHECB OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Yl N o rtlo�zn� �� ,pl1. .
, PID:
DESCRIPTION OF WORK: L�v'/� At-��-�z o�
ZO.�Tl�Ti G REV�W BY: DATE APPROVED: 6-2 -03
BUILDING REVIEW BY: -- DATE APPROVED; � � �
��(A�p�ns5 w o c.✓.P. <sr� c.��c y s
FEFS TO BE CHARGED: r Misc. Fees Calculated By:
PERNIIT Yes �/' No
PLAN REV�W Yes �' No SE'9VER CONNECITON
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SIT'EINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CHECK LIST zoning District: �Jv c��,rc,,�e
Fire Department: � Post Ofhce: School District: -
Lot Area: Sq�.ft. Acres � Width � Depth _ _
Survey Submitted: Yes � No Date of Survey:
Progosed Setbacksi �
Front(I.ake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: We and: .
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: B : Council Approval Date:
Septic: Staff Approvat Date: B :
Zoning File: # Resolution:# Resolurion Date: �
Shoreland District:
Avg. Setback: Bluff Setback: Lflt Coverage:
E�cisting Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes� No Date of Council Approval:
REMAItKS(in house): _
7
BUILDING REVIEW CHECK LIST .
�
�C' � CONSTRUCTION TYPE: —
_ Sq Footage $Per Sq Ftg
� Basement . . . x _ .
lst Floor � x . . _ - . � .
2nd Floor x � _ .
��e x — -
a _
TOTAL �
F.stimated Construction Value: $
Inspections Required: , 1�vork Requiring Separate Permits:
Site PIumbing Fire
Hazdcover Removai Mechanical Water Connection
• FO°�g � �Pu� Sewer Connection
� " Framing Fireplace Lawn Irrigation
Insulation (MasonrY) Other
Wall Boazd . • (Mfg.) _.._ WeA(State Permit) _.-__
—�F� Grading/Filling Electrical(State Permit) �
Other
REI�ZARKS(IrT HOUSE): �
REY�W BY OTHERS: DATE:
Access: Eaisting New .
Access Approval: Date gy. �
RFMeRTrc �O BE NOTED ON PERNIIT): � �
8
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Project: Prepared By:
Job No. Phone:
• ' Date: Fax:
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