HomeMy WebLinkAbout1993-005403 - door relocation � PEI�MIT �
'� � CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 �,E 1 I�[:i;�si�
Orono, Minnesota 55356-0815 Permit Number: _
Date Issued: t�i;��.i;:;
(612) 473-7357 t 3;:,i t:ii�..,`'.�:�:
SITE ADDRESS:
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DESCRIPTION:
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APPLICA /PERMITEE SIGNATURE ISSUED BY:SIGNATURE �'—<i •
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. . CITY OF ORONO - BIIILDING PERMIT APPLICATION
To�aI =ee: S Date P.eceived:
Date P.�Droved:
Entered By: � /'�� `��: .
Pe�it�: '
AT•T• INFORMATION MIIST B$ SIIBMIT'�� IN FIILL B�FORE PI.AN REVIEW WII�L B$ STAR�ED
(See Check-off List Enclosed)
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T� APPLICANT IS: (circle one) OWNER or CONTRACTOR
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JOB SITE ADDRSSS: ' ; �` � �/iC/`t���+r %i",' ��, r !-G�f., lf,', ZIP:
(work)�>,�`_ "�';�
*7'�i�: OF OWNER: �d��� �"�'�a!"/�/�C� L-w� «'tZ G 6��t�'r<'± PHONE: (home) `{��- "` L�G��
:�iAILING ADDRESS: �%`�f� f�Cv[��ny %�, CITY:��d L ct�l� ZIP:
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�ON'Z'RI�C'1`OR: '�J%,��1 �!;'C ' �"' �;/���' L.!"!,'��h. ���; � �i�i';, �' JPHONE:
'3AII�ING ADDR.ESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: PHONE:
MAIZING ADDRBSS: CITY: ZIP:
NAM�: RSGISTRATION 4
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSF.D WORR (describe in detail) : �'�L�l/�'/�� l�.�'"�% � /�'/�'�r
:.TORZES: SQ. FEBT OF EACH FZOOF2 r
:?�t7. OF B$DROOMS: G�GE STI�LLS s ATT. DET.
�STIHATED CONSTRIICTION VALUATION (eaclnding land) s $ % ��� • ��%�
= hereby apply for a building permit and I ackaowledge 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
�derstand this is not a permit and work is not to start without a permit; and
:at the work will be in accordance with the approved plan. .
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��PLICANT'S SI6NATQRE: �'�7 ���� DATE: ,�
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,.,.,;.;, , 6:�-��' Post Office Box 66•Crystal Bay,Minnesota Sa323•Municipal Offices
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=�`�' �' On the North Shore of Lake Minnetonka
' � � A �;.,
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
license fro Sri certain pr�ate or conf dentia le nf rmationmay require
you to furni
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 license.
3. The information may be shared with other �ocal , 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. Your full name is required to process this application or
permit.
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Fir Middle Last
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Address
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City State Zlp
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Phone
I understand my rights as stated above.
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Signy�- ure �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—�73-7358
• PUBLIC WORKS—473-7359
ASSESSIN G
_------— - �
... . ,
� L .. •
. SI3.04 �G� �F ��� OF DATA '
gubdivision L TYPe
of data. The rights of individu$ls on whom the data is e
stored or to be stored shall be as set forth in this section.
� . Subd. 2. Information required to be given individusl. An.individual esked to
- ' 1 rivate or confidentiel data concerning �R15�n the collec�ting stat agency, .
suPP Y P
purpose and intended use of the requested �t whether he may refuse or from his
political subdivision, or statewide system; �oWn consequence arising
required to supply the requested dat8; (c) a�Y �d (d) the identity of
� supplying or refusing to supply private or confidentiel dais;
other persons or entities authorized by state or�e�kedltc s PP1Yein�th g�e �a a
requirement shall not apply when an mdividual
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav olacL tax re�und inst�uctions�nsteadh°S
subdivision in the individual income tax or pr��er
on those orms. . - � -— � - " .
Subd. 3• �
Access to data by in�vid�al- UPon request to a responsible
euthority, an individuel shall be informed wheu�c hp=vate orlconfidential.e Pon �
individuals; and whether it is classified � P ect of stored private or public data on
further request, an individual who is the subj e ta �m �d� � he, desires, shall
individuals shall be shown the data withou�fen�y ��8. �ter an in�yl�u� �s be�n
6e informed af Lhe content and meaning the dats need not be c�isclosed to
shown the private dats and informed of its m�e�a��on purs�►t to this section is .
him for six months thereafter unless a d�SP �
' endin or additional data on the individuel h�ateQor public dataruponarequest by
• P g rovide copies of the p may require the
responsible authority shall p The respcnsible authority
the individuel subjeet of the data• certifying, and comp�g the
requesting person to pay the actual cosLs of makinB,
copies. it ssible, with any request
The respensible authority shall comcly immediatelyo f � �te of the request,
made pursuant to this subdivision, or withir���'��mmediate comglianc� is not
excluding Saturdays, Sundays and legsl
ossible. If he eannot comply with the request �thin that time, he shall so ��th the
P have an additional five ys v+►ithin which to comply
individu8l, ar►d mey �d Ie al holidays•
request, excluding Saturdeys, SundaYs g lete. An indiv�� may
Subd. 4. Proced�e �►hen data ig not ac�te or comP ���. To
contest the accuracy or completeness�of public or private data concerning
notify in writing �e �P°��e authority
exercise this right, a� in��� �e�n� �e Tesponsible authority shall within 30
describing the nature of the disagr lete and attempt to
days either. (e) correct the data found to be inae��e���ng re�pients named by
notify past recipients of inaccurate er incomP
the individuel; or (b) notify the individual ��du�,�statementofadisa�m nt is
Data in disp i f t h e i n
ute s h e ll b e d i s c l o s e d o n l y �
• included with the diselosed data• � 8ppealed pursuant to the -
' The determination of the responsible au t hority ��Y�ntested cases•
provisions of the administrative procedure act relating
" , � " CHECR OFF Z,IST FOR ISSIIANCE OF PF.RM3TS
� FOR OFFICE USE ONI�Y
ADDRESS OR I�EGAL: PID'
DESCRIPTION OF WORR: '
-----------------� ---------------------
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ZONING REVIEW BY: DATE APPROVED:
BIIILDING REVIEW BY: DAZ'$ APPROVED: ��
-----------------
FEES TO BE CHARGF.D: Misc. Fees Calculated By:
PERMIT Yes� No
PLAN REVIEW Yes� No SEWER CONNECTION
STATE SURCHARGE Yes�( No WATER CONNECTION
INVESTIGATION FEE Yes No PARR FEE
SAC � Yes No� SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------------------------
ZONING CHECR LIST Zoning District:
Fire Department• Post Office: Schoo� District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake) : Right Side:
Rear (Street) : Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt-
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: By= Council Approval. Date:
Septic: Staff ApprovaJ. Date: By'
Zoning File-� _ Resol tion � • Resol.ution Date:
��N ��
REMAF2KS in house) : �f}v�- « v �-�
�
.
BIIILDING REVIEW CHECR LIST ' ♦ ' `' ,
4 . _
IIgC: � -�, �� CONSTRIICTION TYPE: � �
Sq Footage $ Per Sq Ftg
Basement X - .
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL
Estimated Construction Value: $ ;�V(��
Inspections Required: Work Requiring Separate Permits:
Site � Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
�Fina� (Mfg.) Other
Other Well (State Permit)
El.ectrical (State Permit)
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�F.MARKS (IN HOIISE) :
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REVIEW BY OTffi2S: DATE:
Access: Existing New
Access Approval.: Date BY=
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REI�iARRS (TO BE NOTED ON PERMIT) :
DATE � � To12M
CITY OF ORONO CALLED IN '
INSPECTION NOTICE j�i � SCHEDULED — — 3 •� /l�,
PERMIT NO. �" COMPLETED
ApDRESS ��_ � Z� ►.9 —
OWN E �t� CONTR. �v ('��Q
TELEPHONE NO. ��� —� ���
� DESCRIPTION ��_I 'fY��Ar�Z���T�' .�-�Ug�c,C� � )
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
� 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORENUETLANDS
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEEf YOU:_YES_NO
v�, COMMENTS:
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d ,,j�,��ORK SATISFACTORY:PROCEED
W� � ❑PROJECTCOMPLETE
W CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION' TEMPORARY
� BEFORECOVER�NG PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR C CITATION ISSUED
�INSPECTION REQUIRED.CALL TO AFRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContr r site:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice