HomeMy WebLinkAbout1993-005788 - land alteration PERMIT
CITY OF ORONO PERMIT TYPE:
r,
2750 Kelley Parkway - P.O. Box 815 I NEE:
Permit Number:
Orono, Minnesota 55356-0815 171
Date Issued: i C%I i
(612) 473-7357 X_! JI
SITE ADDRESS:
T C;
DESCRIPTION:
ALTERAT I ON
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REMARKS: i�!4
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FEE SUMMARY:
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CONTRACTOR: . P F,I i C;@-,-I t. OWNER:
HAYIE'z. f-EXCAVR00 ING -7
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N 3N'] R 1 LE MN I AING LA�--:*E lei N .5 f-::_;7;t_'
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THE !1jN10FH._R,'_3IGN-'__D HIEF%--EBY REQUEOT'_ PERMI,_,_ I CN P J111`)J"E TH11:1 i
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PEC:IFIEF..' !`IND HG'REE':_"-' --: 0 [).J A-1-j- WFIF,"k, -111-41 1- 1 A-NC:E 4 L I I I
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11IR-C-0 i i JfRiD,I NANC-6- ;AND S'fi�)I-E uF IM I NN1;;_S'Cj'rA L01"NG C-JOCIE REQt.)I REr1E_N*T'_--" .
IS
APPLICANT,PE RMITEE SIGNATURE ISSUED BY:SIGNATURE
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE nONLY
ADDRESS OR LEGAL: (p OC.0 C4VJA &d/i Q!Y PID:
DESCRIPTION OF WORK: LLlf L
---------------------- --- ----------- -------------_-----
ZONING REVIEW BY: DATE APPROVED
BUILDING REVIEW BY: /Ul/�- DATE APPROVED:
------ -------------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
� --&(Z1�(0��
PERMIT Yes Ng o
PLAN REVIEW Yes Nowt SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No p1,. SITE INSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------- ---------
ZONING CHECK LIST Zonin District:
Fire Department: Post Office: Sc o 1 District: _
Lot Area : Width: Dep h:
Survey Submitted: Yes No Date o Survey:
Proposed Setback
Front (Lake Right Side:
Rear (Stree ) : Left ide:
Adjacent S ruct res : W tland:
Building Height Def Hgt. Peak H t.
Avg. Setback: Lot overage:
Existing P oposed
Hardcover: 0-7 '
75-25 '
250-5 0 '
500-10 0 '
Hardcover Var ance Required: Ye No Date of ouncil Approval:
Grading: Staf Approval at By: Cou cil Approval Date:
Septic: Staff Approval Da By:
Zoning File• # Resolut n # : Resolution Date:
REMARKS (in house) :
BUILDING REVIEW
/yCHECK LIST
UBC:— A rI'' CONSTRUCTION TYPE:
Sq Footage Per 'Sq F
Basement -
1st Floor
2nd Floor
Garage
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
_2LFinal (Mfg. ) Other
Other Well (State Permit)
Electrical (State Permit)
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REMARKS (IN HOUSE) :
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REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMIT) :
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit1r:
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
-----------------------------
-------------------------
THE APPLICANT IS: (circle one) O NER or CONTRACTOR /
JOB SITE ADDRESS: (O 0 Cr 5��� "�` I ZIP:
(work)
NAME OF OWNER: Or'G it t 2 S IDPHONE: (home), � r� I `
CITY: -[�1Lct �'�+ 4- ZIP:
MAILING ADDRESS:
s
CONTRACTOR: ) 1 CaLl e 5 L_ PHONE: `► 7
MAILING ADDRESS: Drake �r ► ✓¢: CITY:
STATE LICENSE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) : 12 S ` b + )F?_ ,I ITS
11
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
4
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.
DATE:
APPLICANT'S SIGNATURE:
/ -
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
On the North Shore of(Lake Minnetonka
DATA PRIVACY ADVIS ORY
In accordance with M.S. 13.04, Subd 2, "Rights of subjects of
data", we would like to inform you that our 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 wi� 1 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 sharedl with other local, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or be lOene a regnresCouncil action
to approve, some information may public.
5. You have certain rights under iM.S. 13.04 to review private
data on yourself.
6. Your full name is required to process this application or
permit.
First Middle i Last
I
Address
City Zi State i P
i
i
Phone
I understand my rights as stated a ove.
Signature �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINA!NCE—473-7358 • PUBLIC WORKS—473 7359
ASSESSING
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