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HomeMy WebLinkAbout2001-P04509 - land alteration PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P04509 Crystal Bay, Minnesota 55323 Permit Type: User Defined (952) 249-4600 Date Issued: 10/19/2001 SITE ADDRESS: 500 Orchard Park Rd Long Lake,MN 55356 PID: 32-118-23-23-0003 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: Thomas F. Adams OWNER: Thomas Adams&Janette Weaver 500 Orchard Park Road 500 Orchard Park Rd Long Lake, MN 55356 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. N—j(ANYYV1/4..Q.kD • yCfk APPLICANT PERMITEE SIGNATURE / ISSUED BY SIGNATURE Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1 10/12/01 08:28 FAX WELLINGTON WINDOW Q001 Total Fee: $ Date Received: / 0-1 ^01 Entered By: 614A Permit#: Pot(s--G CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. -__ (please print all information) THE APPLICANT IS: (circle one) WNOR CONTRACTOR JOB SITE ADDRESS: 5 00 ordqkra pay k rZoa d ZIP: SS B510 NAME OF OWNER:1 hor 'Ops F MA wt s PHONE: (home)q'a-416 0373 (work) 95Z-93 --z'737 Ei 3o MAILING ADDRESS: 500 OrchG Pyrk I2Cf.. CITY: L010‘.5 tAlce ZIP: SS' S'(c CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCLUTECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detail): �X+e VIS; 11 o0.3.- d 0Y i Q WW1 t IO- ' • E h d4 approx. 3501 0 in I eve�+�, ! -prod- deep asira.v el 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,t the info tion above is complete and accurate; that the work will be in conformance withihe e's of the Citirland with ilie;:S.latc`$uildL3 Code;;tha I'understand this;i.rpot a permit and world.i o to,start without a permit; and that the work will be in accordance with the approved plan. ' ' - J., '! APPLICANT'S SIGNATURE: 7'•A4O1)i-vDATE: 14)f I LI zoo( G W NOTE! Parade of Homes events require separate periniliapproi�tztby PoliJet 'epai*ment and City Council 60 days prior to the event. Non permitted events will not be allowed. CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: n--00 O n1c_togoe Pei-tel c /?,r, PID: DESCRIPTION OF WORK: (,,t4 O inr6 0/6.4(A/4y ex �� : ZONING REVIEW BY: aDATE APPROVE( D: a-c 3 -o/� BUILDING REVIEW B tv ( 4 . DATE APPROVED: FEES TO BE CHARGED: IPAA-ofKy MiseFQees Ca___ ulated By: PERMIT Yes ✓ 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: /VD CC-1ieir 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: Rear(Street): Left Side: Adjacent Structures: Wed. 'd: Building Height: Def. Hgt. Peak gt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # "esolution Date: Shoreland District: 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: REMARKS(in house): 7 • • BUILDING REVIEW CHECK LIST UBC: CONSTRUCTION TYPE: Sq Footage $Per Sq Ftg Basement x = 1st Floor x _ 2nd Floor Garage x = x = TOTAL Estimated Construction Value: $ (74y i, w/e. G. �+ . • Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical Water Connection Footing Septic Sewer Connection Framing Fireplace Lawn Irrigation Insulation (Masonry) Other Wall Board (Mfg.) Well(State Permit) Final Grading/Filling Electrical(State Permit) Other REMARKS(IN HOUSE): - REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMIT): 8 10/12/01 08:28 FAX WELLINGTON WINDOW (J004 � 1 Sec.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 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 statewide system; (b)whether he may refuse of is legally requited to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or enddes authorized 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 required 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 privfite'o;,public,data on individuals shall be shown the data without any charge:to him and.if he delires,shall be informed of the content ". and meaning ofthat data. After an individual has been shown the private data and informed of its'meaning;the data need not be disclosed to him for . c w; six Months thereafter unless a'dispute or action pursuant to this section is pending or additional data on the individual bas been collected or created. The responsible authority shall provide copies of the private or public data upon,request by the individual subject of the data. The responsible authority m'hy'require'the requesting person rd pay the actual'costs of making,certifying,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 data Ls not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing 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 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 are notified that: 1. A; •The information you furfish will,be used to.determine your qualification for the permit or license requested. '2. You may.refuse to supply d9.ta, but refusal May require that the City_deny the permit or lice e. 3. The'iiiMortination ri y'bb h a'4idh otherilodal, state or federal agencies tvt�t extegtiiecessaxi+tipgrocess 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. lhamas fredtv►'cic,_ P cut4s First Middle Last 500 ©r& Park. Rood Address q Lam s tJ IMN 5 3P qs2 L?b 03? City State Zip Phone I tindet:stantr f ny nghts as stated above/_..h. . . %--41,11440--4.A.ficu Signature