HomeMy WebLinkAbout1995-007342 - master suite remodel P��RMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -,;; - -- -
Crystal Bay, Minnesota 55323 Permit Number: �� �_=�.''-:�`����
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(612) 473-7357 Date Issued: _ ``
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SITE ADDRESS:
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REMARKS: -
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FEE SUMMARY:
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CONTRACTOR: - : , _ .. _._. -.-_ -- OWNER:
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APPLIC /PE TEE SIGNATUFE ' ISSUED BY:SIGNATURE �
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; Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
�
� _ � 0 On the North Shore of Lake Minnetonka
DATA PRNACY 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
Iicense 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 wil.I be used to determine your
qualif ication f or the permit or I.icense requested.
2 . You may refuse to supply data, but refusal ina� require that
the City deny the perr,iit or Iicense.
3. The in�ormation may be shared with other local , state or
federal agencies to the extent necessary to process the permit or
license.
a_, If your reauested permit or 3.icense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review prica��
data on yourself.
E. Yaur fu'_I r.ame is required to process this applica�icn o�
permit.
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,� ,j � .�) � ` ��.4�i
First Middle La t
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Address
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• �%���� l �;"� �r---
ity State Zip
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Phone
I under n my rights as ted ab e.
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Signat e
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINAYCE —473-7358 • PUBLIC WORKS—473-7359
ASSES3ING
s _ CITY OF ORONO - BC}�DT'.'� pg�2M.IT APPLICATION
' /, �,� � Date Received: ;�(�%S
iotdl. r��: $ (L? l..F
DdtA AD�Z'CVEG� :
���e=ed B� � ,� ��` Permit tt : �`� r
AT.T• INFORMATION MIIST BS SIIBMSTTSD IN FL�I' B��� p�'N ��I�"� �� B$ STARTF.D
(See Check-ef� List Enclosed)
-------------------
---------------
.� Appr,=�7� I5: ( circle one) G��L� or CONTRACTOR
3'CB SITE ADDRSSS- I� ��� ���l��/1� L-16�� ���- ZIP:
(work)
�'�=�/t���� ,�. C PHONE: (home?
*7P.ML C� O�lNER: � l / � �.
� !' CITY• ��=-�-�rL.7� ZIP: �5�� �
?�.�II,ING ADDRESS: � Z Z� S�`�..��-�Lc1� �.,�
`,-..,--� ���� PHaNS: ��'-�z ...._'����,-�"
CONT?.ACTOKs ��v�'� L � - ,
ti
'. �� �"�CSG'���tc �'�t�c�: C�1fL�c..�� zzP: �� � ,
,s�IZING �iDDRESS: �C _
;TATE LI,..:�NSE: T ( � ��'� ��
�, �---�,a � �-�� PHoxF::_�7`7-� �Z � I
'r?2�HSTEC�'/ENGIrTEI'.R: �� —
�s DP.ESS: � � �C�i � �7�� ��' ,�__�ITY: 'L'[(,� -�Z� ZT�': �S�F� �
�L�NG � ``
RBGIS�RATION A
N�:
�pE OF WOR�: New
Addition Acc�ssorJ Struc�ure Move
�e�;o ReTnodel./Alteratio� Rer,ov�te Land Alteration
L� �(� `�=�-�S
PROPOSED WORR (describe in detail) : � ��y �����
�L-'L�-� �''�l-^� ?� ��Z'� ��-'i'\
FE4T OF �CH FI�QOR: �C-�_.,f ��- �—
STOR�:ES:�-_ S�• (r i
�i0. OF BEDROOM.S: � C�R1�� STALI,S: ATT. DET.
.-��
� C�` -
�STIMATED CONS3�ZIICTIQN VALIIATION (eacluding Ia.nd) : $
� hereby apply for a building permit and I acknowledge that the infor.nation
�cove is co:.iplete and accurate; that the work wi11 be in c�niormance wi��na�h�
ordinances and codes of the City and with the State Building CD erm;_t; and
understand this is not a permit and work is nat to start without a p
t�at the work will be in acc� ce wit e ap�oved pl.an. �.
� �
�._ppZZCANT' S SSGNATURE:
DATE:� �
CHECK OFF LIS'I` FVR ISSSE ONL 4F PERtiIITS
FOR OFFICE U
�DDRESS OR LEG:3L: i L2 S sl�'��`'�� `�2 PID
DESCRIPTIO\ OF j�'OR�: �72��'? �"r�°'� —�'Z'� s�, r�'
------------ --------- N(/,� DATE APPROVED:
ZO�Zti G RE«j`' B� : DATE APPROVED: S - i Z � 5�S'
BLILDL�G REj�tiy BY:
FEES TO BE C�L�RGED: l�fisc. Fees Calculated By:
Yes �' No
PERti1IT SEtiVER CO��CTIOi�t
PLAN RE`ZE�V Yes �' �ro
ST:�TE SURCH:�RGE Yes I No WATIIZ CO�.�Ni ECI'ION
�o pARK FEE
IVVESTIG:�TIOv FEE Z'zS S� �SPECTION
S�C Yes �to
OTHER (specify)
tiumber of S�C linits ____
-----------------------------
ZO\�G CHEC�i LIST Zoning District:
Shorel District :
Fire Deoart nt.
Posc O�ce: School istric :
Let Area: .n-
Acres � Width Depth
r �
f �io Date of Surv�y:
Survey Su' �tted: Yes � �
Proposed e ac!:s: J
/` ,' � I
! Ri�flt Side� �
F on �Lai:ej: �—
� �`
!
err ( cree:): �' Left Side�� j
Wdjaceai\Structures: �
I�,Vetland: �
, �I 1
Buildin� Height: be�. Hgt. � Peak H,t. a
i ��
Bluff Secback' Loc Covera�e. �
Avg. S��back: � �
i,
� Existin� ;� Pro -- '�
Hardcpver: 0-75�' I`
75-Z� 0' ��
250- 00' �
� �00-1 QO' E',
i '
Har�lcover Variance Re uired: Yes No Date oi Council Approval: ____
! gv; Council �pproval D te:
Gr�ding: Staif �pproval Dat : -
Se tic: Staif �pproval Da By:
Zo ' o Fi?e: ;�—
Resol ion: ' Resoiution Date:
RE�LARKS (in house):
26
' �
BL'II.,DL\G RE�`���' CHEC� LIST
L�c: �L - 3 covsrxucTTov �E: vN
Sq Foocase 5 Per Sq Ftg
Basement �
lst Floor �
2nd Floar c
Gara�e c
C -
TOT.�L
�
Estimated Construciion Value: � �� �6
Inspections Required: �Vorl: Requiring Separate Permits:
Si�e �_ Piumbin; Fire
Hardcover Removal � �fechanical �Vacer Connection
Foo�ins Sepcic Sewer Connection
�n� Framing Fireplace Lawn Irrigation
_e� Insulacion (�iasonry) Other
_� Wali Board (Mfg.) Well (Stace Permit)
� Final Grading/Filling � Electrical (State Permit)
Other
REI�IARKS (L�i HOL'SE):
- -----------------------
REVIEW BY OTHERS: DATE:
Access: Existing �e`h'
Access Approval: Date By: _
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RE��IARKS (TO BE NOTED ON PER1tiIIT):
27