HomeMy WebLinkAbout1999-011103 - remodel laboratory ` 7 �f 1
Total Fee: $ �7=� �( Date Received: �� ' � ``�� �f�
Entered By: � Permit#: %� /�: �%
;
CITY OF ORONO - BUII�DING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICAI\� IS: (circle one) OWNE �OR CONTRACTOR
JOB SIT`E ADDRESS: Z `��� SGlF'�%�y i.t,'c�c�v �.l� ZIP; �S� � .� 1
�/'�t v��i�.��
1\TA1�IE OF O`�'ER: C�� 2 c=i� � PHONE: (home) G .�I� `���GG�3:
(work) �C iz) '�y Z - 3 `�y (�oN 1�'"'�^`��o-�c
1ti1AII.ING ADDRESS: Z a o/ �/2 C�S�'y ��'%JCITY: U�<��/2�a'r�l ZIP: 7 5
CONTRACTOR `— ��a�'�'.� � PHONE: ' �
CONTACT PERSON: MOBILElPAGER: � ->�r� �� Z ,
MAILI1tG ADDRESS: CITY: Z�=
STATE LICENSE: #
ARCHITECT/ENGINEER: ~- <��1 ��c�i<< PHO�IE: �
MA.IL�TG ADDRESS: CITY: ZIP:
rJ�,ME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detain: �c:��Uf-�G=L- <,�a��� /'�)'t�% �`�=�
r;�.«t�����<� .,_<< i?�-�>�_�
STORIES:�� SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
5f
ESTII-i ZATED CONSTRUCTION VALUATION (excluding land): $ ��' ��'� r' C �-�'
I hereby apply for a buildin� 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 pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
. �'� ;.
APPLICAi�1T'S SIGNA.�.��� z2� ��� - ,v � DAT'E: � 2 � `f ��
`"��:' ,
NOTE! Parade of 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.
� I
Sec.13.04 RIGHTS OF SLTB.JECTS OF DATA
Subd. 1. Type of data. 'fhe rights of individual on whom the dara is stoced or ro be s[ored shall be u sec forth in this secdoa.
Subd.2. Information reqirired to be givea indIvidual. An individual uked w supply privare or confidential data conceming himself s6a11
be informed of: (a)the purpose and inteaded use of the requaud data wi[hia the coUecdag itace agency,polidcal subdivision,or statewide rysum:
(b)whaher he may refuse or is legalty required to supply ehe requesud dara:(c)any 1rnown consequence arising from his supplying or refusing w supply
private or confidendal data;and(d)[he idendry of ocher persoas or enddes auchocized by stace or federal(aw to nceive the data. 'lhis requiremeat shall
not apply when an individual is asked to supply invesdgadve dara,pursuant ro secdon 13.82,subdivision 5, w a law enforcement officer.
The commissioner of rcvenue mav olace che nodce rewired under this subdivision in the individual income rax or orooem taa refund
instructions inscead of on ehose forms.
Subd.3. Accas to data by iadividual. Upon rcquesc to a responsible authority,an individual shall be informed whether he is the subject
of scored data on individuals,and whe�her it is classified as public,private or confidenaal. Upon his further requesc, an individual who is the subjecc
of scoced private oc public dara on individuals shall be shown ehe dara wichout any charge to him and;if he desires, shall be informed of the content
, and meaning of that dara. After an individual hu been shown che privare daca and informed of ic�meaning,the data need not be d'uclosed to him for
suc monrhs theceafter unless a dispute or acdon punuanc to this secaon is pending or addidonal dara on the individual has been collecud or creared.
The responsible auehoriry shalt provide copies of�he privace or public daca upon request by the individual subjecc of rhe dan. The responsible authoriry
may require che requesring person to pay the actual coscs of making,cerdfying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,wi[h any requesc made pursuant co this subdivision,or wichin five days of
the date of che requesG excluding Saturdays,Sundays and legal holidays,if immediace compliance is not possible. If he canaot comply with the request
wirhin that ame,he shall so inform che individual,and may have an addidooal five days within which to comply with che request,exciuding Saturdays,
Sundays and legal holidays.,
Subd.4. Procedure whea data is not accurate or complete. M iadividual may contesc the accuracy or completeness of public or private
data conceming himself. To exercise chis right,an individual shall noafy in wridng che respoasible au[horiry describing the nature of the disagceement
The nsponsible auchoriry shall within 30 days either: (a)correct the data found to be inaccucate or incomptete and attempc to nodfy past ncipiencc of
inaccunce or incomptete data,including recipieacs named by che individual:or(b)nodfy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagrecment is included with che disclosed dara.
The determination of the rosponsible authoriry may be appealed punuanc to the provisions of che adminisQarive procedure act reladng to
contesad 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 Ciry 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 Ciry deny the pemut or license.
3, The information may be shazed with other local, stace or federal agencies to the e=tent necessary to process
the permit or license.
4. If your requested perm.it 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 perm.ic.
First �tiddle Lasc
Addreu � .
Ciry Sate Zip Phone
I understand my rights as stated above.
Signamre
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFI USE ONLY ,�
ADDRESS OR LEGAL: � ^ �� �J�--��
PID:
DESCRIPTION OF WORK: LAQ �Z,�n�oc�
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Z0�1G REVIEW BY: DATE APPROVED: l Z-Z(• 9�3
BUILDING REVIEW BY: DATE APPROVED; (Z-Z� •y'�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes _�G No SEWER CONNECTION
STATE SURCHARGE Yes � No WATElt CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CH�CK LIST Zoning District: /v o Gl�N���
Fire Department: Post O�ce: School District:
Lot Area: Sq.fr. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side
Rear (Street): Left Side:
Adjacent Structures: W tland:
Building Height: Def. Hgt. Pe • Hgt.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: y:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac : L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
BUILDING REVIEW CHECK LIST
UBC: � CONSTRUCTION TYPE: /lvD C�(fr9yK%1Q
Sq Footage $ Per Sq Ftg
Basement x —
lst Floor x —
2nd Floor x =
Garage z =
R =
TOTAL
Estimated Construction Value: $ S p,d oo�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical • Water Connection
Footing ' Septic Sewer Connection
�Framing Fireplace Lawn Inigation
�_Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
Final Grading/Filling �Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REIVIARKS (TO BE NOTED ON PERMIT�:
8
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ADM�IISTR�IV� DIY�SiUN
PO Bar 6699
MinaeaPotie,MN SW�-b899 ����
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DATE ME
CITY OF ORONO CALLED IN `�-.� ` ` � �
INSPECTION NOT E .� � SCHEDULED -� • � �
PERMIT NO. �� COMPLETED
ADDRESS ��`�� �' �`��''''�
OWNER ��-� ' ' CONTR. ...��'-��
TELEPHONE NO. ��� � � �ib
� DESCRIPTION � �.�'LQ. �_ C�'�'� -.fl:�'�a�
� 01 FOOTING 11 MECHANICA � 18 EXCAV/GRADING/FILUNG
Q 02 FRAMING 13 MECHANICAL FINAL <<< �� 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL , / 1 S SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI V 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL �� Oj�S 36 FOUNDATION/REMOVAL
Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� �'1NORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑COflRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
. PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
Ci CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contrac o e:
Inspector.
White Copyllnspector's Fil Canary CopylSite Notice
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