HomeMy WebLinkAbout1993-005354 - add/remodel � PERMIT
EITI�'OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: �'���`�'����s'
Orono, Minnesota 55356-0815 iiir�;:=;!;f.,.
(612) 473-7357 Date Issued: �y��������;�;
SITE ADDRESS:
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FEE SUMMARY:
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CONTRACTOR: — . ;:�;i. t��:t�t. -- OWNER:
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APPLICANT%PERM� SIGNATURE ISSUED BY:SIGNATURE
,. .
. CITY OF ORONO - BIIILDING PERM.IT APPLICATION
� �/ � ,� �1� �/`�'J
jo�zl ree. $ Date Received: ! 1�
, _ Date P.pproved:
�,��
Entered By: ' I` �
Pe�it�: •. -�`J �
✓�
AT•T. INFORMATION MIIST BS SDBMITT� IN FIILL BEFORE PLAN RF.'STIEW WII.L Bg STAR�F.D
{See Check-off List Enclosed)
-------------------------------------------- =—==_`�-------------------------
T� AppyICANT IS s (circle one) OWDIER o CONTRACTOR
JOB SITE ADDRSSS: �2 �1'C�' �'�-�,=�� � ���' �'�� � l"-�`(�"�� ZIP:
(wark)
:d� OF OWNER:��� �� �`��`��r'���~' PHONE z (home)
:�II,ZNG ADDR.ESS: �� �� �-'�� W ��� r�`' �ITY: �'n'�i��l ZIP•
CONTRACTOR: � JL�1 �'�� ����I��L'�'� PHONE: �� �) I � ��_�.
��zrxG x�DxESS: `� 3 z-� C��l�1 b'��,�C�'�"c�� � I r��=�'���f�IP: �� � Q S
_ �
STAZ'S LICENSE: � �)��' 2� � �
ARCHSTECT/ENGINEER: ��n'�''J (h '�'����'r� PHONE: �"l � � � � ��
� �� -z� G�������..,,��,-r�� �� t,r����r-� ZZP: ��'3as
.KP,.ILING ADDRBSS: � �
'iAME: R$GISTFt�TION A I �� �J C` .
'�YPE OF WORR: New Addition Accessary Strncture Move
Demo Resnodel/Alteration� Renovate Land Alteration
?ROPoSF.D WORK (describe in detail) : ������`� -�
�TORSSS: SQ. FEBT OF EACH FLOOR:
y0. OF BSDROOMS: GARAG$ STAI.I�S: ATT. DET.
� � 4 �� , � �7
�STIIrSATED CONSTRIICTION VALIIATION (eacluding land) : $ /
: hereby apply for a building permit and I acknowledge that the iaformation
.�bove is complete and accurate; that the work will be in conformance with the
;rdinances and codes of the City and with the State Building Code; that I
-:nderstand this is not a permit and work is not to start without a permit; and
:aat the work will be in ccordance wi the approved plan. .
1� ,_ `, P DATEs � 1I✓� l� i l ���
'�DPLICANT'S SIGNATURE: � �
^�
BIIIZDING REVIEW CHECR LIST
4
IIgC: �`� /` -3 CONSTRIICTION TYPE: �
Sq Footage $ Per Sq Ftg
Basement X =
lst Floor X =
.
2nd Floor X =
Garage X =
x =
TOTAL
$stimated Construction Value: $ 3 d.O-Od °0
,
Inspections Required: Work Requiring Separate Permits:
Site � �Plumbing Grading/Filling
Footing Mechanical Fire
�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
p�Wall Board (Masonry) Lawn Irrigation
�c Final (Mf g.) Other
Other WeI.� (State Permit)
Electrical (State Permit)
-----------------------------------------------------------------------------
�FMARK$ (IN HOIISE) :
-----------------------------------------------------------------------------
REVIEW BY OTHE�f2S: DATE:
Access: Existing New
Access Approval: Date BY=
-------------------------------------------------------------------
REHlARRS (TO BE NOTED ON PERMIT) :
`� CHECR OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY ' .
ADDR.ESS OR LEGAL: Z�v S�`f�Dy �'`f�'�� pID'
DESCRIPTION OF WORR: W�-sf'►'k���
-------------r --------------------
------_---------------
ZONING REVIL�7 BYs 1� 1 � DATE APPROVED
BIIII�DING REVIEW BY: DATB APPROVED: �] - �"S
---------- ------
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 SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------
ZONING CHECR LIST Zoning District:
Fire Department• Post Office• School District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Surve :
Proposed Setbacks :
Front (Lake Ria�ht Side:
Rear (Stree L f t Side:
Adjacent St tures : We land:
Building Height: D f. Hgt. eak H
Avg. Setback: Lot Co erage:
isting Prop sed
Hardcover: 0-75 '
75-250 '
250-500
500-1000
Hardcover Varia ce Require : Ye No Da e of Council A provaJ.:
Grading• Staff pproval Dat : By• Council Appr val. Date:
Septic: Staff prova]. Date: By'
Zoning File:# Reso u ion Q : Resolution ate:
;
RF.MARKS (in house) :
I
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��'< .=��r,..��~r�`..T C I�Y of ORO�
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� ;�-,e.��;�
;'�� �t � Post Office Box 6&•Crystal Bay,Minnesota 5a323•Municipal 4ffices
-U�_. .
! �
� ' a � • On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
��In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of
data , we would Iike to inform you that your request for a permit or
license fromri certain pr vate or onf dential e nf rmationmay require
you to furnis
You are notified that:
1. The information you furnish wil.l be used to determine your
qualification for the permit or license reques�ed.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Yaur ful.l name is required to process this application or
permit.
�N � - � ���''.�
First Middle Last
��L� C'����i��� -�tii'z-�-�
Address �
I '��' ,�^�IC. _ ��S
City tate Zip
�'� � �f � `�
Phone
I un rstand my r' ghts as sta'ted above.
\ ' � _
Si ature
BUILDING&ZONING-473•7357 • ADMINISTRATION&FINANCE-473-7358
• PCBL(C WORKS -473-7359
ASSESSI:VG
----� - r .
� � � t .
. SI3.04 RIGHTS OF SIIBJ'ECTS OF DATA '
gubdivision L TYP�
of dats. The rights of individuals on whom the data is e
stored or to be stored shall be ss set forth in this section.
S�d, 2. Information required
to be given in�vi�uaI- An.individual esked to
� ' su 1 private or confidential data concerning amwi�in the collec�ting stat gency, .
PP Y uested da
purpose and intended use of the req �b� whether he ma� refuse or from his
political subdivision, or statewide system; �own consequence arising
required to supply the requested date; (�) �Y �d (d) the identity of
� supplying or refusing to supply private or confidential detia;
other ersons or entities authorized by stste or federal lav+► to receive the dat8- T1�-
p when an individusl is asked to suQply investigative data,
requirement shall not apply
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mev �le�t tgz re�und insuuctions�nsteadhos
subdivision in.the individu8l income tax or �r��
on those orms. - - � --- � � .
II on request to a responsible
Subd. 3. � Acces; to data by in�viduaL P
euthority, an individusl shall be informed wheu�c h r vate oruconfidentiaLe Upon his
individuals; and whether it is clessified 8s p � P ublic data on
e to him and, if he desires, shell
further request, an individuel who is the subject of stored priva e or
individuels shall be shown the data withou�fan�y��g. �ter an individuel h�s been
6e informed of the content and meaning the data nesd not be �sclosed to
shown the private data and informed of its u���gcUon pursuant to this section is
him for six months thereafter unless a d�SP
' endin or additional data on the individu e h�ateQor pu�lic dataruponarequest by
� responsible authority shall provide copies of th p � require the
the individuel subject of the data. The respensible authorit may the
re uesting person to pay the aetual costs of makinB, certifying, and �°mP�g
Q yvith eny request
copies. 1mmediatelY, it pessible,
The responsible authority shall comQly ' of the date of the request,
made pursuant to this subdivision, or within five days
and le holideys, if immediate compliance is not
excluding Saturdays, SunasYs � with the
essible. If he cannot comply with the request �thin that time, he shall so inform the
P hsve en additional five ys within which to comply
individual, and maY �d Ie al holidays•
request, exeluding Saturdays, Sund�Ys g
te or complete. � ����. To
Subd. 4. Procefia'e �►hen da� � ublic o�p ivate data concerning hiTnself
contest the accuracy or completeness�of Pnotify in writing t�e �Ponsible authority
exercise this right, an indiNdual e��n� �e r��ible authority shall within 30
describing the nature of the disagr
days either. (a) correct the data found to be inae��ei°�u�g Tec pients namedt by
notify past recipients of inaccurate or incomP
the individuel; or (b) notify the individual ��du�,��em��fa�greem nt is
Data in dispute shall be disclosed only it th
• included with the disclosed data• � BPPQ�1ed pursuant to the �
' The determination of the responsible authority Lp�ntested cases.
provisions of the administrative procedure act relating
CITY OF ORONO CALLED IN v Dl i�I-q3 ,T�M,E,� �
INSPECTIAN NOTICE SCHEDULED l v-► �-�13 1 C� ' ��D@►->•
PERMIT NO. 5 COMPLETED �_ '
ADDRESS � t�G'�
OWNER � ' -e(� �� /1�l�r1 CONT�.IC,-�'�I\���r�
TELEPHONE NO. ��-'� � I I '3 r--�
� DESCRIPTION ,�y�ric�-G J�,
� 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVlCRADINGIFILLING
y 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORFJWETLANDS
O
Z 0 D. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINA 13 METER SET/TURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
� 07 UEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR T MEET YOU:_YES_NO
� COMMENTS: ? �'' �- K — C 7
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W� WORK SATISFACTORY:PROCEED �ROJECT COMPLETE
W CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContr r ite:
Inspector.
White Copyllnspector's 'e Canary CopylSite Notice
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