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lii 11 oi <muA<i <br />Building Permit p!:rmit no.6195' <br />G <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66. CRYSTAL BAY. MN 55323 473-7357 <br />DATE ISSUED JC- H ' .^1 <br />ZONING DISTRICT <br />FIRE DEPARTMENT <br />POST OFFICE <br />VAR. DATE <br />COND. USE DATE <br />LOT AREA <br />V«/IDTH DEPTH <br />PROPOSED SETBACKS; <br />FRONT R. SIDE <br />REAR L SIDE <br />LAKE WETLANDS <br />ACCESS <br />NEW EXISTING <br />AGENCY-APPROV. DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />SITE ADDRESS L-A <br />PROPERTY IDENTIFICATION NO (PIDl - M *7 - ^ ~ CCj ^ > <br />LOT_____________BLOCK________________SUBDIVISION__________________ <br />OWNER (Name) <br />ARCHITECT/ENGINEER - Must Cerl <br />(Address)(Phone) <br />V7Z.-^Z_IT <br />(Firm) <br />Must Certify Multi-Family. Commercial & Industrial Construction Plans <br />(Address) (Phone) <br />BUILDER (Firm) (Address)(Phone) <br />TYPE OF WORK New Addition Remodel Renovate <br />CONST. TYPE4 BUILDING SIZE <br />L. W.Ht. <br />OCCUPANCY <br />CLASSIFICATION <br />DWELL <br />UNITS <br />STORIES B 1 2 3 <br />GAR. STALLS <br />ATT. <br />DET. <br />NUMBER OF BEDROOMS <br />SEPTIC <br />APP. DATE <br />PROPOSED USE <br />COUNCIL <br />APP. DATE <br />REMARKS;,^CjJCTKjre^ f\G"r <br />Estijnated Construction Valuation <br />o Ow <br />BLDG. PERMIT <br />STATE FEE <br />PLAN REVIEW <br />SAC CHARGE <br />SEWER UNIT <br />PARK FEE <br />PENALTY <br />OTHER <br />PERMIT FEES <br />TOTAL DUE 7,<S,SO <br />A 3r>* K L /L^Ara</A(._ <br />INSPECTION REQUIRED <br />.. FOOTING before pour <br />□ .......FRAMING rough-in <br />□ .......INSULATION <br />D............WALLBOARD before taping <br />CD............FINAL before occupancy <br />□ .......SITE INSPECTION <br />WORK BEYOND OR WITHOUT A RE­ <br />QUIRED INSPECTION WILL BE SUB <br />JECT TO PENALTY. <br />INSPECTIONS MUST BE CALLED-IN <br />24 HOURS IN ADVANCE. <br />WORK REQUIRING <br />SEPARATE PERMITS <br />PLUMBING............................□ <br />MECHANICAL.........................□ <br />WELL...................................n <br />SEPTIC.....................................u <br />SEWER....................................□ <br />WATER..................................n <br />GRADING & FILLING..............□ <br />FIRE.......................................□ <br />ACKNOWLEDGEMENT <br />THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES <br />UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT­ <br />ANCE OF ALL INFORMATION. CONDITIONS AND REQUIRE­ <br />MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER­ <br />SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM­ <br />PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br />OF MINNESOTA BUILDING CODE REQUIREMENTS. <br />COPY WHITE-FILE <br />CANARY-INSPECTOR <br />PINK-ASSESSOR <br />•(••ktv* Mf. e Ad». Ca. Inc. M12t MI-4470 <br />GREEN-FINANCE <br />GOLD-RECEIPT <br />City of Orono