HomeMy WebLinkAbout1996-008302 - add/remodel ,, PERMIT
�'�TY �F ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;t_l;;_;i T;.�ii
Crystal Bay, Minnesota 55323 Permit Number: �:;�a,y,.,iR�^.,
(612) 473-7357 Date Issued:
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SiTE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
, Total Fee: $�f l� ���� Date Received: :.����-`%�
Entered By: __'`� Pernut#: �'��L,��
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CITY OF ORONO - BUILDING PERMIT 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
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JOB SITE ADDRESS: .S� � 7 S�U'��L�fV� �� ZIP: S�-j��
NAME OF OWNER: /�',�-L'�. L�I��SC��I.-� PHONE: (home) `�?�—���Z�
(work) t-(�7/— 2�%�
MAILING ADDRESS: f L Sf�G.r'FL/�'✓� �L/1�CITY: S.�'/� Pl,�/I/7 Z�: _S�_S�c��/
CONTRACTOR: �f���L'�'✓ r`I�/�i�'S _/�?�l?r9' ���. PHONE: �7/���/�
CONTACTPERSON: /;aU�. Ll��'SG' MOBILE/PAGER: ;'Z3--l�c�U
MAILING ADDRESS: �%/G� ,S/���'s�(%"✓�-= l'�' CITY: S?`.�(,�'/� F�4�:'� ZIP: s`�".����
STATE LICENSE: # �v�tZy
,—
ARCHITECT/ENGINEER: 5��� PHONE:
MAILING ADDRESS: S'i7r'7� CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�� Land Alteration
PROPOSED WORK(describe in detai�: �'�� G�f��'i9G� �C%C��� /�'��Z� G,�t���
- -;G �4.��"tv�^-_�-L I '�5�,!'� C.i r v�'`%� �1.t1 /TCiS`,EA/ !'j�'�'ff S,�/BE�'"?�'FC".
�`,n-► N�vv rr�i�^✓�k��uy� f1�V'1,� L��%��.�.� � f�L[. i�.�21� 'Tc� c.� R� s r�i� �v�E�.
STORIES: � P��- SQ. FEET OF EACH FLOOR: /'d�G'C' �'�J�'`�
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /��'�/����'
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 Ciry and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE: �-t_ DATE: C�������
NOTE! Parade Qf Homes events require separate pernzit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
� 4 �
Sec.13.04 RIGHTS OF S[JB.TECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stoced shall be as set forth in tlus secdon.
Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidendal data conceining himself shall
be informed of: (a)the pucpose and in[ended use of the�equested data wichin the collecdng State agency,polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally rcquired co supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidenaat data;and(d)the idenaty of other persons or enaaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesagadve data, 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 procerev tax refund
insavcrions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible aurhoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public,private or co�dendal. Upon his further request,an individual who is the subject
of stored private or public dara on individuais shall be shown the data wichout any charge to him and,-if he desires, shall be informed of the concent ,I
and meaning of that da[a. After an individual has been shown the private da[a and informed of its meaniag,the data need not be disclosed w him for i
six months thereafcer unless a dispute or action punuanc to this secuon is pending or addiaona!data on the individual has been collected or created. I
The responsibie authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible au[horiry
may require the requesting person to pay the actual coscs of making,cerdfying,and compiling the copies.
The responsible authoriry shall comply immediacely,if possible, wich 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 requesc
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 is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To ezercise this right,an individual shall noafy in writing the rosponsible authority describing the nature of the disagreemenc.
The responsible authority shall wichin 30 days ei[her: (a)correct[he data found to be inaccurau or incomplete and attempt to notify past recipienu of
inaccurate or incomplete data, including recipiena named by the individual;or(b)notify the individual that he believes the data to be correct. Data
in dispuu shall be disclosed only if the individual's statement of disagreemenc is included with the disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 permit or license from the City of Orono or any of its departments may require you to fumish certain private or
confidential information.
You aze notified that:
1. The information you fumish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shazed 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.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Y ur full name is required to process this application or permit.
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Address
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C��, State Z►p Phone
I underst my ri ts as tated above.
Signature
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� � � CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 g7� SNc,�L„vL, �(Z
PID:
DESCRIPTION OF WORK: �'?�vv� ,��eL. — S"iv-�yt�� p ti.c�
---------------:--------------------
ZONING REVIEW BY: f l� DATE APPROVED•
BUILDING REVIEW BY: DATE APPROVED: 8 • 2 3-7�
-----------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes No c/ SEWER CONNECTION
STATE SUR�HARG� Yes c/ No WATERCONNECTION
INVESTIGA'I'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District:
Fire Department: Post Office: c ool District:
,
Lot Area: S . . Acres Width Depth
Survey Sub 'tte : Yes No Date Surve :
Proposed Set ac •
Fro (L ):_ Right S de:
Rear(Street : Left Si e:
Adja ent Stru tures: Wetland:
Building Hei t: Def. gt. Peak H .
Lot Coverage:
Grading: Staf Approval te: By• Council Appr val Date:
Septic: Staff pproval Date. B :
Zoning File: Reso ution: # Resolution Date:
Shoreland Dist ict:
Avg. etback: Blu Setbac : Lot Covera :
Exi ing Proposed
Hazdc ver: 0-75'
75-250'
250-500'
500-1000'
Hazd ver Vaziance Required: Yes No Date of Council Approval:
REMARKS(in house):
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BUII..DING REVIEW CHECK LIST
iTBC: 1�,- 3 CONSTRUCTION TYPE: v�
Sq Footage $ Per Sq Ftg
Basement a =
1 st Floor x =
2nd Floor x =
Gazage x =
R =
TOTAL
Estimated Construction Value: $ (0 .C�Oo�`'
Inspections Required: Work Requiring Separate Permits:
Site .�Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
_�D Framing Fireplace Lawn Irrigation
_� Insulation (Masonry) Other
�Wall Board (Mfg.) Well (State Permit)
��� Grading/Filling �, Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
REMARKS(TO BE NOTED ON PERMIT): �
27
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE �?� U��'`SCHEDULED � c =�C>
PERMIT N0. coMP� ED _s�` �
ADDRESS <--� � � ���c� (���;�,,n I")
OWNER '�`'����- CONTR.
TELEPHONE NO.
� DESCRIPTION 16�1��t c�� �'E,{�,(� ���
� 01 FOOTINCi 11 MECHANICAL RI 18IXCAV/QRADINQJFIWNQ
y 02 INCi 13 MECHANICAL FINAL 19 LAI�SHORE/WETIANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SfTE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UO 06 PROGRESS
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEM�FINAL 75 SEPTIC INSTALL. 22 FOLLOW-UP
i 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PEflMANENT
❑CORRECT UNSAFE CONDITION WITH�N HOURS. r pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ext inspection 24 hours in advance.473-7357
Ownerl r site:
Inspector. - .
White Copylinspeclor's ile Canary Copy/Site Notice
L DATE TIME�
CITY OF ORONO CALLED IN v� �' �� a�
INSPECTION NOTICE SCHEDULED S�?i-�l7 % !�Q/f'i
PERMIT NO. -y�C J' COMPLETED
ADDRESS �
OWNE CONTR.
TELEPHONE N0. _ �� 1 - c�- �/(o �-� 7oZ. -�COI�
� DESCRIPTION �,
� 01 FOOTING 11 ECHANICA I 18 EXCAV/GRADING/FIWNG
�Q 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORElWETLANDS
� 031NSULATION 24/25 WOOD BURNER/FIREPLACE �3q 7qE VAL
Q04 WALL BD. 12 WATER HOOK-UP ,.� 17$�TE�_�SPECT�p�
= OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
�' 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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0 BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ,,- pHOTO TAKEN
INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContractor ite
Inspector. .i
White Copyllnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN �` /��i •'
INSPECTION NOTICE �� 3 SCHEDULED �, /_3 ,,� / %��
PERMIT NO. � COMPLETED � ��
ADDRESS ��_%:��"� �r�L.,� I�.<<-_����i
OWNER:�� _. �� CONTR.�1rC �/
TELEPHONE NO. 7� 3 --/(i'�L
� DESCRIPTION �"�_!��:�t 4'
� 01 FOOTING 11 MECHANICAL RI 16 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORENVETLANDS
p 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE FEMOVAL
Q04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
�� �I 14 SEWER HOOK-UP 06 PROGRESS
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� 07 DEN10—SITE 27 SEPTIC MAINT. 21 COMPLAINT
W 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= f�P UMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 0 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. — pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
'- CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the xt inspection 24 hours in advance.473-7357
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OwnerlContr r o it
Inspector. � � `� �
White Copyllnspector's File Canary CopylSite Notice
OATE TIME
CITY OF ORONO CALLED IN �-��� �17
INSPECTION NOTICE SCHEDULED � l�' �.. -��
PERMIT NO. 3�'�' COMPLETED �'�..
ADDRESS d 77 � /�/`t�
OWNER CONTR. —
TELEPHONENO. � 7� l�a �
� DESCRIPTION
� 01 FOOTINf3 it MECHANICALRI 18IXCAV/aRADIN(3lFIWNO
� 02 FRAMINO 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
� NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 12 WATER Fi00K-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UP O6 PROQ�RESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMQ-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBIN(i RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINQ FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. r- pHOTO TAKEN
INSPECTOR WILL RETURN `"
❑STOP OROER POSTEO.CALL INSPECTOR '- CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins tion 24 hours in advance.473-7357
OwnerlContractor �site:
,
Inspector. � t'
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White Capyllnspeetor's File Canary Copy/Sife Notice