HomeMy WebLinkAbout1999-011817 - land alteration .
. � � PERMIT
�CITY OF ORONO PERMIT TYPE: -- � --- -
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2750 Kelley Parkway- P.O. Box 66 Permit Number: �!� �
Crystal Bay, Minnesota 55323 `` � }''" f
(612)473-7357 Date Issued: ;�.°�;;';����;,:'�=�°,=;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: ��� F��`��= �- � =�" � -
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ITEE SIGNATURE ISSUED BY:SIGNATURE �iA
CiTY ,C= ORONO � 612249461b OS/31/99 10:21 � :02/03 N0:428
Total Fee: $ �_ Date Received:
Entcred By: �� A Permit�: j� /r!
CI'TY OF ORONO - BUILDII�IG PERMIT tiPPl,ICATION
All inforrnation must be submitted in full before plan review wilf be started.
(please pnnt ad! rnformaaion)
----------------------------••--------------------------- --------------___..__----------------------
--••---------
THE APPLICANT 1S: (circle one) OWNE OR CONTR.ACTOR
JOA SI`TE ADDR�:SS: 550 Oxford Road, Orono ZIP: 55391
NAME OF OWNER: Dou� & 1vlary Knutson _ PHONE: (home) 475-0773
(work)
MAILING ADDRESS: 1452 Hunter Drive _CITY: Wayzata ZIP: 55391
CONTR.ACTOR: Steiner & Koppelman PHONE: 473�5435
C(�NTACTPERSON: David Stein�as MOBII.E/PAGTR:
MAILING ADpRE55: 18340 Minnetonka Blvd. CITY: Wavzata ZIP: 55391
STATE LICENSE: � 3721
A��=�T�r'�,����IEEl�: Steiner 7 ko pelman _PHOli1;�: 473-5435
MAILING AllDRESS: 18340 Minnetonka Blvd. CITY: _wayzata ZIP: 55391
NAME: T REGISTRAT'TON l�
TYP� UF WORK: New xX Addition Accessory Structuce
I�Iove Remodel/Alteration Land Alteration
PItOPOSED WORK (describe in detai�: ���' � ,�,��.�� ��S^ > r'r��e� �
}-� �+ t�. _ �
_L_i ,[���,��_ 1 ���'r1 .ti��� -- c,
j.�@��' ���7�r�s
S�'ORIES: r'�`� SQ. FEET OF EACH FLOOR: ��a�—�;�.�,f,
NO. o� s�nRpoMs: �_ GA�LAGE STALLS: ATT. � DET.
E.4TIMATED CONSTRUCTION VALUATYON (excluding land): �
I hereby apply for a building permit and I acknowledge that the information above is complet� and
aecurate; that the work wiU be in conformance with the ordinances and codes of the City and wit}�
th� Stac� �3uildiqg Code; that 1 uuderstand this is not a permit and work is not to scart without a
permit; and that the work will be in accordance with the approveQ plaii.
�
APPLiCANT'S SIGNATURE� ' ` DATE; ��I I 1 � c�c ,
� �y-r--�----
=----�
NOTF,.' ��d�f Ha es events reyufre separate permit approvad by Police Department and
C�ty Couracll 60 days prior to the event. Non permitted events witl not be atlowed.
S
CiTY �F ORONO � 6122494616 08/31/99 10:21 � :03/03 N0:428
See,19,04 RIGHT6 UF SUBJECT3 OF DATA
5ubA. 1, 'I�p�of drto. The rlghrs oP individual on wnom ihe dara is s�nrrJ or w he su,red ehall be u�ae[fonh in rhis secdon.
Subd.2. InformWon requlr�d to be�Jvrn lodivldual. M;ndividwl asked�n dupply privqt�or confidential datn concomkny himself
ehell be infbrmsd of: {a)�e yurpoen and Luaded uae oP tho requas�d c�ata wifiin d�e callecu��g erx�e agency,polldcal subdlvision,or Atatcwide
9ysoem;{b)wluther ho may refuae�r iy le�ally requinA ro supply the t�quested do�;(c)any known cr�c�aequence�rlsing from hls supplying or
reNsing to ropply privam or eonP,dcntial dae�;erd�dl rhe idcndry oP othcr persoru or enuoes authorizeei by slatr,or Pederei!aw tu recelve the dat�.
Thl� requireatent ahall not apply whon an Individu�l is �sked to euppiy invearigedve dau, purAuam rn acction l3.N2, sub�llv[sion S, to a law
cnforcamcnt officer.
'�+,,,,�c�ur�.�ei��r of royqrn�n�av c�!aee Lhs ro�Ge ien�;i d �nd r�a� ivl lon in he lndlyjd�el'�oma x or oZgpertv tak�j{�
8•
Subd. 3. Accer�to d.ta by IndlvJdual. Upon requcst to e res,�onaible.uehoriry, an i�tdividue)ohall be Infuimed wAather he is tAe
eubJect of smrod dais on individusle, and whedter it is classlfled ae puDlic,private or confiden�ial. lJpon hlx fi�rther requesi,an lndlvldual wLo
is du aubjact of atoraJ pr�vaae ur piblfc dota on indlviduol9 sltall be shown the dota wirhuuc any ohar�e w him arul, 1/he�esires, Rhall be informed
of the coruent end meuniry;of that data. After an individual has heen shown tho privace du�u and informed uP its meaning,the dou need noc lx
diaclosed fn him for Aiz tfumdu thercatter uNeas e digputo or eccion pursurr,c w rh►s sectkm la pzniing oe uildida�nl dem on che indivldual has bern
o�llecoed or craaomcl. Tha aspopalAle sudwrity shell pr�vida copies of thc privum or pu6Ue duta upm reyuest by ehe lndividunl subject of tho ciata.
'1?ie rospuneiblo aurhority rt�y raqulre the requesein�porsun to pay�c ectt�al cosw oP muking,�eruMying,end compfling the coples,
1?�a reeponeibk authorky ehall compty imtnedistaly,if pveaible,widt irry roquos�ma�pursuanc to this eubdlvlslon,oc w(thin flve days
a(the dota ot tl�e roques[,eacfuding Sanirdeys,Suncleye ard legel hol(dQys,if Immediata compliaocc is rux pc�,aAlhle. IP he cannot comply wltlt
the roquest wichin thet�imo,he �hap so inform dm indlvtefu�l,and�nay have an eddi[ional five days within whlch m comptr u�{��e requese,
ezcluding Seturdays, Sundays atd le�al holidays.
3ubd.4, procedute whea data!e not wecurate or eumplete. An lndividual may u�ntes�die accuracy or completenese oP public or
pdvsce dam concerning himeelf. Tu cxereiae�hla riYht,an indfvidual shall ru�ri(�in wrltinp the res�xm�iblo authority de9t;rlbiny the naNra oP the
dl9agt�ement, 11fe rosponsibla auctwrity sluill wlthltt 30 days eitlur. (r)u►rnst Che deta fwnd to ba inacwrata or lrr:amplote and attwmpt w nodfy
peat ceclplenet ol inaecureoo ar incomplooa data,ineluding reciplonts namnd by the Indivldual;or(b)nodf�j rho indivldual thac he believee the da�a
to be carrect. Uat�in dispuoe sitall be dixalused only 1f tha Indlvlduat'e etatement of disrgroement is inctuded with dic disclos�td da[a.
11u determine000 at dic reaponafble authoda mey be appeelsd purs��ant to�ba provisione oP the adminl9trative prc�cedure act rclating
to cunteerod cases.
�ATA r�ACY aiDYISpAY
1n accordanc� wi[h M.S, 13.04, Subd. 2, "Ri�hts of subjects of da[a", we would like to info�m you that your
request for a permit or l�cense from the Gity of Orono or any of its depHrtmcnts may require you to fumish certain
private or confidential information.
You are notifled that: �
1. The intormatlon you furnish will be used to determine your quallficatlon for the permi[ or license
requested.
2. You may refuae to supply date, but refuea( may �oquire that the City deny [he permit or license.
3. ?he information may be shaeed with nther local, �rate ur federal agencies tu the exeent necessary to
procoss tbe permi�or license.
4, If your requested permit or license requires Council actioti co apyrove, somo inforrriatian may become
publlc.
5. You have certain ri�ts undcr M,S. 13.(?4(aveilablc upon requcst) to review private data Qn yoursclf.
6. Your full aame is required to proceas this ap�lic�tion or perm3c.
\ �' _— -_��Y�?..o � ��—
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P�fRt Middla l.aee "—
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,,��a�� ����:� �� `�`�3�=t ( `�1.:�.-cr7'13
City � 9rate 7.ip Phone
I underetand my right� a��tated abovc.
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9lpnaaro �__�__—G-�_,__--- ________ . --
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� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY •
ADDRESS OR LEGAL: S S� O X�0 R J� ��A�✓J
PID•
DESCRIPTION OF WORK: �(Z �,�w�,,, ,A�cb (��sc.��n�,
ZO�TING RE`VIEW BY: DATE APPROVED: -�'!- L�S�
BUII.DPTG REVIEW BY: --- � DATE APPROVED:
FEES TO BE CHARGED: ����} Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No SEWER COriNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER(specify)
ZOYING CH�CS LIST Zoning District: � c r��.(
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:
Reaz(Street): Left Side:
Adjacent Structures: Wetl d:
Buildin;Height: Def. Hgt. Peak gt.
Lot Coverage: �
Grading: Staff Approval Date: By Council Approval Date:
Septic: Staff Approval Date: By
Zoning File: # Resolution:# Resoludon Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
�
BUII..DING REY�W CHECK LIST
.•
�C� '"" CONSTRUCTION TYPE: —
. . Sq Footage $Per Sq Ftg -
� Basement . . x =
lst Floor x =
2nd Floor x =
Gazage x =
x —
TOTAL
Estimated Construction Value: $
Inspections Require@: Work Requiring Separate Permits:
�Site Plumbing Fire
Hudcover Removal Mechanical Water Connection
F��g � Septic Sewer Connection �
� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit)
� F�� Grading/Filling Electrical(State Permit)
Other
REMARKS(IN IiOUSE):
REVIEW BY OTI3ERS: DATE:
Access: Existing New
Access Approval: Date gy;
--- -------------------------- :
REI�ZARI�S (TO BE NOTED ON PERMII�: S �n3 t�rse (L�.. ��t.�.�-r� �3_�2c.
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