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PERI!
CITY OF ORONO PERMIT TYPE: �;;F} � ;�,ra��
1335 Brown Rd.South•P.O.BOX 66 Permit Number: s j��'����-
Crystal Bay, Minnesota 55323 Date Issued:
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(612)473-7357
SITE ADDRESS:
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APPLICANT/PERMITEESIGNATURE ISSUED ' JRE
CITY OF URONO - BQILDING PffitMIT APPLICATION
Total Fee: $ ��' � � Date Received:
Date Approved:
Permit#: �-3 Project#:
Building Permit Application Requirements:
1. Building permit application - to be filled out completely and signed
2 . 2 sets of construction plans to include the following:
a) Floor plans ;
b) Footing and foundation plan;
c) Elevations (of all sides) ;
d) Wall sections and cross sections;
e) Details - stairs and any special connections.
3. Certificate of survey with location of existing and proposed
structures including hardcover calculations and grading and drainage
plans as required.
4. Energy calculations - form provided.
5 . Septic report and design if required.
ABOVE INFORMATION MDST B$ SIIBMITTSD IN FQLL BEP'ORB PLAN REVIEW WILL BE STARTED
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: �$�%: ����'(�/C.�i�L�l�G- ��� V��`- ZIP: �����
PROPERTY IDENTIFICATION NO. : 2D '- 1 ��- �� Z� Dc�v�
C�7t�-�.�� (work) �Y�S-�y��
NAME OF OWNER: � [.� �/I�i(,,��Gl,�'� PHONE: (home)
1�AILING ADDRESS: � i CITY: ZIP: ����
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CONTRACTOR: PHONE: �7�-��.�,�
MAILING ADDRESS: ,j,�/.,5� ��� 1�GV CITY: � ZIP: �.��31
ARCHITECT: /�-'/� PHONE: �i'v�,,�-
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MAILING ADDRESS: CITY: ` ZIP: �--
TYPE OF WORR: New Addition Accessory tructure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSBD USE (describe in detail) : ��ij2�9',/,(11 �
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STORI$S: SQ. F$ET OF $ACH FLOOR:
NO. OF B�ROOMS: GARAGE STALLS: ATT. DET.
,
$STIMATED CONSTRDCTION VALIIATION (excluding land) : $ ��f1�' "
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 2
understand this is not a permit and work is not to start without a permit; and
that the work will be in acco ance with the a proved p1an.
APPLICANT'S SIGNATURE: l/` DATE: � 2�-�g�
(Please f 1 o he reverse side of this form)
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���`,�a s���ft'�,/' $�'� Post Office Box 66�Crystal Bay,Minnesota 55323•Municipal Offices
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�;�, , On the North Shore of Lake Minn.etonka
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DATA_ PRIVACY ADVI$ORY
In accordance with M.S. 15.165, "Rights of subjects of data", we
wou2d 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 license requested.
2. You may refuse to supp3y data, but refusal may require that
the City deny the permit or license.
3. The information may be shared with other local , state or
federa3 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.
5. You have certain rights under M.S. 15.165 to review private
data on yourse].f .
6. Your full name, and date of birth are required to process
this application or permit.
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First � Mid Last
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Ci - - - - - ._ _State - Zip
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Phone
I understand my rights as stated above.
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Signature
BUILDlNG&ZONING—473-7357 • ADMINISTRATION&F1NA[VCE—473-7358 • PCJBLIC WORKS—473-7359
A3SESS[NG
i
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE/ /�3 SCHEDULED
PERMIT NO. � COMPLETED '�� � �
ADDRESS ��� �rc� I � v�� ,o���
OWNER CONTR.
TELEPHONE NO. �
�OOTINCa ❑ PLUMBING RI ❑ SITE INSPECTION �Fp
FRAMING ❑ PLUMBING FINAL ❑ EXCAV./GRADING/FILLING Y`'�
�' (�O INSULATION ❑ MECHANICAL ❑ LAKESHORE/WETLANDS
� ❑ WALL BD. ❑ WATER HOOKUP O LICENSING
� ❑ FINAL O METER SET/TURN ON ❑ COMPLAINT
� ❑ PROGRESS ❑ SEWER HOOKUP � fOLLOW-UP
y O DEMOL. O SEPTIC INSTALL. ❑ SEPTIC FINAL
Q O FIRE PREV. ❑ SEPTIC MAINT. ❑ FIREP�ACE/WOOD BURNER
Z ❑ WELL TEST PUMP ❑
Q COMMENTS:
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V �CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING
� CORRECT UNSAFE CONDITION WITHIN HOURS.INSPECTOR WII.L RETURN.
❑ STOP ORDER POSTED.CALL INSPECTOR.
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
�
Owner/ r. s te
Inspec r � "��� � 413'7351
White/Inspector's File Canary/Site Notice
C • DATE TIME
CITY OF ORONO CALLEO IN '�� �o�.p-�
INSPECTION NOTICE SCHEDULED //- �1-s� o a.�3a .
PERMIT NO. � �� � COMPLETED �g� � � ��
ADDRESS �� /� �
OWNER CONTR.
TELEPHONE NO. �'j'SS,' ' / 3 (�
❑ FOOTING ❑ PLUMBING RI ❑ SITE INSPECTION
O FRAMING ❑ PLUMBING FINAL ❑ EXCAV./GRADING/FILLING
� ❑ INSULATION ❑ MECHANICAL ❑ LAKESHORE/WETLANDS
� ❑ WALL BD. O WATER HOOKUP O LICENSING
W �FINAL ❑ METER SET/TURN ON ❑ COMPLAINT
Q PROGRESS ❑ SEWER HOOKUP � FOLLOW-UP
y ❑ DEMOL ❑ SEPTIC INSTALL. ❑ SEPTIC FINAL
Q O FIRE PREV. � SEPTIC MAINT. 0 FIFiEPLACE/WOOD BURNER
Z ❑ WELL TEST PUMP ❑
i COMMENTS:
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W ORK SATISFACTORY:PROCEED O PHOTO TAKEN
� ❑ CORRECT WORK 8 PROCEED
❑ CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING
� CORRECT UNSAFE CONDITION WITHIN HOURS.INSPECTOR WILL RETUfiN.
O STOP ORDEFi POSTED.CALL INSPECTOR.
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
Owner/Contr on site
I nspector � 413'7351
Whitellnspector's File Canary/Site Notice