HomeMy WebLinkAbout1999-012002 - addition/remodel PERMIT
C'`TTY OF ORONO
PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number: "' ,-F.' :`v-'
Crystal Bay, Minnesota 55323 `-'``
(612) 249-4600 Date Issued: -
SITE ADDRESS:
DESCRIPTION:
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REMARKS: _ _
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FEE SUMMARY:
ase Fee
Plan �Revlew
CONTRACTOR: OWNER: - ►::pp I i r a m. -
i i A,0 T i_)tj t:AWA, RD,
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THE 'UNDERSIGNED HEREBY PE���:3E ST 1 PERM I�.5I�,�hl T�� I"i t .E °THE REAL '1P±riDUEl�I
SPECJFIEQ AND AGREES TCf DCt ALL GOOK INr TRIaC.T -IMPLIANCE:�i�L�R:
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APPLICANT/PERMITEE SIG URE ISSUED BY:SIGNATURE
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Total Fee: $ y� a •� Date Received: 61301,7-9
Entered By: Permit#: 2.00Z
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) NER R CONTRACTOR
JOB SITE ADDRESS: //510 7gp A�k,+U).4 R D ZIP:
NAME OF OWNER: A rh&_r 0 4 eafh u L t<:_ PHONE: (home)
(work)
MAILING ADDRESS f/` 0 -Tt9A,;,t I,EZ k o CITY: LDN6 Lk. ZIP:
CONTRACTOR: S G If PHONE: 7 t—f S 3 3
CONTACT PERSON: 477f y oR rck vaIOBILE/PAGER:
MAILING ADDRESS:/�j� -rVP
AAah# CITY: ZIP:
STATE LICENSE: #
i
J Q M o�c, 1Qa Wt.-
ARCHITECT/ENGINEER: ZU M )tfs h PHONE: 4011-
MAILING
0`1 -MAILING ADDRESS: 00 _Rgeilc4c A,0 CITY: ZIP: 4 3 c
NAME: REGISTRA ION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail): 6jfA,ConM c
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. _ DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $436-0,000
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: G —30 - f
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
•„ a of
Sec.13.04 RIGIITS 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 section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of. (a)the purpose and intended use of the requested data within the collecting State agency,political subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13:82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or Property tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data 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 public data 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 thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority 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.
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 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 incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
r 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 shared 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above. ,
Signatu
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 1140 "r0NK4c.-►01-, Izo.4,0
PID:
DESCRIPTION OF WORK: ,•-) --wua0c-
-
-------------------------------------n ----------------------------------------------------------------------
ZONING REVIEW BY: cf DATE APPROVED: y-99
BUILDING REVIEW BY: DATE APPROVED: to f Y-S 9
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURA LARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yzs No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: J A- )13
Fire Department: " Post Office: School District: &AA3-�o
Lot Area: Sq.ft. 2').1f$6 —Acres .1,2 Width 1 10.1•S Depth 2 f S"•(Pq A 4
Survey Submitted: Yesvt— No Date of Survey:
Proposed Setbacks: ,
Front (Lake): _Y&� Right Side: I L N
Rear(Street): 104 � . Left Side: t
Adjacent Structures: N 1 p Wetland:
Building Height: Def. Hgt. t9 -1:7- Peak Hgt. q!
Lot Coverage: 11 • 5
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # 23 9 0 Resolution: # `i 11 V Resolution Date: ,-7 3- Qt 6
Shoreland Dist•ict: l/{S
Avg. Setback: J A 2,AwrA Bluff Setback: (A- Lot Coverage:
Existing Proposed
Hardcover: 0-75' 3%.9 2 ZS•
75-250' 43-41
Z'°�•`�
250-500'
500-1000'
Hardcover Variance Required: Yes K No Date of Council Approval:
REMARKS(in house):
26
. y
BUILDING REVIEW CHECK LIST
UBC: A - 3 CONSTRUCTION TYPE: v AJ
Sq Footage $ Per Sq Ftg
Basement x =
1st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 3 S't0,uoo 00`
Inspections Required: Work Requiring Separate Permits:
Site K* Plumbing Fire
Hardcover Removal K Mechanical Water Connection
cK Footing Septic Sewer Connection
,K Framing Fireplace Lawn Irrigation
o Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
A Final 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
DATE TIMEy,
CITY OF ORONO CALLED IN /a�a �� -eAIZC�
INSPECTION NOTICE. SCHEDULED 1' g :
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
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PERMIT NO. 12� COMPLETED d� v
ADDRESS 1/Lin yr ► �--��
OWNER CONTR. /Yl ✓tel% ` Q� S
TELEPHONE NO.
DESCRIPTION
W 01 FOOTIN 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
Z 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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❑CORRECT UNSAFE CONDITION WITHIN HOURS. I- PHOTO TAKEN
INSPECTOR WILL RETURN
CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
Owner/Contractor on site:
Inspector.
White CopylInspector's File Canary Copy/Site Notice
DAT IME
CITY OF ORONO CALLED IN / 1130
INSPECTION NOTICE SCHEDULED o • 1' 0
PERMIT NO.0 12 0 d ;2—, COMPLETED �� � 0'CIO
ADDRESS
OWNER CONTR. ou
TELEPHONE 532—
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01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
LC 02 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
LU 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
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OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
OwnerlContrgccttor on site:
Inspector.
White Copylinspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN D�
INSPECTION NOTICE SCHEDULED _3lOd
PERMIT NO. da A0.2— COMPLETED 2 3 6
ADDRESS //V6 •J �e�/
OWNER CONTR.
TELEPHONE NO. 3 2 �5�
DESCRIPTION
0101 F�� �_ 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
Q 02 FRAMIN Oj G� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULAT N 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
UTJ 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR tV MI(ET_YOU:_nYES_NO
C MMENTS:12
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INSPECTOR WILL RETURN
CITATION ISSUED
O STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
Owner/Contractor on site:
Inspector 1&4�c�Ct til'
White CopylInspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN 3���a 0
INSPECTION NOTICE SCHEDULED —� / c) d o
PERMIT NO. b 1,2-002- COMPLETED
ADDRESS /f/`/0 •9,el cnv
OWNER CONTR. �
TELEPHONE NO. --5-�
DESCRIPTION
01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 G 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Lul 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:
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W ❑❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE
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INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in adva ce. 249-46
Owner/Contractor on site:
Inspector.
White CopylInspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED � — CX3
PERMIT NO. C-��2—Q�a COMPLETED 5 —31'c)
ADDRESS ���0 "Tb� W� Rd
OWNER CONTR. C�(1�-►' 'lLI 2)Vo=� '
TELEPHONE NO. S-3a,-4
DESCRIPTION
W 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
W 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
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04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. I' PHOTOTAKEN
INSPECTOR WILL RETURN CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
Owner/Contractor on site:
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. COMPLETED
ADDRESS — (z
OWNER CONTR.— by
TELEPHONE NO. p
D IPTIONi�G�C�
01 FOO 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
W h 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:
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❑CORRECT UNSAFE CONDITION WITHIN HOURS. PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
OwnerlContracto�Jr on site:
Inspector. � ?
White Copy/inspector's File Canary Copy/Site Notice
TE TIME
CITY OF ORONO CALLED IN 1�J- l�M Iv
INSPECTION N TICE SCHEDULED bd
PERMIT NO. �i ?_00Z COMPLETED
ADDRESS I HCS O_l!yA
OWNER I(,Sj S CONTR. (n( KjS
TELEPHONE NO. X32- 41
DESCRIPTION E i AAL
W 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
W 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
g O5 FIRAC- 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACT TO MEET YOU: YES NO
COMMENTS: JmY
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❑CORRECT UNSAFE CONDITION WITHIN HOURS. PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
Owner/Contractor on S;1t �
Inspector. eo(z (/x`'64-)
White Copy/Inspector's File Canary Copy/Site Notice