HomeMy WebLinkAbout1994-005927 - interior remodel PERIl�IIT .
C�Y OF ORONO PERMIT TYPE:
r 2750 Kelley Parkway • P.O. Box 815 �;�_'I�_f i I���i��
Orono, Minnesota 55356-0815 Permit Number: -
Date Issued: ����"�i`�'`�
(612) 473-7357 i�7:;'!`:�:=;/'��ii
SITE ADDRESS:
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CONTRACTOR: OWNER: -- E-t�_:��,s. ; �,ti-;�. --
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APPLICANT/PERMITEE SI ATURE ISSUED BY:SIGNATURE .G-�,
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CITY OF ORONO - BOILDING PERMIT APPLICATION
Total Fee- $ `%� �4 ` Date Received:�- � +� �� �
Date Approved:
Entered By: ' , "'!1 _
Permit�: �'
AT•T• INFORMATION MIIST BE SDBMITT� IN FIILI� BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
TSE APPLICANT IS: (circle one) OWNER or CONTRACTOR
-� —� ��..
JOB SITE ADDRSSS: �`���L,.� �hP`��` �'-' �; ;;'j _ �s,�Y ZIP: � j -� �7i
(work) �l T��5�� �
s� oF owNEx: �iC h�l?�� (,�� � ��p�'��i,�jV�S� P$orrE: (home) �I�''Z�-5 �,
MAILING ADDRESS:,���� �-bi�V��I�'J � �1�' CITY:��ij'�1��iYr� ���ZIP: `.����Z�
CONTRACTOR: ����'�7 �' PHONE:
MAIZING ADDRESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: �i�!'�J � PHONE:
�iAILING ADDR.$SS: CITY: ZIP:
�I�ME: RSGISTRATION �
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration � Renovate Land Alteration
/ / � ,.
PROPOSED WORR (describe in detail) : ���i��l�'1 C' � ����'/` � �- /—` ��` � � �
�� l:f�� 'r c� D�"��L � �-1 r� -
STORIES: �c��' SQ. FEBT OF EACH FLOOR: �`�� �
NO. OF BBDROOMS: � ((,'�j C-�ARAGB STAI.LS: ATT. DET.
�/ � '
�STIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ ���y�-�LJ �' ���
i hereby apply for a building permit and I acknowledge that the information
;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
�inderstand this is not a permit and work is not to start without a permit; and
;nat the work wiI l be i a�co�ance with the approved p an.
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'.PPLICANT'S SIGNATDRE / � - �'�;L � - y2L � �t ti.� DATE: � ._ _ �
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�� CITY of ORONO
Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices
•
� - � � 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 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 permit or Iicense requested.
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 priva��
data on yourself.
6. Y�ur ful.I name is required to process this appl.icatian or
permit.
-%
�'��� '� l•G� . �,) � �C��-'y��;� i, !. '
First iddle Last
L��3� ��� �L� �� �'"
Address
--�',,
� f ^ //" / �'� �-' -5 ,�
Ci �y State Zip
. __ �-�`^' /__ 7 � `'��
= �-
Phone
I unde and"my rights �.s s�.at`d abov .
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`,
S ' gnature i� � '
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BUILD[NG&ZONING—473-7357 • ADMINISTRATION�&.FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
� .. . ,
513.04 RIGflTS OF SIIB�F•CT5 OF DATA � .
'vision L T�ipe oi ��- The rights of individuels on whom the data is
Subdi
stored or to be stored shell be es set forth in this section.
g�d. Z. Information re9uired
to be given indi���" An.individusl asked to
" data within the ccllecting state agency,
� su 1 private or confidentiel data concarning himself shall be informed of: (a the
PP Y uested
purpose and intended use of the req tem; (b) whether he may refuse or is legally
pclitical subdivision, or statewide sys . �oWn consequence arising from his
required to supply the requested dats, (c) �y
su 1 in or refusing to supply private or confi federal la w o receive the data.1tThis-
PP Y g state or
other penons or entities suthorized by 1 investigative date,
requirement shall not apply when an indt�via1a en orcementuofflcer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individual income tax or ro ert tax re und uistructions instead o
on those orms. . - --- - � .
Ac� � �� � ����. Upon request to a responsible
Subd 3. �
authority, an individusl shall be informed whe blic hp=vateeor confidential.e IIpon his
individuels; and whether it is classified 8s p � ublic dats on
e to him and, if he desires, shall
further request, an individuel who is the subject of stored private or�du� � �en
individuels shall be shown the data witho of�hat data. After an indi
6e informed of the content and meaning t� �� need not be �isclosed tc
shown the private dats end informed of its uL��action pursuant to this section is
him for six months thereafter unless a �p n request by
� ending or additional data on the individuel h�8te or p blie datarupoeated. The
• P uire the
responsible authority sha]1 provide copies o t e P o�ible authority may req
the individual subject of the data. The r�P certifying, and compiling the
requesting person to pay the aetual costs of makinB,
copies. y ssible, with e�nY request
The responsibls authority sha]1 comply immediatel , if po
made pursuant to this subdivision, or within five days of the date of the request,
and le holideys, if immediate complianas is not
excluding Saturdays, SundaYs � with the
ossible. If he cannot comply with the request within that time, he shall so inform the
individual,
and may heve an additional five daS'S Within which to comply
request, excluding Saturdays, 3ur►daYs and legal holidays•
d�e when data is not acc�ate or complete. An ind�ms�. To
Subd. 4. P� rivate data concerning
contest the accuracy or completeness�of public o ln �i� the respensible authority
exercise this right, an individuel shall notify �ible authority shall within 30
describing the nature of the disagreemenL The respe lete and attempt to
days either: (a) correct the data found to be inae��aei°�udingrecipients named by
notify past recipients of inaccurate or incomP
' the individuel; or (b) notify the individual that he believes the dat8 to �ement is
Data in dispute shall be disclosed only if the individual's statement of �8� t to the
• included with the diselosed data. � 8ppe�ed pursuan
' The determination of the responsible authority to contested cases•
provisians of the administrative procedure act relating
" ' ' CHECK OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3�`'(O S�'�C.�N�: �(Z. PID:
DESCRIPTION OF WORR: ,2-C-7'IiVO iOGZ- ^ l/U TL'��' ��� �''�- S��'�'�
-----------------------
ZONING REVIEW BY: N��" DATE APPROVED:
BIIILDING REVIEW BY: � DAT$ APPROVED: j.��� y
------------------- ---
FEES TO BE CHARGED: Misc. Fees Ca7�culated By:
PERMIT Yes " No
PLAN REVIEW Yes �o SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No—�� PARK FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTxER (specify)
---------------------------------------
ZONING CHECR LIST Zoning District: _
Fire Department: Post Office: Scho istrict:
Lot Area: Width: Depth:
Survey Submi ted: Yes No Date of urvey:
Proposed Set cks:
Front ( ke) : Right ide:
Rear (S r et) : Left ide:
Adjacen tructures: Wetla d:
Building Hei ht. Def . Hgt. Pe k Hgt.
Avg. Setbac : Lot Cove age:
Existing Propo d
Hardcover: -75 '
75 250 '
250 500 `
500 1000 '
Hardcover ariance R quire : Y s N Date of Council A rova�:
Grading: S aff Approv 1 D te: By: Council Appro al Date:
Septic: St ff Approval te: BY=
Zoning Fi e:# Resol tion # : Resolution D te:
REMARRS (in house) :
BQILDING REVIEW CHECR LIST • ., . .
IIgC: �- Z CONSTRIICTION TYPE: �� .
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL
$stimated Construction Val.ue: $ 3, W� e�
Inspections Rem,;red: Work Requiring Separate Permits:
Site � �Plumbing Grading/Fil.ling
Footing �Mechanical Fire
�Framing Septic Water Connection
Insu�ation Fireplace Sewer Connection
Wal� Board (Masonry) Lawn Irrigation
inal (Mfg.) Other
Other Wel.l (State Permit)
_�ElectricaZ (State Permit)
----------------------------------------------------
REMARKS (IN HOIISE) :
-------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
----------------------------------
---------------�----------------�
�LF1�IARKS (TO BE NOTED ON PERMIT) : V/V�Oe"CL:-'fL-1 w�+t.� n c�-".��` �"` `$ ��''"e
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13 METER SET/TURN ON 17 SITE INSPECTION
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White Copyllnspector's File Canary CopylSite Notice
DATE TIME
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V BEFORECOVERING PERMANENT
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Call for the n xt inspection 24 hours in advance.473-7357
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White Copyllnspector's Fil Canary CopylSite Notice