HomeMy WebLinkAbout1994-006100 - land alteration PERMIT
PERMIT TYPE:
CITY OF ORONO t!`=ER DE€=fNFE3
2750 Kelley Parkway .56P-.O. Box 815 Permit Number:
006100Orono. Minnesota 5530815 Date Issued: tyc ii�:y
(612) 473-7357
SITE ADDRESS: j
1 :�f i OLD CRY'S TAL BA'v RD N
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�`. I . -11'8-;':w:-4._— 00ci
DESCRIPTION:
User Permit• Type LAND ALTERATION
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HECK 1.•1 GEN f00
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REMARKS:
' I NE ER I NG INS N�T INCLUDE EN :° :FEE D� = : :( _ r; : .IeiRER IT � �_ l : .j AO THE H _ttIFOE PAID °* PEfi ION FE . WHICH ARE
FEE SUMMARY:
Base Fee ' s 1:-..1 1:2
Total Fee $76 .00
CONTRACTOR: OWNER: - ? is nt. -
i�ROi jO YOt 1.1 H E=A'= A;
�EE _L A'E°_y C:
LONGLAKE hN 555E,
479-1307
TRE, 1 S�{ � � � ESS PERMISSIONTO E T� Ems.: IMPROVEMENTS
SPECIFIEDG �< €" � ' �RI�T COAtiritl MM -I',it,' CITY Or
RU RDI LANCES ;.T� OF ftI `; A 81J DE :R 1 a. r
•'•PLICANTTERMITEE SIGNATURE sY ISSUED BY:SIGNATURE /a.y. •
CITY OF ORONO - BUILDING PERMIT APPLICATION
Date Received:
Total Fee: $
Date Approved:
Entered By: Permit Q: 06 _
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE. SMARTED
(See Check-off List Enclosed)
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
ADDRESS: /030 N , 101ST h^ exiva ZIP: j5 ��
JOB SITE
(work) 479-73, 7
//�KO1 O �` , PHONE: (home)
NAME OF OWNER: (� �'��J ZIP: �,S .3�'
MAILING ADDRESS: I �5�
CITY:
CONTRACTOR: 4110/ PHONE: 1-4e)2 o
q Rk / � CITY P22176
MAILING ADDRESS: ! as 5 C�
STATE LICENSE:
PHONE:
ARCHITECT/ENGINEER:
CITY: ZIP
MAILING ADDRESS:
REGISTRATION a
NAME:
Structure Move
TYPE OF WORK: New Addition Accessory Land Alteration
•
Demo Remodel/Alteration Renovate
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 dw that I
th the
ordinances and codes of the City and with the State Building and
understand this is not a permit and work is note o start ata without a permit;
that the work will be in accordance with the app
•
APPLICANT'S SIGNATURE: Olke,ed___
DATE: ` -ate'�
• -
7,7_
__ ORONO
CI
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
OF °=
QRCNO On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would like to inform you that io itsr request forts may require or
a permit or
license from the City of Orono or any of
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 oor
r
federal agencies to the extent necessary to process the permit
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
S. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to process this application or
permit.
Fi Middle Last
/SS 4//,144,.e,e)
Address
(�� )4; Iv
I
Cit State Zip
i/7q- X 30
Phone
I understand my rights as stated above.
ature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL s x -- :I0 / Octi— " sP - "PID - - _ .._. _-_ _._..
DESCRIPTION OF WORK: C9 ' J(N(
_ JC:L�-- .,.. - DATE - -
ZONING REVIEW BY: - APPROVED: -
�������
BUILDING REVIEW BY: IV - DATE APPROVED: -
FEES TO BE CHARGED: Misc. Fees Calculated By:
6_-_)(2-44Ot p i -7c ,00 -E ENGfN-e-e,2
PERMIT Yes No 11/15 (1-441PLAN REVIEW _ Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LI T Zoning District:
Fire Department
Post Office: \,, School �st' ict:
Lot Area: , Width: Depth:
Survey Submitt=d: Yes No1_ Date of S rvey:
Proposed Setba ks:
Front (La e) : \ Right Si•e:
Rear (St eet) : Left Sid: :
Adjacent Structures: Wetland
Building Heig t: Def Hgt Peak-'Hgt.
I
Avg. Setback: Lo Coverage:
Ex sti g *roposed�
Hardcover: 0 75 ' /
1
75- 50 '
250-•00 '
500-1.00 '
Hardcover Valiance Required: Yes N. Date of Council Approval:
Grading: St-ff Approval Date: By: Council Approval Date:
Septic: Sta f Approval Dae: By:�
Zoning File:# esolution #: II Resolution Date:
REMARKS (in house) : If \
. , .
_,. . . _ .
BUILDING REVIEW CHECK LIST
b
UBC. CONSTRUCTION TYPE: -*
til: _. : eri SI�r x= -1 >•
- Sq Footage • $ Per Sq Ftg
-Basement
1st Floor x
f--' ♦ - .++-eek
2nd_Floor . _ .._.. .x.z _ _ ..•.. _- _ �- �����- { �-
_.Garage x
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
Final (Mfg.) Other
Other Well (State Permit)
Electrical (State Permit)
REMARKS (IN HOUSE) :
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT) :
•
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