HomeMy WebLinkAbout1998-010766 - upgrades CITY OF ORONO PERMIT PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66Permit Number, E-Rt_j 1 L�Lj-1(v{;n
Crystal Bay, Minnesota 55323 C,1 0716tS
Date Issued:
(612) 473-7357
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: pp OWNER:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ `fa? Date Received:
Entered By: Permit#: /1)7Co (c
CITY OF ORONO - BUILDING PERMIT 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: � /Y GIP:
NAME OF OWNER:Lool� � � PHONE: 1� �
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: ,l�L 1� 'T ✓/�� E%PHONE: 61,,,2
CONTACT PERSON: D OBILE —�
MAILING ADDRESS
:t� CITY: �r?�"
STATE LICENSE: #
ARCHITECT/ENGINEER: QLp � ��G�5 P O '
MAILING ADDRESS: CITY ZIP:
NAME: �C�TI'- G �.l,FE� REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�C_ 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 SIGNA ,� ��2%��� DATE:
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.
See.13.04 RIGHTS OF 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 forth in this section.
Subd.2. Information required to be given individual. An individu 11 asked to supply private or confidential data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within he collecting state agency,political subdivision,or statewide system;
(b)whether he may refine or is legally required to supply the requested data;(c)a iy known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities autho 'zed by state or federal law to receive the data. This requirement shall
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 notice reguired under this subdivision in the individual income tax or property tax refund
instructions instead 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 data on individuals shall be shown the data without y charge to 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 i nd 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 pend ng or additional data on the individual has been collected or created.
The responsible authority shall-provide copies of the private or public data upon quest by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of making,certifying and compiling the copies.
The responsible authority shall comply immediately,if possible,wid any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if imm late 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 fie days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An in ividual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall notify in wridng the 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 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 VISORY
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 de partments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to dete a your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may 4uire that the City deny the permit or license.
3. The information may be shared with other local, s ate 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 applic ion or permit.
11��� � >O. f
First die Last T
Address
City Sta Zip Phone
I understand y rights as stated above.
Signamre
CHECK OFF LIST FOR ISSUANCE OF PERNUTS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: („X35 (�t✓►'J R S"r14C_ Q Apt (Zoa ,a
PID:
DESCRIPTION OF WORK: _ 1:--)W �InAl2sHAu.S p ,e� P !l�4pG S
ZONING REVIEW BY: NIA DATE APPROVED:
BUILDTi tG REVIEW BY• DATE APPROVED: q ,i o •S
FEES TO BE CHARGED: Misc. Fees Calculated By: ~
PERMIT -Yes V No
PLAN REVIEW Yes c/ No SEWER CONNECTION
STATESURCHARGE Yes No WATER CONNECTION
INVESTIGAZION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units -OTHER (specify)
ZONI WG CHECK LIST Zoning District: tJo -�-
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 Sid :
Rear(Street): Left Side
Adjacent Structures: Wetland:
Building Height: Def. Hgt. eak H-t.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Set ack: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes o Date of Council Approval:
RE1l�IARKS CLa house):
.i t •26
BUILDING REVIEW CHECK LIST
UBC: C CONSTRUCTION TYPE:
Sq Footage S Per Sq Ftg
Basement x _
1st Floor : z
2nd Floor x
Garage x
x
TOTAL
Estimated Construction Value: $_ I6 5 1
— Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire .
Hardcover Removal Mechanical
Footing Septic Water Connection.
_� Framing p Fire lace Sewer Connection
Insulation Lawn Irrigation
Wall Board (Masonry) Other
oe— Find (lyIfg•) Well (State Permit)
Other GradinglFilling Electrical (State Permit)
REMARKS (IN HOUSE):
-------------
--------- DATE
REVIEW BY OTHERS:
Access: Existing
New -
Access Approval: Date
-------------------------------— BY
REMARKS (TO BE NOTED ON PERtiIIT):
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DEC-05-1997 17:23 612 223 5646 9e% P.02
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ORONO SCHOOLS HIGH SCHOOL CONCESSION AREA
AUGUST-4, 1998
ITEM/QTY WIDTH LENGTH AMOUNT @ LABOR @ MATERIAL @ SUB
0 0 0
REMOVE CASEWORK
1
DOOR AND FRAME
1
REBUILD CASEWORK
1
MISCELLANEOUS PATCH
1
PAINT
1
GENERAL CONDITIONS
1
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