HomeMy WebLinkAbout1997-008807 - interior remodel PERMIT
�ITY OF ORONO PERMIT TYPE:
` 2750 Kelley Parkway- P.O. Box 66 Permit Number: -`=''"=
Crystal Bay, Minnesota 55323 Date Issued: � - :� � � -
(612)473-7357 - -
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: -- . ,- . .. _ _ _..�;:: - _ � . _.._. .. OWNER:
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APPLICA /PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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, ' Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will �=s�����`
(please print all information) ��� 2 a jg��
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR ;:t-i Y OF vR0I�0
JOB SITE ADDRESS: � j � l �J '1 �c� w oo c{�. R� ZIP: J�S � ��
�r�n r� (,�tt.�j Z u.TCti /��
/
NAME OF OWNER: ��vt r�. �'��+-c.<< ��- PHONE: (home) �7 7 � �Y2 S
(work)
MAILING ADDRESS: � (�' �`i��Q c,,o UQ � CITY: (,�C� z. afi�- ZIP: � .5�� �l /
CONTRACTOR: �o vr� l�h o�`7-0� ���' -e o�fi�- PHONE: ``l7`� �I� � �
CONTACT PERSON: 7`0 � h'n 9 w I Tfl � MO E/PAGER:
MAILING ADDRESS: ` �'/ 3�-� .S� T CITY:�,�c-� �! r v r ZIP: �Ss� 3
STATE LICENSE: # �`� 2.5
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
� ��i�v u a-�� Move Remodel/Alteration )C. Land Alteration
PROPOSED WORK(describe in detain: ��� �a�� b�,�, (�z�.��e.� ..��c�s I��hy �aa-��,
Q..¢�r�0 0� .f��-�ho c�lc ..�x L J t��q c.LN -�i n c�J�� cL v-�c�S, J.e t�uyr-e— -��,e.-c,"t�^� �
F�C�+1 1% /1-'i.c�.7 Y_i— w.�!f .�� � ct' ^t�'I y Ct,- /o � c: . -W C„��
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � y ��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 that the work will be in accordance with the approved plan.
,
APPLICANT'S SIGNATURE: t-�..,, / DATE: � -2 S^� -�L
�
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.
6
1
Sec.13.04 RIGHTS OF SITB.T�CTS OF DATA
Subd. 1. Type of data. The rights of individual on w6om rhe data is stored or to be stored shall be as set for[h in this secaon.
Subd.2. Informatioa req�rired to be given individual. An individuai asked to supply private or coafidendal data conceming himself shall
be informed of: (a)the purpose and in[ended use of the mquesced data within the collecting§tate agency,poGdcal subdivision,or statewide system;
(b)whether he may refux or is legally required to rupply the requested data;(c)any lmown consequence arising from his supplying or nfusing to supply
priva[e or confidendal data;and(d)the idendty of other persoas or enddes authorized by state or federal law to receive the data. This requirement shall
not appiy when an individual is asked to suppiy invesdgadve data,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the norice reauired under this subdivision in the individual income rax or Dropertv tax refund
insavcdons instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be iaformed whether he is the subject
of stored data on individuals,and whe[her it is classified as public,priva[e or confidential. Upon tus fur[her request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the content
aad meaniag of that data. After an individual has been shown the private data and informed of its meaaing,the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addiaonal data on[he individual has been collected or created.
The responsible authoriry shatl provide copies of the private or public data upon request by the individual subject of the data. The cesponsible au[horiry
may requiro the requesting pecson to pay the acmal cosu of making,cemfying,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 dau of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
within that time,he shall so inform the individual,and may have an addidonal five days within which to 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
data concerning himseif. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement.
The responsible authority shall wi[hin 30 days eirher: (a)correcc rhe data found to be inaccurate or incomplete and attempt to norify past recipienrs of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individuai that he believes the data to be cornct. Data
in dispuu shall be disclosed oniy if the individual's scacemenc of disagreement is inctuded with the disclosed data.
The determinadon of the responsible 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 pernut or license from the City 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 fumish will be used to detemune your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut 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.
/h,O�n a..S �2�" � lil O(�J I�o h --
g��� Middle Lasc
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Addressf� / ,�n� ���� / / �[ prO�//
F�-�(L..P�[ .f lv r— �r/ C I (n
C�h, $tace Zip Phone
I understand my rights as stated above.
Signature
, ' CHECK OFF LIST FOR ISSUANCE OF PERiI�IITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z l�`1 S I-I r�Y_`.�l w�;r r:._� 1������
PID:
DESCRIPTIONOFWORK: ��,--�-t�°`�u,r` i��:�l-�,���
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ZONING REVIEW BY: 1"V �'� DATE APPROVED:
BUILDING REVIEW BY: � ,y � DATE APPROVED: _� • b � �; 7
------------------------------------------ � ---------------------------------------y:-------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated B
PERMIT Yes �-- No
PLAN REVIEW Yes �- No SEWER CONNECTION
STATE SUR�HARC� Yes ,/ No WATERCONNECITON
INVESTIGAT'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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�Z0�1IltiTG CHECK LIST zoning District:
` Fire Department: Post Office: School District:
� Lot Area: Sq.ft. Acres Width Depth
� Survey Submitted: Yes No Date of Survey:
IProposed Se[backs:
I Front (Lake): Right Side:
I
� Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Heigh[: Def. Hgt. Peak Hgt.
^1,�
I"
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
j Shoreland Dist:ict: _
� Avg. Setback: Bluff Setback: Lot Coverage:
s
'i Existing Proposed
Hardcover: 0-75'
• 75-250'
��f . 250-500'
:
500-1000'
� Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
• 26
BUII�DING REVIEW CHECK LIST
UBC: �� •3 CONSTRUCTTON TYPE: �(N
Sq Footage $ Per Sq Ftg
Basement x —
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ I `-(�y�j�j°¢
Inspections Required: Work Requiring Separate Permits:
Site . ,__;�__ Plumbing Fire
Hardcover Removal � Mechanical Water Connection
Footing Septic Sewer Connection
_�C Framing Fireplace Lawn Irrigation
_� Insulation (Masonry) Other
�_ Wall Board (Nlfg.) Well (State Permit)
� Final Grading/Filling pC 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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REMARKS(TO BE NOTED ON PERNIITj:
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" . TOM KNOWLTON CaRPE9VTR1'
• 191 Third Streef
6ccelsior, ,N11V 55331
(612) 474-90�6
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