HomeMy WebLinkAbout1993-005068 - remodel main & baths _ _
r � PEI�MIT t -
CITY OF ORONO PERMiT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: �:t�'�-�y��`��'
Orono, Minnesota 55356-0815 Date Issued: 4�i?�t}�"-
(612) 473-7357 ���r i'�;''�:::
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: — �t�=��Iic�nt. — OWNER:
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APPLICA ERMITEE SIGNATURE ISSUED BY:SIGNATURE�
v
' ' � CITY OF ORONO - BUILDING PERM_.IT APPLICATION
Tota1 Fee: $ ;�.'? '/`� Date Received: 7 -�� � �--)
Date Approved:
Entered By: ��"jv _
Permit tt: .C�t, �,
AI�L INFORMATION MIIST BE SIIBMITTSD IN FDLL BEFORE PI,AN REVIEW WILL Bg STARTLD
{See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRBSS: �c3 (p� ��c5� f�. C C2.Gc,c= ZIP: �c���
(work)
N�ME OF OWNER: k7t��Tl t� t��t c= S PHONE: (horae)
MATLING �Dx.Ess: 13C� r2c�S� ��. cce. _ cz�: (`�gc��v c7 zlp:JJ�Co�l--
CONTRACTOR: �('f c=��S C.0�9a'i PHONS: ��1 �7UO�p
�+iAILING ADDRESS: zI�Z7 c5G-fr�uVl?�9Ot� �t� CITY: �/�`.'��fi. ZIP:�� 3� r
STATS LICENSE: � Z z 3 �
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRBSS: CITY: ZIP:
NAME: RBGISTRATION n
TYPE OF WORR: New Addition Accessory Structure Mave
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSED WORK (describe in detail) : Qc=("'fC9c7 ('1�'tt�� � �T t3/`�?E-l.s
�w ��x� r�o 2�t�t� � �-�A�3 t N�S
STORISS: SQ. FEET OF EACH FLOOR:
NO. OF B�DROOMS: G�G$ STAI.I�S: ATT. DET.
. ,- �p `
ESTIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ c�c��� •
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
tnat the work wil 1 be in accordance with the approved plan.
APPI,ICANT'S SIGNATORE: �%�r� � DATE: � �C� � 3
' ' �' '
�
C ITY of ORONO
Post Office Box 66•Crystal Bay,Minneeota 55323•Municipal Officea
•
� - � a On the North Shore of Lake Minnetonka
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
Iictense from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that,: �
l. The information you furnish wi3.I 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 Iicense.
3. The information may be shared with other Iocal, state or
federal agencies to the extent necessary to process the permit or
license.
I' 4. If your requested permit or 3.icense requires Counci3. action
to approve, some information may become public.
5. You have certa;in rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Your full name is required to process this appl.ication or
permit.
M r�aP[� f� , �����-f�l-�/Z 1�
First Middle Last
Z l7 7 c�-�c7�V�9�1C�c� 2t�
Address
1�J-�`�Z�►Ti� I`1 i� �S'J���
City State Zip
�( 7l -7DC��
Phone
I understand my rig,hts as stated above.
�j 2.�
Signature
BUILDING&ZOIYING—473-7357 • ADMINISTRATION&.FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
,�____._..._-- ---- ---_. _ .
� ♦ Y
S73.Q4 RIGHZS OF SIIBJECTS OF DATA � .
Subdivision L T`ype af data- The rights of individuels on whom the data is
stored or to be stored shall be es set forth in this section.
- to be given individusl- An.individuel asked to
Subd. 2. Information required
� ' supply private or confidentiel data concernina �8mwithf in the collect g state agency,
purpose and intended use of the requested
political subdivision, or statewide system; (b) whether he may refuse or is legally
required to supply the requested date; (c) any known consequence arising from his
supplying or refusing to supply p
rivate or confidentiel data; and (d) the identity of
other persons or entities authorized by stat�u��e�kedlto supplyeinvest gat ve data,
requirement shall not apply when an indivi
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma lert taX re°una�nstructionsuinsteadh�s
subdivision in the individual income tax �r r•
on those orms. . � --- -- -- - _
Ac� to �� by ����. Upon request to a responsible
Subd. 3.
authority, an individual shall be informed�whetbh�c hPr vateeor confident a1.� UPon �
individuels; and whether it is clessified p � ublic data on
further request, an individuel v�►hc is the subject of e to�mrl��if he desfres, shall
individuels shall be shown the data witho of�hat da a. After an individuel has been
�e informed of the content and meaning t� �ta need not be �isclosed to
shown the private data and iniormed of its u���8ction pursuant to this section is
him for six months thereafter unless e �SP
, � ending or additional data on Lhe individuel h8s been ��lie d�atarupon request by
p rovide copies of the private or p
responsible authority shall p The responsible authority may require the
the individuel subject of the �� ��rtif n and compiling the
requesting person to pay the aetual costs of making, Yi g�
copies. lmmediately, if possible, with any request
The responsible authority shall comply ' of the date of the request,
made pursuant to this subdivision, or. within five ��mmediate compliance is not
excluding Saturdays, Sundays and legal holidays,
possible. If he cannot comply with the request within that time, he shall so inf�th the
hsve an additionai five daYS With�n which to comply
individuel, and n►eY �d le el holidays- ' '
request, excluding Saturdays, SundaYS g
Subd. 4. Procedia'e when data is not acetirate a' co�nPlete. An individual may
tumself. To
contest the accuracy or completeness�of public e lnri�� the�responsible authority
exereise this right, an ind�v�duel she� notify �ible authority shall within 30
describing the nature of the disagreemenL �e r�P°
days either: (a) correct the data found,toom lete data, includin6 pec pients namedt by
notify past recipients of inaccurate or inc P
the individual3 or (b) notify the individual in�v dual� Statementof disagreement i
Date in dispute shall be disclesed only if th
• included with the disclosed data• � 8ppe�e� p�uant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
' � CHECK 'OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY -
'-�DDRES S OFL LEGAI�: �3�oO �;5.� f��r✓u' C,t 2C��PID: �7'//�-2 3 3�'. �c�3�
3SCRIPTI4N OF WORR: �-Cw�'U�.�- �3A-'�t S
----------------------------
JNING RL'�TIEW BY: N�(a DATE APPROVSD:
?ILDING �EPISW BY: � C� DATS APPROV�: H�� ��3
--------�---------�------------------------------------------------------
�S � g� �g�p: Misc. Fees Calculated By:
?ERMIT Yes �No ' -
�LAN REVI'EW Yes No ✓^ SEWER CONNECTION
=TATE SIIRCHARGE Yes t// No WATER CONNECTION
�NVESTIGATION FEE Yes No �^ PARR FEE _
3AC � Yes No ✓ SITE INSPECTION
:lumber o£ SAC IInits OTHER (specify)
---------------------------
;ONING CHECR LIST oning D' strict:
:�ire Department: Post Of ice: School D' str ct:
ot Area: Width: Depth:
�urvey Submitted• Yes No Date of Survey:
Proposed Setback : �
Front (Lak ) : Right ide:
Rear (Stre t) : Left S'de: �
Ad�acent truct res: Wetla
\
Building Heigh : Def Hgt. Pe Hgt.
Ang. Setback: Lot Cove age:
E istin Propo ed
Hardcover: 0 75 '
75 250 '
250 500'
500 1000'
Hardcov�er ariance Requ r d: Ye No Date of Council A proval.:
Gradinq: taff Approval ate: By: Council. Appr val Date:_
Septic: S aff Approval Date: BY=
�oning F' e:# Resol tion #. Reso�ution Date:
REi�RRS (in house) : .
.
BIIILDING REVIEW CHECR LIST � �- - .
IIBC: �S. �'� CONSTRIICTION TYP$:.�L�'— _ .
Sq Footage $ Per Sq Ftg
Basement _ x _ _ _ _ :
Ist Floor x - _ _ _
2nd Floor X . _
Garage X -
x =
TOTAL
$stimated Construction Valne: $ S,fg'O o
Inspections Required: Work Requiring Separate Permits: .
Site � �C Pl.umbing Grading/Fill.ing
Footing MechanicaJ. Fire .
. Framing Septic Water Connection
�Insulation Fireplace Sewer Connection
�Wa7�1. Board (Masonry) Lawn Irrigation
Final (Mfg.) Other
Other WeI.I. (State Permit)
_�Electricai (State Permit)
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REMAFtRS (IN HOIISE) :
------------------------------------------------------------------------------
REVIEW BY OTHERS: DATS: �
Access: Existing ' New
Access Approval.: Date BY-
REMARRS (TO BE NO�ED ON PffitMIT) :
,
�
_�
� pATE TIME
CITY OF ORONO CALLED IN �//9��
' INSPECTION N ICE SCHEDULED 'i�/.2o/93 .' o
PERMIT NO. �� � COMPLETED U '
�
� ADDRESS
OWNER � CONTR. ��1�i �� �
TELEPHONE NO. 'SC7� - '70C�
� � DESCRIPTION �?�e1�
� � 01 TING 11 MECHANICALRI 16WELLTESTPUMP
I02 FRAMING 11 MEC ANICAL FINAL 18 EXCAV/GRADING/FILLING
y
Q N 24125 WOOD BURNER/FIREPLACE 19 LAKESHORFJWETLANDS
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
J 07 Al � 27 SEPTIC MAINT. 21 COMPLAINT
Q
09 PLUMBING R 5� 15 SEPTIC INSTALL. 22 FOLLOW-UP
v 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEET YOW:_YES_NO
� COMMENTS:
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W� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REIt�SPECTION TEMPORARY
V BEFORECOVERING PEHMANENT
❑CORRECT UNSAFE CONDITION V�yITHIN HOURS. �, pH0T0 TAKEN
INSPECTOR WILL RETURN �CITATION ISSUED
❑STOP ORDER POSTED.CALL INSI�ECTOR
❑INSPECTIONREQUIRED.CALLTdARRANGEACCESS.
Call for the next inspect on 24 hours in advance.473-7357
OwnedContractor o s' :
t
Inspector.
White CopylMspector�s File Canary CopylSite NoHce
�
ATE TIME
CITY OF ORONO CALLED W c �'3
INSPECTION NOTICE SCHEDULED �/-Zc/4 � /' 3 c>
� PERMIT NO. ----� �� � ✓ COMPLETED A <<
ADDRESS / U � � •
OWNER ��--�- _ CONTR. J�-^�
TELEPHONE N0. �7�- �I C���C�,
� DESCRIPTION '��`�i>����;�'
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
Z � 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL r�.�,�/ 13 METER SETITURN ON 17 SITE INSPECTION
� DEMO—SITE `/ 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
4Qi 09 PLU �15 SEPTIC INSTALL. 22 FOLLOW-UP
J1 LUMBING FINAL 7�� 23 SEPTIC FINAL
Q OW OR TO MEET YOU:_YES_NO
Z
� � COMMENTS:.��_-_��'
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d WORK SATISFACTORY:PROCEED
W� PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
O C] CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �J CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the n xt inspection 24 hours in advance.473-7357
OwnerlCon or n site:
Inspector. �
White Copy/inspector' ile Canary CopylSite Notice