HomeMy WebLinkAbout1999-012259 - grading PERMIT
� CIT'Y OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: __: ,
(612) 249-4600 Date Issued: ;�;� �:_:��;��-;
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SITE ADDRESS:
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DESCRIPTION:.�� . ".._ _ _ _ _. _.
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: . .
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APPLICANT,iPERMITEE SIGNATURE C ISSUED BY:SIGNATURE C�C
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Total Fee: $ Date Received: �2 -to —4 9
Entered By: ,C�, Permit#: �iZ�S 9
CITY OF ORONO - BUILDING PERNIIT 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 R CONTRACTOR
JOB SITE ADDRESS: �,S Q�(F'o�o( �Q�. ZIP: .SS3S6
NAME OF OWNER: J,•m K,�/,�jc,,�.� PHONE: (home) 7'ys= y9S2
(work) �S/-�'y6-9Yo/
MAILING ADDRESS: j�0 f3ox, �38 CITY: Ol'on o ZIP: SS.�S"�
CONTRACTOR: 1/an�e� l,'no��� ��c PHONE:_
CONTACT PERSON: �Ja,� ,//c�/�r/,',u�;e MOBILE/PAGER:
MAII.ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration_�
PROPOSED WORK(describe in detai�: Re�no� ex�S���s �n�,S' Co�r'� ano�
F,��[ ��ea b�� fo �1�.fv�a,! O�'aoC� .
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED 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: !�'!f�'�T��
NOTE! Parade of Homes even s require separate permit approval by Police Deparlment and
City Counci160 days prior to the event. Non permitted events will not be allowed.
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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 confidendal data concerning himself
shall be informed of: (a)the purpose and inte�ed use of the requested data withii►the collecting state agency,political subdivision,or statewide
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 or confidential data;and(d)the identity of other persons or entides authorized by state or federal law to receive the data.
1'his requirement shall not apply when an individual is asked to supply invesdgative data, pursuant to section 13.82, subdivision 5, w a law
enforcement officer.
The commissioner of revenue mav nlace the norice reauired under this subdivision in the individual income tax or�rocertv taz refund
inshvctions instead of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as pub(ic,private or confidenrial. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without any 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 and informed of its meaning,the data need not be
�disclosed to ttim for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the,individual has been
collected or created. The responsible authoriry shall pmvide copies of the private or public data�pon request 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 authoriry 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 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. Prceedure when data is not accurate or complete. An individval may contest the accuracy or completeness of public or
private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the darn found to be inaccurate or incomplete and attempt to noafy
past recipients of inaccurate or i�omplete data,uxluding recipienu 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 authoriry 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 �ity 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 licens�. •
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
Ciry State Zip Phone
I understand my rights as stated above.
Si ture
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �-1 g S p X i'�a-✓� � A✓-�
PID:
DESCRIPTION OF WORK: f�-e�u,o".e rv�s vot�� t �,.�
------- -___----------------- - -------------------------------------------------L��-----S---
ZONING REVIEW BY: �� DATE APPROVED: � c�.�
BUILDING REVIEW BY: DATE APPROVED: r���
FEES TO BE CHARGED: ��,,,� Misc. Fees Calculated 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: /�-o �'�(�4r�b.a���
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 ide:
Rear(Street): Left S e:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
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 Setb ck: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Vaziance Required: Yes N Date of Council Approval:
REMARKS(in house):
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BUII.DING REVIEW CHECK LIST
UBC: ' � CONSTRUCTION TYPE: '
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ �—
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal M�chanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit)
�Final Grading/Filling Electrical (State Permit) .
Other
REMARKS(IN HOUSE):
REV�W BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
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