HomeMy WebLinkAbout1997-008936 - remodel PERMIT '
. CITY`OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 'z-_� �'>
Crystal Bay, Minnesota 55323 Permit Number: ;_�i_};��'=:�.�,:��
(612)473-7357 Date Issued: _-- . _ _ . -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APP I V RE ISSUED BY:SIGNATURE
' Total Fee: $ T�� `- ' Date Received: f� -. ":� i� %
Entered By: Permit#: =�'�% ? -
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �� �,� S �ID ��O�-��.ZIP: 5����
����� �
NAME OF OWNER: l//��-v' � �/� rSG� PHONE: (home)C�7..z 'c���U
(work) �/7 �— �7�UU
MAILING ADDRESS: `�3 8.1, �v t�����c ��, CITY: j/1�c��u H-r ZIP: S'S�'
CONTRACTOR: S-z � � PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: '� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Additi Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSEI�WORK(d scribe in detain: /�-- /Z �� c�' � ��/ l.�r�i��v�
-, y r� - � .�--� 2 L
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
G C.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ s'O�"
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 pernut and work is not to start without a
permit; and that the work will be in accorda ith pproved plan.
APPLICANT'S SIGNATURE: 'f �� � DAT'E: �~ �- '
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.
Sec.13.04 RIGHTS OF S[JBJECTS OF D�TA
Subd. 1. Type of data. The righrs of individual on whom che data is stored or to be stored shall be as set focth in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data concerning himself shall
be informed of: (a)the purpose and intended use of che requesced data within the collecting�tate agency,polidcal subdivision,or sratewide system;
(b)whethet he may refuse o'r is legally required to supply the requested data;(c)any lrnown consequence arising from his supplyiag or refusing to suppiy
privace or confidenaal data;and(d)the idenary of ocher persons or enudes aurhorized by state or federal law to receive the data. This requiremenc shall
not apply when an individuai is asked to supply invesd¢adve dara,pursuant to secdon 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or aropem tax refund
instrucdons ins[ead of on[hose forms.
Subd.3. Access to data by individuai. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data without any charge to him and;if he desires,shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuanc to this secrion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the accual costs of making,certifying,and compiling the copies.
The responsible authority shail comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data ic not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this ri¢ht,an individual shall noafy in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccucate or incomplete and attempt to nodfy past recipienu of
inaccurate or incompiete data, including recipients named by rhe individual;or(b)nodfy the individual tha[he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination 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 pemut or license from the Ciry 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 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 permit or license.
3, The information may be shared 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.
g, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(, Your full name is required to rocess this application or permit.
, (��/ � SG
iddle � �j.�st
First � �O � � �L
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Ad�� c,� U 1/�G�� s"�3 r� �7�- ��v��
Clty State Zip Phone
I understand n hts state ab ve -
Signature
, ' CHECK OFF LIST FOR ISSUANCE OF PERiI�IITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: .�3�� �,'t-��^,�:2:,21 NL- C)�'`
PID:
DESCRIP'I'ION OF WORK: T.,t��t-(=�c�:` P,k('4-t-�r�a.,,=�
ZONING REVIEW BY: �U 1� DAT'E APPROVED:
BUILDING REVIEW BY: �,!�,;(� �,,` DATE APPROVED: y-�;� �;�l
-------------------------------------——�-----------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �.–� No
PLAN REVIEW Yes No � SEWER CONNECITON
STATE S UR�HARG� Yes -�'` No WATER CONNECTION
INVESTIGAZ'ION-FEE Yes No PARK FEE
SAC Y�s No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZO�TIlVG CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
A`.�
I�
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland Dist:ict:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
� 250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
� 26
BUII.DING REVIEW CHECK LIST
UBC: t� CONSTRUCTION TYPE: Y'ti
Sq Footage � Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ �:�•��=
Inspections Required: �Vork Requiring Separate Permits:
Site . Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
C' Franung Fireplace Lawn Irrigation
Insulation (Masonry) Other
jE Wall Board (Mfg.) Well (State Permit)
� Final Grading/Filling � Electrical (State Pemut)
Other
REMARKS (I�i 1 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:
27
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DATE TIME
CITY OF ORONO CALLED IN �v' " `�-�17 ' �
INSPECTION NOTICE SCHEDULED cS-��/ =3 �r�,
PERMIT NO. OMPLETED � �
-� ,
ADDRESS
OWNER CONTR.
TELEPHONE NO. �7�"' 7�D�
� DESCRIPTION
� 01� F�OOTIN-G� 11 MECHANICAL RI 18 D(CAV/(iRADINC�/FIWNO
�Q�02�FRAMINC3 13 MECHANICAL FINAL 19 LAI�SHOREMIETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UP O6 PRO(3RESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
�Q 07 DEMo--FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBINO RI 23 SEPTIC FlNAL 35 HARD COVER REMOVAL
� 10 PLUMBINO FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTHACTOR TO MEET YOU:_YES_NO
� COMMENT
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�d C WORK SATISFACTORY:PROCEED
-: PROJECTCOMPLETE
W C' CORRECT WORK 8 PROCEED ` ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL REfURN
O STOP ORDER POSTED.CALL INSPECTOR '^CITATION ISSUED
❑INSPECTION qEQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContra
Inspector.
White Copylinspector's File Canary Copy/Site Notice