HomeMy WebLinkAbout1999-011953 - replace windows . PERMIT
CI�Y OF ORONO PERMIT TYPE: _- � -
2750 Kelley Parkway - P.O. Box 66 Permit Number. ;��,�. �,°�a.'�;': � '
Crystal Bay, Minnesota 55323 _ ... _. _
(612) 249-4600 Date Issued: _;�',';:�,:z--,�
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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PP CANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, GITY OF ORONO � 6122494616 08/31/�I 10:23 � :01/03 N0:429
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Total Pe:e: $ . `°`� Dat+e Received;
Bntcar�Sy: Yerrsn#t#: I 9��'—.
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��o� o�ao�vo - B�L��TG �RMIT APPLICA'TION
AIt�f'orq�at�on must b►e submitted in i"uU before p1a�n review wtll b�ata�rtted.
(ptease prinr adt��{�rirmation)
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� AP'�'T.ICAiV'i' �S; (c�rcte ont) OWNEIt Q CONTRACTOR
,�c�� srr� �►n�ss: —Sha , zrp: ��53 9/__,�.
Oro o,
�v� c��c�wr�t: � �-_ -��sorrE: tr��> �I a-�'�/�Dllo�
(wurk)
1VIAIL,Yi1TG AADR�SS: ��!�$,�L��C3'�'Ys t�C Qn a-mn! �:�' �9/
CO�i'i'RACT(�it: , 1�y1 i n��J �..� �-e- PHONE: ��!5 a��.�',7
�ONTkCT PEF�50Nt -r, l i��,, ,K. , MO�.EJPACEIt: 39 t- S� i�
11�AI�.�IIYC�►A�DDR�RS: $.'�,�' `��. _��_ o. CITY: oo�IC! Pan�7�IP:,��s'
STA�TE L�CENS�: A��Q�g � S�. l�'1
A'�C�T/ENGIN�ER: �ON�:
11�AILII�G ADDRESS: CX'TY: Z�":
Nl�ME: REGI5TRA'�'�C1N A�
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TYP�UF WbRK: New Addition Ac.cxRsory S�'e
Mov� Remodei/Alteratioa Latul Altaration --- -
P°ROPOSE3�1 wO�(de�crtbe�rt derai�= `rx�txaS
9TQRTES: � SQ.F�ET 4�'EACH FZ.AOR:
1Vd. �F B�D�A�I�i$: GA�At��STALI.3: ATT. DET.
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�nv��n co�v�vc�rox vai.vA�or� c��a���a�: � 1�f ADD- °� _
�tureby agp[y for a building pexnait and I ack�aw�adge that thc�aformadon atyove is completc and
accuratc; thac tt�e work wsii be in cvn�armance w�th the ardinanc:es �nd codes of thc City aAd with
the StAte Buiiding Cad�; t6�at I umlcrstand thls i�nat a permit and wGrk is not to atart withaut a
permit; and thst the work will be fn �ccardan�c witb the approvad plap.
APPLICANT'S S�GNA : , � ��I,a�l�c. I)ATEs q- I�-�,�
11�07'Ll �',�dv�'.�1p11� ever�ts reqr�r� se,par�a�te ptrr�it approval by Pol�ce I�►eparhnant a�d
GYty Cowtctl 60 dayx prrtar to the evsRt. Nany�srrreiu�d eysnts wtll nat be aliowed.
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Sec.13.04 RIGATS OF SVBTECIS OF DaTA, - __ . .-_ .- -- - • . ' .
Sabd. 1. TTpe of data. ?he sighcs a�i�d����on whom the data is smced or oo be smc:d shall be as sec[oc�h�this secdoc. �
Subd.2. Information nqmred to be givm iadividual. ,1n�dividuaI uked to suP41Y Princ.or confideaeal daa eocceraiag himsetf shail
be iafac�:d o� (a)the parpasc aad iac:aded y,se of the r..,^u�dan withia the cotlecdag;ta�ageary.polidaI subdivisioa,or sratwide ryst:m-
' (b)whe�e:he r..ay r.hise aT u le3aFiY requu=d yo suPPjY.�=�esced dnta:(cj any I�awa eaasaqueece arisiag(rom his suppiyiag oe refusiag W suppty
privac:or ee:s::deacal daa;arid(��:idenary o[ocherpersocs or e:ddes nn�arix:d by snie orl:�e='I:z�r._:ive the d3a. This r.quite�eac s.haI! . .
..not a,�pty w:.ea an ir.dividua!is uked to suppty iavesagiIIve daa,yuisuaa�oo secdaa 13.82.subdivision S.ao a hw eafac�emeat officer.' ..-•,• :. . � .
'[he eec:tr�tissiorter of reveette mzv 1ace.die noeee r.auir.d und:r this subdivision in the individual income ttz oc cooeetv taz tefur.d
tnmuedans iascead oten those foesRs.
Subd.3. Aceess to data br tadividual, Upen requesc oo a respansible authoriry.an individual shaIl be infotmed whe�her he is che subjecc
e[stor:d daa on iudiv{duaIs.arid whaher ic is ei�ss�fc:d u pablic.privac:or conF.dendal. Upon his furrher r.ques�aa iedividual who i���yubjecc
af sioce�i priva::ar publie daa on individuals sha11 be shoara ehe daa wirhout any chacge to him and;i[he daires,shall be intocaud o[the eonaac
aad meaaiag o[dut dara. Ahec aa�ndividval his beaa shown che priva�e dan acd Informed ot Ia meaaiag.che daa ne:d aot be disclosed oo him for
siz moadu thereafuc unIess a d'ispute or udoa purs�u3nc to�his secdoa is peading ot addidooal dar�oa the IadividuaI hat beea eellected or erea�d.
The cespoasbie andsociry shalipcovide eopiu of�he privaL orpubtie daa agon teqaat by the tadividual subjece o[�he daa. Ttie cespoesRb(e authociry
may require the requesdng person to pay rhe acanl cosu et making.eecdfying,aad comp�iag the eopia. . �
Ttie cesgonsibte aurhoriry s2u11 eomply tmraediacety.tf poss3Te,wi�h aay request asade pursuant co this subdivisioa.or wiehin five days of '
the dar�of die teqaa�ezcludiag Sacurdays.Sundays and k3al halidays.i!'uamediare compliaace u noc pouibte. If he eaaaoc eompty with tiie request �
wichia that drue,he shall so infocrn�ke iadividual.and may have an addidoaal tve days wirhin whith to eompty wich the request,exeludiag Satu�days. '
Saadays aad IegaI holidays. � , . . . • �
• .
Sutd.4. Procedure r�hea cUta i�aat aecunte ar eomplete. An iedtvidual may eontest the aceunry o�eompleteneu ofpnblIc orprivace
dza conceming li�mseIf. To ezercise dus dgh�an�sdivi�,u1�1 aa�y��$�e res�Oas�3le auchociry daeribiag the oaaire o!die d'uagreemeac '
The cespoasible au�horiry shall wichia 30 days eie.4ec: (a)cocreec che daca found to be inaceunre or iacompte�e aad att:mpt to nodfy pasc reeip;encs ef
tnaccuate oc tncomptete data.inctuding�eeipieacs narned by�he iadividual;or(b)uoafy tht individuai thac he believes the dat�to be correct Dats
ia dispu�e shalt be disclosed oaly it the individul's sacee.eac o!d'�sagreecn:at is tacluded aith the diselosed daa.
'Ihe decerminadon of the rtspocuible auchoriry may be appealed purncanc to the provisioas of tht admiaisondve procedum aet t+eladng to
eorttescd cases. ' . . , . .
DATA PRIVACY ADYISORY � . � ,
;
In accordaace with M.S. 13.04�Subd.2, 'Ri�hhu of subjeccs of data",we would Iike to inform you that your request
for a permit or Iicense from the Ciry oE Orono or any of its departments may require you to furnish cercaia private or
confidential informatioa.
You are notified that: �
,�
1. 1he inforruation you furnish will be used to determine your quaIification for the permit orlicense requuted. i
2. You may refitse to suppty data, but refusal may require that the Ciry deny the permit or license. � � ;
3. The information may be shared w7cfi ocher local,state or federal ageacia to the etteat necasary to process ,±
the pecmit or license. '
4. If your requesced pecmit or licease requires Couacil actioa to approv�, some iaformatioa may become �. ;�
. public. ' � •� _ �. � . .. . , . � � � � �
. .'S. Yoa.have certain nghts under M.S. 13.04 (availabie upoa requat) to review private data oqyourself. . .
6. Your ful! narae is required to procas this application or permit. �
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F�� � �r�aa�t i,,n .
. aaa� � .�«. ....
Ciry Scue Zip P�oae
I de st y ' s ed above.
/L�-0 ; . �
Signacure .
Total Fee: $ Date Received: '
Entered By: . Perm.it#: �
CITY OF ORONO - BUII�DING PERMIT' APPLICAT`ION ` � -
- _ � .. . �
.A11 i.nforma�ion must be submitted in full before plan revie�v Rill be started. .
. . � (please print all information) ._ . . . � . ' I
Z'HE APPLICA2r'T IS:. ��� � (circle one)�.� O�NER OR CONTRACTOR � �.. . - . - � • . - .
_ �' . . Z�: I
JOB SIT'E ADDRESSs -
. , .. �._., .- - _ __ _ _. ._ .
rIA11�� OF O�i'ER: � PHONE: (home) �
. � (work) '
IYIA1'LPIG ADDRESS: � .CI'I'ys . ZIP:
� � � �
- PHONE: - � ;
. CO�RACTOR: � � ,
COti'TACT PERSO�I: . MOBILE/PAGER:
r2AIL .T�i'G ADDRESS:
CTTy. ZIP:
STATE LICE�SE: # _ � • .
� ARCHITECT/EhGINEER:� . . . , . � . PHO��:.. . , �
CTTY• � � ZIP:
MAILING ADDRESS: � � �G,Yg�gA,TIOV#
� rIA.ME;
TYPE OF tiYORK: New Addition_ Accessory Structure
Move______ Remodel/Alteration _ Land Alteration
PROPOSED tiYORK(descn'be in detai�: .
STORIE�S: SQ.FEET OF EACH F'I..00R: . ,
1h0. OF BEDROOiViS: _. GARAGE STALLS: ATT. _ DET._____ . . .
EST .Il�i IA.TED CO�ISTRUCTIO�i YALUATION(exCludi.na lanc�: $ � -
I hereby apply for a building permit and T acknowledge that the information above is comp�a�
accurate;that the work will-be in conform�nce with the ordinances a.nd codes of the Ciry
the State Buildi.*►g Code; that I understand this is not a permit and work is not to starc without a
permit; and th�c the work will be in accordance with the approved plan.
APPLICAI�"T'S SIGNATURE: DATE:
NOTE! garade o Ho�es events require separate permit approvai by Police Department and
� City Council 60 days prior to the event. Non permttted events Knt1 not be atlowed.
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CHECK OFF LIST FOR ISSUANCE OF PERNIITS
FOR OFFICE USE ONLY •
A.DDRESS OR LEGAL: I�y c� �t�l-o4�pU w c�d co , .
PID:
DESCRIPTION OF WORK: l,���p L w s
Z0�1ING REVIEW BY: � l � DAT'E APPROVED: �
BUII..D�TG REVIEW BY: DATE APPROVED: �c� -5-`19
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓' No
PLAN REVIEW Yes No � SEVVER CONNECTTON
STATE SURCHARGE Yes v No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE '
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: rU� G l-��h^� .
Fire Department: Post OfFice: School District: �
Lot Area: Sq.ft. Acres � idth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Street): Left Side:
Adjacent Structures: Wed d:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage: '
Grading: Staff Approval Date: B : Council Approval Date:
Septic: Staff Approval Date: B :
Zoning File: # Resolution: # Resoludon Date:
Shoreland District:
Avg. Setback: Bluff Setbac : Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250' '
250-500'
500-1000'
Hardcover Variance Required: Yes Date of Council Approval:
REMARKS(in house):
7
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BUII.DING REVIEW CHECK LIST
�C� 2� � . CONSTRUCTION TYPE: '�N
Sq Footage $Per Sq Ftg ,
Basement. . . x =
lst F1oor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $_ 1 2, �oc� �'
Inspections Required: Nork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
F��g ' Septic Sewer Connection �
� �C Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit)
�F�� Grading/Filling Electrical(State Permit)
Other
REMARI�S(IN HOUSE): .
REV�W BY OTI�RS: DATE:
Access: Existing New �
Access Approval: Date gy:
RENIARKS (TO BE NOTED ON PERMII�:
8