HomeMy WebLinkAbout1999-011912 - remodel PERMIT
��TY OF ORONO PERMIT TYPE:
* 2750 Kelley Parkway - P.O. Box 66 - - - -
Cr stal Ba Minnesota 55323 Permit Number: _ :_, .:' _
y y' Date Issued: L- � '•'.�.;� 1��
(612) 249-4600 j�;_ .i S^�;_;f<,�,Y
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: _ _ :;; _ : i.._ _ _f - - OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �,�,
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� Total Fee: $ ��J�� �'� Date Received: �
Entered By: mQ�.,` Permit#:
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CITY OF ORONO - BiTII.DING 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 O ONTRACTOR
JOB SITE ADDRESS: Z,000 S�A�(�I W o a�f �oq� ZIP: S�3�} (
NAME OF OWNER: �b�e� �- L v c y (�,��c��►e (' PHONE: (home)
� (work)
MAII.ING ADDRESS: ZOO O S�i�a w�.�r,/ �CITY: d r o/►�o ZIP: 5 S 3g �
CONTRACTOR e I o� o d e��`� �' o HONE:_�/Z - �12 - D l l �
CONTACTPERSON: fi�' �Z�'� �0��0�5 MOBILE/�AGER:
MAILING ADDRESS: �� �0 kJ u.r74 �l�,�Z I Z CITY: W!7f (��} ZIP: S o
STATE LICENSE: #T��
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 detain: q/a,..r �n-��y.:o r u�a I 1 S � o e w a�f_�_
�ll i n P�C-� t� n r.loT(�rn G , P'Q �' n 1�-� �!,n.,b,Y�ti. .t y.► _ ��Z�Y�m�
STORIES: � SQ.FEET OF EACH FLOOR: J�/��
NO. OF BEDROOMS: Z GARAGE STALLS: ATT. 2_ DET.
ESTIlVIATED CONSTRUCTIOti VALUATION(excluding land): $ Z 6, OO�
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 pemut and work is not to start without a
pemut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATLJRE: G'Q�_ DATE: /-/�" 7 r'-/
NOTE! Parade o�'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
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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 ro supply private or confidential data concerning himself
shall be informed of: (a)the purpose a�intended 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 lmown consequence arising from his supplying or
refusing ro supply private or confidential daa;and(d)the ideatiry of other persons or entiaes authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply invesagadve data,pursuant to secdon 13.82, subdivision 5, to a law
enforcement officec
The cortLm�ssioner of revenue mav olace the notice rewired under this subdivision in the individual income tax or orocertv tax refw�d
inscruceons instead of on those forms.
Subd. 3. Access to data by indivIdual. Upon request to a responsible authoriry,an iadividual shall be infortned whed�er he is the
subject of stored data on i�ividuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the dara without airy 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 mondu thereafrer unless a dispute or acaon pursuant ro this section is peixling or additional data on the i�ividual 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.
11te responsible authoriry may require the requesting person to pay the acmal costs of maldng,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 u►dividual,and may have an addirional five days within which to comply with the request,
excluding Saturdays,Su�ays 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 conceming himself. To ezercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara fou�to be inaccurate or incomplete and attempt to nodfy
past recipients of inaccurate or it�omplete data,including recipients named by the individual;or(b)norify the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the i�ividual's statement of disagreement is included with the disclosed data.
The determinaaon of the respoasible 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�ity of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze 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 City deny the permit or license.
3. The information may be shazed 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.
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Ci�y State Zip Phone
I understand my rights as stated above.
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� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Zo c�o sM r���,,�oo,p t�.o,4,p
PID:
DESCRIPTION OF WORK: , .�v�n.��R �2�ww�p� ;
ZONING REVIEW BY: DATE APPROVED: 9• L 3-9 q
BUII�DING REV�W BY: DATE APPROVED: y• z3- hg
FEES TO BE CHARGED: ,Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes �' No SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No � � SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: /(�o C �-F.4N6,�
Fire Department: Post Office: School District:
. Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
� Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetl d:
Building Height: Def. Hgt. Peak gt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
. 250-500'
500-1000'
Hazdcover Vaziance Required: Yes No Date of Council Approval:
REMARI�S (in house):
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BUII.DING REVIEW CHECI� LIST � �
UBC: R•� CONSTRUCTION TYPE: �VIV
Sq Footage $Per Sq Ftg
Basement . x =
lst Floor r x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ 2�o,C�c�O �
Inspections Required: Work Requiring Separate Permits:
Site a(' Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
K Framing Fireplace Lawn Irrigation
_o�Insulation (Masonry) Other
_�Wall Boazd (Mfg.) Well(State Permit) .
_�Final Grading/Filling _�,Electrical (State Permit)
Other
REMARKS(IN HOUSE): .
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARI�S (TO BE NOTED ON PERMI�:
8
DATE TIME
CITY OF ORONO CALLED IN ��Y-�' `3 b
INSPECTION NOTICE SCHEDULED =���� —`!F�—
PERMIT NO. COMPLETED "7 ',��
ADDRESS �7 b o ',�
OWNER ��.`OLC ONTR. �
TELEPHONE NO. �P I�-- �I Z � �1 �
� DESCRIPTION _ �a����
lyi 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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� 5 FINAL � 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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d�ORK SATISFACTORY:PROCEED /`F-�PAOJECT COMPLETE
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� ❑ CORRECT WORK&PROCEED { f- ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
Ci INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
OwnerlContracto on site:
Inspector.�%l��/
White Copyllnspector's File Canary CopylSite Notice
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G�TY oF OROl�4 pAT�:_____
BUi��JlNG �RM T PLAh RCVIEW 7-26-99
NEW FLOOR PLAN ����`�E`'`�R --_—_--
c�,;� •23-9� ,P�Prr:ir�vo. DRAWING
_--------- ---__ __-- [� A?P�?�VCD AS�U�:;�ir'f�D NUMBER:
SCALE: 1/4" = 1'-0" �'�i='����'�����°Lf;���c:o�;E�t����s�s t�:��TE7 1 OF 5
❑ �lr�:�At f�,^Vt�D---CC�'�;�CT P.�R�S�13n�;1' _______-----
T:^.ese co�-�n;�n!s are for y�ou�inicrrr��:ion. A.1!wofk shall be done
ie ?�:;I CO,r,�;�li�r.�g wiih aM a�:�fi.ucl: buldinc� and zoning code.
F.sc�r,�=:r;en:s inc;ud;�g items r+o�spaciticaiiy ne,ad in this ra�diew
K�EP TNtS Pl.AN St7 ON SITE AT ALL fiMES/�� .
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BATH FILL IN
REMOVE ALL OFFICE N04K
FIXTUftES
REMOVE PANELING
(SAVE FOR PATCHINGj
AL(GN KITCHEN
�REMOVE PANELiNG & SO�FFITS CABINETS
(SAVE FOR PATCHING) �
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APPLfANCES 1N o
REMOVE ACCORDtAN GARAGE FLUE " �
DOOR (SAVE) FOR PICK UP � ? � o
SAVE S1NK FOR � � � o�
RE-INSTALL � � o�
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QRAWN BY:
DINING I LIVrR1G c. DAV{ES
D E C K REVISED:
DATE:
7-26-99
DRAWIIYG
DEMOLITIQN PLAN NUMBER:
2oF �
SCALE: 1I4" = 1'-0"
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8� DINING j C�RPET CABINET ELEVATIONS
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LAMiNATE ' SCALE: 1/2" = 1'-O��
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DRAWN BY:
C. DAVIES
000o p p REVISEO:
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DATE:
7-26-99
DRAWING
NUMBER:
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SCALE: 1/2 1 -0 a tL' ta„o
• � � DRAWN BY:
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REVlSED:
DATE:
7-26•99
3'5 3/8 DRAWING
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POWDER 4 � CABINETS
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� � � � r" m D D ROGER & LUCY KIRCHNER ROELOFS
� '' � � � C � 2000 SHADYWOOD ROAD REMODELING 8 RENOVATION
� rn � ORONO, MN 55391
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