HomeMy WebLinkAbout1998-010541 - land alteration PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - PO. Box 66
Permit
Crystal Bay, Minnesota 55323 umber: ;1 ;541
(612)473-7357 Date Issued: _ED/9-
SITE ADDRESS:
DESCRIPTION:
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REMARKS:
FEE SUMMARY:
CONTRACTOR: OWNER: -
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OR0NO MN
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�*A NTPERMITEE SI TURE ISSUED BY:SIGNATURE �!,
Total'Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PER1MT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: , b A)e 2)tfn�v ✓i ZIP: SS3`t
NAMEOF OtiVNER: ����+�� ���L PHONE: (home) ! ? 1- 73>
(work)
MAILING ADDRESS:,� 6S—V .,Vvfzi iff-R,' /¢+�� CITY•Wr4Y74 7 4 ZIP:
CONTRACTOR: S ec..E= PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAIILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move - Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail):
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED 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 City 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 in accordance with the approved plan.
APPLICANT'S SIGNATURE: �'� DATE: ak c
NOTE! Parade qf Homes even*ru eparate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rieht_s of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a) the purpose and intended use of the requested data within the collecting State agency, political subdivision,or scitewide 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 orcorfidential data;and(d)the idendty of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve dam,pursuant to section 13.82,subdivision 5, to a law enforcement officer. -
The commissioner of revenue may place the notice reouired under his subdivision in the individual income ax or preoerty tax refund
instructions insread 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 subject
of stored data on individuals,and whether it is classified as public, private or confidential. Upon his further request, an individual who is the subject
of stored private or public dam on individuals shall be shown he daa without any charge to him and,*if he desires, shall be informed of the content
and meaning of that dam. After an individual has been shown the private data and informed of its meaaing, the data need not be disclosed to him for
six months hereafter 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 private or public data upon request by he individual subject of the dam. The responsible authority
may require the requesting person to pay the actual costs of making, terrifying, and compiling the copies.
The responsible authority 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. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when dsta is not accurate or complete. An individual may contest he accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall notify in writing the responsible author-icy 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 he individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with N1 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 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 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
City stat! Zip Phone
I understand my rights as stated abov .
Si na re
r �
• CHECK OFF LIST FOR ISSUANCE OF PERiiNUTS
. FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3164 0 titp(t'i1•��N ,r4y
PID:
DESCRIPTION OFWORK:. _ aMoj -- Zrwca Cy1 a C.y't UVA--JA u
ZONING REVIEW BY: DATE APPROVED: -7-Z9 -fid
BUILD]TG REVIEW BY: At/ . DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes V`0� No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District:
,,Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side: S t
Rear(Street): Left Side: too
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt. — r
Lot Coverage:
Grading: Staff Approval Date: o+b By; .®. Council Approval Date: -�
Septic: Staff Approval Date: By:
Zoning File: # Resolution:# Resolution Date:
Shoreland Dist-ict:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0 75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMAM(in house):
' 26
BUILDING REVIEW CHECK LIST
UBC' — NI CONSTRUCTIOY TYPE:
Sq Footage $ Per Sq Ftg
Basement x _
Ist Floor , x
2nd Floor. x. •• __ .
Garage x
x
TOTAL
Estimated Construction value: $ /V///¢
-- Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical
FootingWater Connection
Septic
Framing Fireplace Sewer Connection
.Insulation (MazomY) Lawn Irrigation
Wall Board er
(Mfg.) , Well (State
— Permit)
OZFinal Grading/Filling Electrical (State Permit)
Other
REi'KARKS (IN HOUSE)-
----------------------------—
OUSE):-------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date- '). Z,7 -dip, BY: (o( 6 COA.&A �
----------------------------- '
REMARKS(TO BE NOTED ON PERIMM:
_
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ORONO PuPlY
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SITE PLAN -X GRADING PLAN _
--- APPROVED -?v Q C,-,kg C.a r F O2«,.e
F APPROVED WITH REVISIONS
❑ DISAPP flo
_ DATE