HomeMy WebLinkAbout1998-010405 - shed/deck/pool replacement PERMIT
,CITI� OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �:;i�!�,;i T(��:t;
Crystal Bay, Minnesota 55323 PermitNumber: �_!�{_�;�i`��
(612) 473-7357 Date Issued: _
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
' Total Fee: $ ��' �� .3� Date Received:
Entered By: �-`.,, Permit#: /��O�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
' ----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 13�°� �AR,t� �r� ZIP: $�3 b�
NAME OF OWNER: �ET�� �.�...AN�H'ER PHONE: (home) y�}z�1\�S
(work) �I��z - y 13
MAILING ADDRESS: 13 5°I�R Rl� �1 R CITY: �T��N� ZIP: 553 t�
.�.,<.,�,�
CONTRACTOR: S EAt'r�RNS CoNSfRuCT tNU PHONE: y���-313D
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS ?5 ��e�.5� �. CITY: lo q. ZIP: 5533
,:,�.
STATE LICENSE: #
_ ,�,
•,�..
.{;�.
�o�oh,�n�cA� � 5��.. PHONE: 5`i Z • oes� , �.,�. .
MAILING AllDRESS: �,��5 t� 1�,.,u I1�� CITY: ZIP: SS�1�
NAME; REGISTRA ION#
, ��
TYPE OF WORK: New k Addition Accessory Structure �
Move Remodel/Alteration Land Alteration
- �i
'�� .
PROPOSED WORK(describe in detain: ��R���� �Am�R�ED �DEt1C A�N� "��1,_. r�' ��
Rn�L Sk}Ell _ ,��
_�; _"
STORIES: SQ. FEET OF EACH FLOOR: "�����
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �,S,0�0
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 accordan e with the approved plan.
,,�
APPLICANT'S SIGNATURE: � � DATE: 3 •3l�•q�,
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.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. I. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set forth in this secrion.
Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenaal data cooceming himself shall
be informed of: (a)the purpose and intended use of the requesud dara within the collecting"state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any l�own consequence arising from his supplying or refusing to suppty
� private or confidendai data;and(d)the idenriry of o[her persons or enriries auchorized by state or federal!aw to receive the data. 'I'his requirement shall
not apply when an individual is asked to suppiy investiearive da[a, pursuant ro secuon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund
instrucdons instzad 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 whe[her it is classified as public, privace or confidenaal. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown[he dara wichout any charge to hun and, if he desires, shall be informed of the conten[
and meaning of that data. After an individual has been shown the private dara and informed of iu meaning,the data need not be disclosed to him for
six monchs thereafce�unless a dispuce or acrion pursuan[to this seccion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry
may require the reqvesring person to pay the actual costs of making, cerrifying,and compiling the copies.
The responsible authoriry 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 immedia[e compliance is not possible. If he cannot compfy with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate oc complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreement.
The responsibte authoriry shail within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempc to noafy past recipients of
inaccurate or incomplete data, inciuding 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[he individual's statemenc of disagreement is inctuded with the disclosed data.
The determinarion 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 City 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 wiil be used to detemune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the pemut or license.
3. The information may be shared with other local, state 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.
(. Your full name is required to process this application or permit.
�E�'E � �-r ►�1(�Tonl `-Rn1'�t�ER
First Middle Last
13 5� �Rx �2���
Address
d�or�� 1�'�n1 553i�`I y�Z- 11�S
Ciry State Zip Phone
I understand rights stated above.
Signamre
, CHECK OFF LIST FOR ISSUANCE OF PERiI�IITS
FOR OFFICE USE ONLY
ADDRFSS OR LEGAL: _ i 35 4� ��QK �('�v� �
PID: �,p
DESCRIPTION OF WORK: �cz,lc �- �'c�. i ('�,�-E�t/+v�vl.�. � � �,i�.:Z�Y. ,(�i9arh�[��
---------------------------
---------------------------
ZOYIl�tG RE'V]E�� BY: , , DATE APPROVED: G,-L`�-��
BUII.,DING REVIE�� BY: � � � DATE APPROVED: �, °�Y-4��?
FEES TO BE C�-IARGED: Misc. Fees Calculated By: �
PERMIT Yes ✓` No '
PLAN REV�W Yes v No SEWER CONNECITON
STATE SUR`HARG�. Yes ,/ No ti�ATER CONNECTTON
�INVESTIGA'I'ION-FEE Yes i/ No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZOI�TING CHECK LIST Zoning District: �-��
Fire Departmenr. (�I,a�.v� Post Office: (,�(,,,.�.�.� School District: _�y;-Z,1,,u;F
Lot Area: Sq.ft._��;,� Acres ,C� tiVidth �(',;�i���-it Depch
Survey Submitted: Yes � No Date of Survey:
Proposed Setbacks: 5(�� ����-��t` ;;r+�e ����1 t-Qz.�.�
F�rvIIt (Lake): .2�y" i d`�.v�Riaht Side: 3 ` � 7j' '
F�ea�r (Street): ��5 2�y Left Side: ��+ � b
�� S i4Lii{ �i;c a t b@.(�C-
Adjacent Structures: 5 �Vetland: /�J✓�
Building Heighr. Def. Hgt. ryt�`/� Peak Hgt. _ �(,r y,Q
Lot Coverage: i?. .�
Grading: Staff Approval Date: •(,/fP} By: ^ Council Approval Date: �
Septic: Staff Approval Date: ��/I� gy: --
Zoni.ng File: # Z31�4� Resolution: # Resolution Date: !� -`� y c� �
Shoreland Dis�ict: �,�5
Avg. Setback: V,;����3 Bluff Setback: NJo� LotCoveraoe: I'7 S
Ezisting Proposed
Hardcover: 0-75' • �7 _ � 7
75-250' �Z�' . �2 v
250-500' •
500-1000'
Hardcover Vaziance Required: Yes� No Date of Council Approval: 6 �� `��
�
REI�ZARKS (in house):_ � = C.�=��(�- C.���=�Za'� tiJc i v i_ ����''���i
. � 26
BUILDTNG REVIEW CAECK LIST .
'u�a�: - /�' 3 ,�ir� covs�xvc�ov�E:
v�v
� Sq Footage $ Per Sq Ft�
Basement x
lst Floor . x _
2nd Floor x _ �
Garage X —
x
TOTAL
Estimated Construction Value: ,"_= �
$ �� C.;E%�=
Inspections Required: � Work Requirina Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical
. � Footin Water Connection
Frami.ug Septic Sewer Connection �
Insulation Fireplace Lawn Irrigation
Wall Board ��0�'� Ocher
�,F�� rn'if�•� Well (State Permit)
Gradin�/Fillin; _�Electrical (State Permit)
Other
-------------------
REi1�IARKS (IN HOUSE): � ---------- _-___�____�------
------------------------ -------
- ---------------------___-
REVIEtiV BY OTHERS: -------------
DATE:
Access: Existing New '
� Access Approval: Date
By:
---------_—__--- ...��__���-----------
REMARKS(TO BE NOTED ON PERitiIIT): �� �'---
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� � UILDING P�fiMiZ PlAN REV! � `
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� PERMiT NO, "� �
� APPROVED A�5t18M17TED
—A^ Q APPROVE[}WiTH GOi�:iEC�Ci:'S AS NO�-
� CI #tOT APPF341tFD---COFi�tECT 8�R�SUSNIIT i�.,,,�.
lt,s9e c.rM�r�cs ars tw your sr�formation./u1 L.ork snan M
� in fufi com�llance with eU appticaDle b�,�ld�rg eM arNn�c ��
� AequiremeQts ir�c�u��ng items not spe�ifica�r rwt�i h this twi �
- KEEP1I'HIS PLAt�i SET ON SITE AT ALL TIM�S a
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✓ey was prepared by me or under my direct supervision and that i am ����0 ����
� Professional Surveyor under tne Laws of the State of Minnesota. -
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