HomeMy WebLinkAbout1998-010161 - addition PERMIT
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Iley Parkway- P.O. Box 66 PERMIT TYPE: � ��
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�. Permit Number: i���;�;_,�
� ' Bdy, Minnesota 55323
;�,�; �+73-7357 Date Issued: i�;�;i i�;��.�t
SIT� aDDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: — �;���:�i a��:y-�t. —
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APPLICANT/P TEE SI ATURE ISSUED BY:SIGNATURE
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- Tota, Fee: $ � � Date Received:
'��E1ltered By: Permit#: � �/ (�, /
' CITY OF ORONO - BUILDING PERNIIT APPLICATION
�_� �
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: vZD%CQ S' t�Aavw ��� i� (2 o:�r 7 ZIP� SS.� 3 ��
NAME OF OWNER: �,c;�.a h d �o��t,�U PHONE: (home) L/7/ —//ytJ
(work)
MAILING ADDRESS: 1�I(� S ff�}�yc���� P2r� CITY: li.��/z 9'T�} ZIP: 5�'3�t!
CONTRACTOR: PHONE:
CONTACT PERSON: 1`+�IOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
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�: �_(xA�AG� r,�vti�a,,, ,��,^r�. ,, . �G���<�
`�F- A IL G t�-
STORIES: SQ�FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
`_
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �� s �v��
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
pernut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: � ' � " DATE: y-a3 --g�'
NOTE! Parade of Homes events require separate permit approval by Police Department ancl
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA
S�bd. 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. �
S�bd.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 intended use of the requested data within the collecang 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 to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigauve data,pursuant to section 13.82, subdivision 5,W a law enforcement officer.
The commissioner of revenue mav nlace the notice required under this subdivision in the individual income tax or propertv tax refund
instiuctions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether 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 individua(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 infora►ed of the content
and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending or additional data on the iadividual has been collected or created.
The responsible authority 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 cosu 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 d�e request,ezcluding Saturdays,Sundays and legal holidays,if immediau 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 within which W comply with the request,excluding Saturdays,
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
dara conceming himself. To ezercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The rosponsible authority shall within 30 days either: (a)correct the data found to be inaccurete or incomplete and attempt to notify past recipienu of
inaccurate or incomplete data,including recipienu 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 the individual's shatement of disagreement is included with the disclosed data.
The determination of the responsible authority 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 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 pemut 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.
��c.�.,a � � l,J t t�L�i A�w— �� � � c���!
First Middle Iast
v101 (o S 6�A�aU w � o fl le� A--@�
Address
� g v zA-�� �� S3'3g� y� �/ -1�90 �
- City State Zip Phone
I understand my rights as stated above.
si
. CHECK OFF LIST FOR ISSUANCE OF PERMITS
� '`' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �C /(� �,�`��(� �..:._� ��L ��.
'PID• /"7- � 3 / Ovc.z.
' DESCRIPTION OF WORK: �plJ c T r o�S
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ZONING REVIEW BY: .� ,,,_,_ DATE APPROVED: Y-Z'�-�'sg
BUILDING REVIEW BY: DATE APPROVED: �-L7- `f 8
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes l/ No
PLAN REVIEW Yes ✓ No SEWER CONNECTION
STATE SUR`I�ARGL Yes �� No WATERCONNECTTON
INVESTIGAT'ION FEE Yes No PARK FEE
SAC Ycs No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: LR • /G
Fire Department: ��N,/� Post Office: w�4�,,�4 714 School District: �,,,ps7tlnl�@'i4
Lot Area: Sq.ft._�,Z?� Acres . 31� Width Depth
Survey Submitted: Yes�_ No Date of Survey: �(•Zrj -9(�
Proposed Setba�ks: POQ�� � 6hQ,4(� G a(bkc�c� Po�u�,
Front (Lake): _ "77 /ZO = Right Side: 0� 6 •�
�
Rear (Street): S 3 y8 � Left Side: 36� (b� '�
Adjacent Structures: F�?7�q�t�c.�r� Wetland: N�t�~
Building Height: Def. Hgt. p.�L Peak Hgt. --'
Lot Coverage: (q•6.3
Grading: Staff Approval Date: /J�}/ By: — Council Approval Date: —
Septic: Staff Approval Date: /�/ �� By: "
Zoning File: # ,,,2�?! - Resolution: # jc�S 7 Resolution Date: =� " ��� `1�J
Shoreland Dist:ict: y�s
Avg. Setback: N(�q-- Bluff Setback: N�/� Lot Coverage: l�'.(0 3
Existing Proposed
Hardcover: 0-75' l d.� I(.L
75-250' y 5.l0$ v5•gY
250-500' 3� .�5 3�.6 2
500-1000'
Hardcover Variance Required: Yes x No Date of Council Approval: �(�2� • 9 7
REMARKS(in house):
� 26
♦ � .
BUII.DING REVIEW CHECK LIST
UBC: R '�3 CONSTRUCTION TYPE: V/v '
' Sq Footage $ Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ Z 5,400�"
Inspections Required: Work Requiring Separate Permits:
Site .� Plumbing Fire
Hardcover Removal oC Mechanical Water Connection
_�Footing Septic Sewer Connection
�_Framing Fireplace Lawn Irrigation
�Insulation � (Masonry) Other
�Wall Board (Mfg.) Well (State Pemrit)
Final Grading/Filling _� Eiectrical (State Pemut)
Other
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERMIT):
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DATE TIME
CITY OF ORONO CALLED IN �_�U � ( 3'`/���
INSPECTION NOTICE SCHEDULED ' "� 'GO, P%�I
PERMIT N0. b COMPLETED �L" �'�� `�'�'
ADDRESS . � ��� � �
OWNER i �cz�CONTR. �w�t�-i'
TELEPHONE NO.�f/�a 7Q 9 �Y��
� DESCRIPTION S�Q.P_t����C � �S��,ro h
t� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 4 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTA�L. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEEf YOU:_YES_NO
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� ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTOTAKEN
INSPECTOR W{LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-46��
Owner/Contr or on site-
Inspector./'��C-ti`C 1�z-ri(�
White Copylinspector's Ffle Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN `��
INSPECTION NOTIC SCHEDULED �
PERMIT NO. dl ' COMPLETED S�—�'��/ "`���
ADDRES��)�D S�1�Cl � '
OWNER CONTR. 6Z�n21�'
TELEPHONENO. ��" s� g�- — ����)
� TION �����
TING 11 MECHANICAL RI 18 EXCAV/GRADING/FIL�ING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
C� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContractor on site:
Inspector.��/�,[.�����
White Copyllnspector's File Canary CopylSite Notice
DATE IME
CITY OF ORONO CALLED IN � - Cd • U ��
INSPECTION NOTICE./ SCHEDULED !�-2_-l-v t.� �o D
PERMIT NO. � �� �w/ COMPLETED
ADDRESS �' �" � t �"���
OWNER �c�Z /`C:�� CONTR. 15�.���'�"�ti4¢��
TELEPHONE NO. ��l� -5 �° � C-t�-r�i�
� DESCRIPTION YiJ�� � � .�2.��'�'�---'
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��8T"FOOTING _,i 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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V BEFORE COVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. r pHOTOTAKEN
INSPECTOR WILL RETURN
CITATION ISSUED
C]STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-460�
OwnerlContra tor on site:
Inspector. ��-�c�CQ�i1 �
White Copyllnspecior's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN �—Z-S""�CX.� L' 3��p��
INSPECTION NOTICE SCHEDULED �1-z7-Uc� 5��LnTa-,
PERMIT NO. COMPLETED �� U.'Dc>
ADDRESS �G/G~ Sh�:,-v; . , ���'J✓�
OWNER ���GZi��c f CONTR. �L-G �'_��4/
TELEPHONE NO. � �� � l f�/� �c/ 7G'� -C�fc/L�
� DESCRIPTION �r����`
l� 01 FOOTING 11 MECHANICAL I 18 EXCAV/GRADING/FILLING
� 02 FRAMING � 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS 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
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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INSPECTOR WILL RETURN
Cl STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
Ci INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 ho�ars in advance. 249-46�0
OwnerlContr c r on site:
Inspecto '� �
White Copyllnspector's File Canary CopylSite Notice
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CITY OF ORONO P jX
INSPECTION NOTIC scHE�u�E� II- U ���� ... G�vY�
PERMIT NO. � COMPLETED � ��
ADDRESS C� U ( �U��' S�� t�Cc D P-�
OWNER I� � ��'Z-- �G ��-I CONTR. a i'Yv�-
TELEPHONE NO. 6�7/ -//g�;
� DESCRIPTION �`����z`���� ��"
ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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= 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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INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCES:i.
Call for the next inspection 24 hours in advance. 249-46�0
OwnerlContract r on site:
Inspector. �/`�.�G r vl�
White Copyllnspector's File Canary CopylSite Notice
il - _ _
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vorthwesterly corner of Lot
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: South from-the Northwest -� 85?Z
, 20 SCALE
:s 30 minutes to the shore of ,
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-therly line of Lot 2; thence -- �
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; all in "Gust S. Johnson's � HousE � %" ' � ''';
cv � � � , JLM \
Eice of the County Recorder, \ �
/ scR� POFtcH; p}-IM = 929.4
DECK �
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:scription you furnished. _ - ' 1�,� �
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-tant. , , - -' � 1��525"E , � � � �
comzrs of the property. N �68 \ �� (CRYSTAL BAY)
_�THc NW'ly COR. OF LOT 2 / N
3522 � �, P�no ePoac �� � �
re not as familiar with your , � ' '� - : o
�vernmental agencies as their , � '� ,- "� �
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i th�t the proposals are what � poaa+". ��.�
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s may have jurisdiction over ; � 0 1 JLM 6�•28 � ; � %�� '
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