HomeMy WebLinkAbout1997-009245 - remodel PERMIT
, _ C�TY OF ORONO PERMIT TYPE: ;; ;; ,-: ,
27 0 Kelley Parkway- P.O. Box 66 ;,:i r:_j:-:;=y�"��� -
Crystal Bay, Minnesota 55323 Permit Number: � - _
(612) 473-7357 Date Issued: _ . - .
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: , _ ,,._..�. .
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FEE SUMMARY:
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� APPLICANT/PERMIT SIGNATURE ISSUED BY:SIGNATURE
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. ,, Total Fee: $ ���_3 7� Date Received:
Entered By: ���; Permit#: `�i�';�-� :�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan re�iew will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �� (��h���`1�^1 c�.,E �,j � ZIP: �$��(n
NAME OF OWNER: � � PHONE: (home) - ^ S
(work) 9
MAILING ADDRESS:�.3[X!S' (�i�'��h�. CITY: ' ' ZIP:,5.�3.��a
CONTRACTOR: PHONE: �,S.S--%J d U -- ��4
CONTACT PERSON: MOBILE/PAGER: � �— � ��. -- 3 �.O '
MAILING ADDRESS: , CITY: °�. � � ZIP: J(�3(�/
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZII':
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detain:����c�'�,�x.� . ,,c, ��,,,�s�t��c��
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ; �'��'C%�. (7��
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 permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: `����,2����
NOTE! Parade of Homes events �equire separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked ro supply private or confidendal data concerning himself
shall be informed of: (a)the purpose and inunded use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may nfuse or is legally required to supply the requested data;(c)any Irnown conseque�e arising from his supplying or
refusing to supply private or confidential data;and(d)the identiry of other persons or entides authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked w supply investigative data,pursuant to secrion 13.82, subdivision 5, to a law
enforcement o�cer.
The commissio�r of revernie mav nlace the nodce rewired under this subdivision in the individual income taz or orocertv tax refiund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an i�ividual shall be informed whether he is the
subject of stored dara 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 pubGc dara 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 thereafrer unless a dispute or action pursuant to this secaon is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public daha upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu of mul.ing,certifying,and compiling the copies.
The responsible authoriry shall 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.
ry
Subd.4. Pro�edure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or i�omplete and attempt to norify
past recipients of inaccurate or incomplete data,i�luding recipients named by the individual;or(b)notify the individual that he believes the dara
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is i�luded 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 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 supply data, but refusal may require that the City deny the permit 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. Your full name is required to process this application or permit.
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C� - State Zip Phone
I understand my ri ts as stated above.
Signatu
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• . CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ 3oy5 �o� 14✓L� �
PID:
DESCRIPTION OF WORK: JL�lv�,opLt.
ZONING REVIEW BY: ' DATE APPROVED: g - y • �i�
BUILDING REVIEW BY: DATE APPROVED: $ -Y�g 7
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓� No •
PLAN REVIEW Yes �- No SEWIIt CONNF,CTION
STATE SUR�HARGE Yes � No WATERCOrfNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Y;:s No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST zoning District:
Fire Depaztment: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): _ Right Side:
Reaz (Street): Left Side:
Adjacent Structures: Wetland:
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 Dis�ict:
Avg. Setback: Bluff Setback: Lot Coverage:
� Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
• 26
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BUII..DING REVIEW CHECK LIST
UBC: /Z- 3 CONSTRUCTION TYPE: �(/`�
• • Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
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Estimated Construction Value: $ 1�,�OU '
Inspections Required: Work Requiring Separate Permits:
Site oC Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
�Insulation (Masonry) Other
p� Wall Board (Mfg.) Well (State Permit)
oc Final Grading/Filling _�Electrical (State Permit)
Other
REMARI�.S (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMII�: �
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FIRE EXIT REQUI�CD �°� =W�; ,--o-�---���
24" MIN. CL.��",R W°I�7H a�s�rre �'-`-1-��_ ,.,..,,,.,....,.,_,. i�RM[F' NO. ._,.,..�,
24" MIN. CLE�1�2 HEIGH7 ? ��.;��.,�;� A� ����,���'��
5.7 SQ. F'f. MIN. OPENING ,�' .�,�rc�v�r3 N�ir�; �c����:a�tONS qS N01�EQ
„ NIAX. SILL HEIGHT �, � ����o s ���,7Fzciv�� — c����:;T � R�susM6r
'�� cnr�t!�erft�� ¢r: fnr yo�t inft.rr:�etks .A!I Wprk shait b!�
13'4 `'�?' ��=�z'�i�'� - w;t!t aSi ��:+,:?!�'�ksi:� ±;' ,:`�' +�i Z�Mdsf(t C't�63�F
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Add two(2)new
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D TE TIME
CITY OF ORONO CALLED IN U �� j7
INSPECTION NOTICE SCHEDULED �i/' %i� %i 3�>
PERMIT NO. COMPLETED /� i _ �1
ADDRESS - � �-% " � � . ���
OWNER � � CONTR. ��
TELEPHONE NO. �7 �"'� 7 c1���7
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� DESCRIPTION���Iz`�.��c�� ��ZrC-�
� Ot FQDIl I�G �/ 11 MECHANICAL RI 18 EXCAV/GRADWG/FIWNG
��02 FRAMING*' `/ �T� 13 MECHANICAL FINAL 19 LAI�SHORE/WETIANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Z 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
�` 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMO—FINAL_ � !�Gf_j 15 SEPTIC INSTALL. 22 FOLLOW-UP
=L�PLUMBWG RI -` �( �" 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� ,-10� BING FINAL 28 CEDAR S GLES 36 FOUNOATION REMOVAL
Q� OWNEA ONTRACTOR TO MEET YOU•_YES_NO
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W PROJECT COMPLETE
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O f l CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. ,- pHOTOTAKEN
INSPECTOR WILL RETUFN
❑STOP ORDER POSTEO.CALL INSPECTOR CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nex�inspection 24 hours in advance.473-73�J7
OwnerlContr _ n ite:
Inspector. �������-��
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White Copyllnspector's File Canary CopylSite Notice
DATE IW�
CITY OF ORONO CALLED IN D '/.S ' c3 i cS
INSPECTION NOTICE / SCHEOULED � � ��
PERMIT N0. � COMPLETED
ADDRESS - � � �
OWN ER CONTR.
TELEPHONE O. T 73" S7� �
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/�RADINQ/FIWNO
y 02 FRAMINO 13 MECHANICAL FINAL 19 LAI�SHORE/WETIANDS
9'iN5QG4Tlp 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UP O6 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
v 10 PLUMBINO FlNAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ` pHOTO TAKEN
INSPECTOR WIL.L RETURN
❑STOP ORDER POSTED.CALL INSPECTOR =CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-7357
OwnerlContra o si
Inspector. �
White Copyllnspector's File Canary Copy/Site Notice