HomeMy WebLinkAbout1995-007469 - deck �
PERMIT
CITY OF ORONO PERMIT TYPE:
� 2750 Kelley Parkway- P.O. Box 66 - '� `°
Permit Number: =�='`"�-'
Crystal Bay, Minnesota 55323 - - =-
(612)473-7357 Date Issued: _
SITE ADDRESS:
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DESCRIPTION:
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CONTRACTOR: __ .-,{,�,; ; , :,;-, :�.-.' . :...��::` _ OWNER:
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AP I ANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE .!�
Total Fee: S `,�'S/_`�1 DateReceived:
� Date Approved:
Entered By: _�� . Permitr: �J���>
CITY OF ORO�tO - BUII..DL'vG PERNIIT APPLIC�TION
:�LL INFOR'�iATION�IL'�ST BE SLBIIITTED �'�-L BEFORE PL�r REVIEW WILL
BE STAIZTED
------------ -------------------------------------------------------- ---�----r- ---------------------------
THE :�,PPLIC��iT IS: (circle onel O�VNER 0 CONTRACTOR
JOB SITE �DDRESS: �/ P .!�'�'^'y'e• ZIP' S�-� 3�'�
N�tiIE OF OW�tER: L-�/�l/�= /�lfL tl i S� PHONE: (home) ��7�-- 7���
(work)
l�1AILING ADDRESS: � l t��f S� �..�CITY: �.�,,�- ZIP: 3� S 3 5�.
CONTRACTOR: %rIC�s �r��rsri''i vLrir�ti t�'Frno�c�HO � �7S-��S'.�.
vIOBILE PHOi AGER: � ���-�`�>' j
v�AIL�IGADDRESS: /��/��/n�.✓E/f/1i/� ..�r/� 1" CITY: S'� . P/�r/� ZIP: SSiUd�
STATE LICENSE: # yS"7.5�
ARCHITECT/ENGTi�tEER: J�/'�►-r� c a�'.T'�?��ru�' PHONE: ZIP:
vIAILItii TGADDRESS: CITY:
v���: REGISTRATION n
TYPE OF WORK: Ne�v � �ddition Accessory Structure
Move Remodel/Alteration Land Alt�razion
PROPOSED`VORK(describe inde�ail): B�Y�p .���� �/'f'/rd� � �X�` w�T� �`��"�yT
//��i✓ 1�./frC�.vC�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOvIS: G�R?,GE ST�LLS: ATT. DET.
ESTlitiTATED CONSTRLTCTION V�I.U�TION(eYcluding land): � c1 p4G�• �O
I hereby apply for a buildin� permit and I acl:nowledge that the inforr�ation above is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City
and with the State Buildin� 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.
:�PPLICr��1T'S SIG�IATURE� 9 .��✓���� DATE: �G'�/�'- �!`
1VOTE! Parade of Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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r�. • � <<y Post Q�'e Box 66
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DAT� PRI'VACI' A.DVISORY
In accordance with �LS. 1�.0�, Subd. �, "Rivhts of subjects or daca". «'e would ii�e to
in�orm ��ou that your request tor a p�rmit or license irom the Ciry of O:ono or any oi its
deoanments may require ��ou to iurnisn cercain pri��a�e or conridential iniormation.
You are notified that:
1. The informa�ion ��ou furnish will be used to determine ��our qualiiication for the
permit or license requested.
?. You may refuse to suppl}� data, but rerusal may require that the Ciry der.y the
�ernit or �icense.
;. The information may be snared «�ith other local, state or i�deral aQencies to the
extent n�cessary to pr�::ess «1� pz;m�t oi license.
:�. If ��our requested permit or license requires Council action to approve, some
iniormation mav becam� puQlic.
�. You ha��� ce::ain ri�hts unde: �'I.S. 13.0? (see fo!lo�vinR paQ=) to revie�v private
data on ��ourself.
�, Your full name is required to process this appiication or permit.
PLE�SE PRL�'T
'�E6 i.v/c 1� G�C� D `�/t'lC�
First �1idd:e Last
/ � � � /r�i�✓i✓� 1�i¢t//� �/E �
��ddress
�T /a�gclG �"''��i/ .5 S�i 4!� ��7�—� "71' �
Cicv Scace Zip Phone
I understand my riQhts as scaced above.
�� , ��� �
Sian e
`" ��xo�rE-sr3-�s�• F�x-.��-osio
�.p,� RIGHTS OF SIIBJECTS OF DATA
gubdivision L TYPe
of data- The rights of individusls on whom the data is
stored or to be stored shall be as set forth in this section. An.individuel asked to
to be given in�vi�uaL
gubd, Z, Information r� ency,
� � within the collecting state ag
su 1 rivate or confidential data concernina 8mself shall be informed of: 8
te
PP Y P
purpose and intended use of the requested from his
litical subdivision, or statewide system; (b) whether he may refuse or is leg y
po known consequence arising
required to supply the requested dat8+ ��� �►y �d (d) the identity of
supplying or refusing to supply private or confidentiel data;
rsons or entities authorized by state or federal law to rice�vest gat ve d a
o t h e r p e 1 w he n a n i n d i v i d u a l i s a sked to supp y
requirement shall not app Y to a law enforcement of ficer.
pursuant to section 1 3.8 2, su b d i v i s i o n 5,
The
commissioner of revenue ma lace taX re°und i�tructions�nste8ah°s
subdivision in the individual income tax or ro ert
on those orms. � - �
Subd. 3. Access tc �ats b9
����, IIpon request to a responsible
orit an individual shall be informed whet�c h r�ateeor confidential-e UPon his
auth y� fied as pub ► F ublic dats on
individuals; and whether it is claul � he desires, shell
further request, an individusl who is the subjecc�ge to himri�� or p
�ndiyidueis shall be shown the data withou�tf aLnh t �ta. Af ter an individuel has been
�e informed of the content and mea�°g t� �ta need not be �isclosed to
shown the private data and informed of its u���8ction pursuant to this sectioT�Q
him for six months thereafter unless a �P n request by
' �n or additional data on the individual h� a eeor p blic dataruQoeated.
. pen g rovide copies of the p require the
responsible authority shall P The responsible authority�a compiling the
the individual subject of the da�• certif n
requesting person to pay the actual costs of making, 3'i g'
copies.
immediately, if possible, with any request
The responsible authority shall comply '
ursuant to this subdivision, or within five �f Simmediateat ompliance e�ues�t�
made p S�da� �d legal holidays,
excluding Saturdays, with the
' le. If he cannot comply with the request �t withintwhich tohcomply f orm t e
possib �Ye an additional �ve YS
individual, and may 5��� �d legal holidays.
request, excluding Saturdsys,
te or complete. An individusl maY
Subd. 4. Proced�a'e �►hen data is not accura �mself. To
� or completeness of public or private data conce o�lble authority
contest the accuracy � �i�g the resp
exercise this right, an individuel sha11 notify �ible authoritq sha]1 v+►ithin 30
describing the nature of the disagreement. The respc
days
either: (a) correct the data found to be inae a�ae�°�uding Pee�iPi��namedt by
notify past recipients of inaccurate or incomp e �
individual� or (b) natify the individual that�ha �,�statementdof disagreement is
the if the indi
Data in dispute shall be disclosed only
• included with the disclosed daLa• �ible authority may be apPealed pursuant t° the
' The determinetion of the respo to contested cases•
provisions of the administrative procedure act relating
PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE
Minnesota Statute Section 176.182 requires every state and local licensing agency to withhold
the issuance or renewal of a license or permit to operate a business in Minnesota until the
applicant presents acceptable evidence of compliance with the workers' compensation insurance
coverage requirement of Section 176.181, Subd. 2. The information required is: The name of
the insurance company, the policy number, and dates of coverage or the permit to self-insure.
This information will be collected by the licensing agency and put in their company file. It will
be furnished, upon request, to the Department of Labor and Industry to check for compliance
with Minnesota Statute Sec. 176.181, Subd. 2.
This information is required by law, and licenses and permits to operate a business may not be
issued or renewed if it is not provided and/or is falsely reported. Furthermore, if this
information is not provided and/or falsely reported, it may result in a $1,000 penalty assessed
against the applicant by the Commissioner of the Department of Labor and Industry payable to
the Special Compensation Fund.
Provide the information specified above in the spaces provided, or certify the precise reason
your business is excluded from compliance with the insurance coverage requirement for workers'
compensation.
Insurance Company Name:
(NOT the insurance agent)
Policy Number or Self-Insurance Permit Number:
Dates of Coverage:
OR
I am not required to have workers' compensation liability coverage because:
(� I have no employees covered by the law.
( ) Other (Specify)
I HAVE READ AND UNDERSTAND MY RIGHTS AND OBLIGATIONS WITH REGARDS
TO BUSINESS LICENSES, PERMITS AND WORKERS' COMPENSATION COVERAGE,
AND I CERTIFY THAT THE INFORMATION PROVIDED IS TRLTE AND CORRECT.
�� � :,�� `� ��1�- / �� ��~-.
(Signamre) (Date)
V-�, � i �
(Company) � (Business Phone Number)
f .
, CHECK OFF LIST FOR LSSUAl�iCE OF PERl�II'TS
FOR OFFICE USE ONLY
fiDDRFSS OR LEGAI.: 2�0 5 Su�A2w�o'� s �2
PID:
DESCRIPTION OF WORK: �=�
------------- -------
Z0�1ING REVIEW BY: DATE APPROVED: i o� z�-�S'
BUII.DING REVIE`V BY: DATE APPROVID: i o � �-�s
- ---------------------------
FEES TO BE CHARGED: �iisc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes v No SEWER CONNECTION
ST�TE SURCHARGE Yes �" No WATER COI�NECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECI'ION
Number of SAC Units OTHER (specify) Y_�_^ w
-----------------------------
ZONING CHECK LIST Z g Dis 'ct: Shoreland District :
Fire Department: st fice: School District:
Lot Area: Sq.ft. Acre W ih Depth
Survey Submitted: Yes �_ No Date of Survey:
�
Proposed Setbacks: � � L'�
Front �e}: � 1��� Right Side: `� 5 �
R�r �e�:l�-c�4l� SZ� Left Side: � � � L�`'J
Adjacent Structures: R i"774�e� Wetland: ^/��
,
Building Height: De . gt. / Pe� �'
Avg. Setback: Bluff Setbac�c: Lot C�verage:
Existing Proposed
Hardcover: -75' �- �
5-250' y � �
250-500' � �
500-1000' ' –
i� �
Hardcover V�riance Requir : Yes % ti'o �Date of Council Approval:
1 � �� %� � —
Gradin�: �aff APProval Dade: �y: Council Ap�proval Date:
�
� 1,
Sepdc: S/aff Approval Date: , �� By�
/
, R�solution: � '� Resolution D�te:
Zoning ile: # --�— ,
` � ,
�lII IlOILSe�: �
,ti
. � , ,
BUR.DING REVIEW CHECK LIST
uBc: 2- � co�rs�rxucTTo�r �E: �l N
Sq Foocage � Per Sq Ft�
Bas2ment C —
lst Floor X —
2nd Floor R —
Garage r —
C -
TOTAL
�
Estimated Construction Value: S �, �('X�'`
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Vlechanical Wa[er Connection
_� Footing Septic Sewer Connection
_� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_� Final Grading/Filling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
- ------------------ -
REVIEW BY OTHERS: DATE:
Access: Ezisting �eW
Access Approval: Date BY�
- ---------------
REI�IARKS(TO BE�IOT'ED ON PER.�'��IIT):
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i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
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DATE TIME
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� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOL�OW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
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Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor s'te
Inspector.
White Copyllnspector's File Canary Copy/Site Notice