HomeMy WebLinkAbout1997-008941 - pool PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 4�`��.�.��i`�`�`'
Crystal Bay, Minnesota 55323 Permit Number: i is,,;�=��:�1
(612) 473-7357 ' Date Issued: i+�:-�i:�,'��,�°=��::
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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APPLICANT�PERMIT�E SIGNATURE ISSUED BY:SIGNATURE
°Total Fee: $ � ��- ?�� Date Received:
Entered By: -F:�i.��' Permit#: `��`,% :�%
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) OWNER R CONTRACTOR
JOB SITE ADDRESS: �'�$ /s'��/�,� , ZIP: SS.��
NAME OF OWNER: SGG�— ✓����h��ec( PHONE: (home) �7,j�7�f"lO
(work)
MAILING ADDRESS: �.�'�,S ��.�7��hi I� CITY:G/2G�C� ZIP: _;�.�
CONTRACTOR: �GG� �G,�/G ��� PHONE: `�7�llS-�'
CONTACT PERSON: }'�GS S MOBILE/PAGER:
MAILING ADDRE5S: ���� ���-y��e�-�--��d CITY: �`�-'�t- ZIP: 5-S'.3�5
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�: s �-rf���l� ��-iG(._
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 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: � Z7 �
NOTE! Parade Qf 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.
5
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 inte�ed use of the requested data within 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 confidenaal data;and(d)the�endry of other persons or enrides 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 mav�lace the norice reauired under this subdivision in the individual income tax or�rouertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible auihoriry,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or conf'idential. Upon his further request,an individuat 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 him for six months thereafter unless a dispute or action pursuant to this section is pending oc additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry 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,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 wiihin which to comply with the request,
excluding Samrdays,Sundays and legal holidays.
Subd.4. Procedure when data is 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 authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be imccucate or incomplete and attempt to notify
past recipients of inaccurate or inwmplete dara,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 die individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 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 Ciry 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 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.
nGss �r���,� ,�r.�-�rG�r
First Middle Last '
(G�G-� �r-!�T Z-Lt—i� y'L`'�-
Address
/�-��.r /I�c% ss3�f' �-Z6'—�l,s3
C��y State Zip Phone
I understand my rights as stated above.
�� �
Signamce
6
� CHECK OFF LIST FOR ISSUANCE OF PERIVIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: z �4��'� ^,.:,"vc-..r �,,�,;,�.�
PID:
DESCRIPTION OF WORK: ���;��i
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ZONING REVIEW BY: r-f' �:. (�,,,.�.— DATE APPROVED: y 3�' `i 7
BUILDING REVIE`V BY: � � �,�,�,�� DATE APPROVED: � - 3� �j�7
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes +l No SEWER CONNECTTON
STATE SUR�HARCrE Yes f/ No WATERCONNECTION
INVESTIGAZ'ION-FEE Yes No ✓' PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning Districr. �',{�- t�
Fire Department: � 1Rru_:. Post Office: C�i�� v�tu= School District: ��;,i���
Lot Area: Sq.ft. ��L'i,i ' Acres Width Depth
Survey Submitted: Yes_� No Date of Survey: C1� l"=l(,.` �.�,�.;;yuc,�
/'
Proposed Setbacks:
Front (Lake): 23i.: Right Side: �> > � '�'
Rear (Street): �`1U � + Left Side: � � S r '�
Adjacent Structures: f Y>` Wetland: �'��1
Building Height: Def. Hgt. Iti' �I� Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland Dist:ict:
�� 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:
1^
REMARKS (in house):
• 26
BUII..DING REVIEW CHECK LIST
UBC: jn � CONSTRUCTION TYPE: �V�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ i U C��%�'�r�'
Inspections Required: Work Requiring Separate Permits:
Site . Plumbing Fire
Hardcover Removal Mechanical Water Connection
►� Footing Septic Sewer Connection
Franung Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Nifg.) Well (State Permit)
� Final Grading/Filling _� Electrical (State Pemut)
Other
REMARKS (I�i 1 HOUSE):
------------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERNIITj:
27
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DATE iTIME
CITY OF ORONO CA�LED IN � -�7'C! 7 - �d�Crh
INSPECTION NOTIC SCHEOULED ' �
PERMIT NO. OMPLETED �.` 30
#
ADDRESS
OWNER CO
TELEPHONE NO. _ �7� " //J 3
��� DESCRIPTION ��
O7 FOOTINO � 11 MECHANICAL�I 18 D(CAV/dRADINO/FIWNO
� , 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
� 03 INSULATION 24/25 W000 BURNER/FIREPLACE 34 TREE REMOVAL
� I04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
2 p5 FINAL 14 SEWER HOOK-UP 06 PROGRESS
F` �7 DEMQ—SITE 27 SEPTIC MAINT. 27 COMPLAINT
J
W tl7 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
2 0�PLUMBINO RI 23 SEPTIC FlNAL 35 HAfiD COVER REMOVAL
v 1 PLUMBINQ FINAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
� O NER/CONTRACTOR TO MEET YOU:_YES_NO
� C MMENTS:
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}i � / - /VORK ATISFACTORY:PROCEED - PROJECT COMPLETE
� W C CORRE T WORK 8 PROCEED �: ISSUE CERTIFICATE OF OCCUPANCY
`; OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFOREICOYERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSP�CTOR WILL RETURN
❑STOP ORaER POSTED.CALL INSPECTOR '-�CITATION ISSUED
❑ INSPECTIQN REQUIRED.CALL TO ARRANGE ACCESS.
CaH for the ne t inspection 24 hours in advance.473-7357
. OwnerlCon� or o ite:
' Inspector. � '
Wh�ite Copylinspector's 'le Canary Copy/Site Notice
t �
MINNESOTA BLUEPRINT 592592
10
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6348 Hwy. 36, Suite 3
MNOakdale, N 55128
(612) 773-7440 - (612) 773-7441 Fax
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Scale
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Sheet
Dated
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