HomeMy WebLinkAbout1995-006888 - tear-off/re-remodel PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- PO. Box 66 Permit Number: j i T
Crystal Bay, Minnesota 55323
(612) 473-7357 Date Issued:
SITE ADDRESS:
DESCRIPTION:
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FEE SUMMARY:
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THE UNDERSIGNED HEREBY REEQUE.r3-TS PERj'-1ISS1ON, TO MAKE THE ,REAL IMPROVEMENTS
SPECIFIED AND S TO DO ALL WORT-,::' IN STRICT COtiPLIANCE WITH ALL CIT' 'OF
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A STATE 'OF 11INNES' OTA BUILDING CODE REA.)UIREMENTS,
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APPLIC"/ ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ G' / Date Received:
Date Approved:
Entered By: Permit#: I V
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
_ ------ -----------------
_ ___ _ -------
----------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: ( � L� YZ/d L6 ZIP:
(work) IL2 -26
NAME OF OWNER: �j��� C PHONE: (-Tcme•)
MAILING ADDRESS:off( /�S' w/�Yr ZA��A-- (3L,) _ CITY: "-pA)0 ZIP: sS3S(c
CONTRACTOR: �� lrC o ®sr� „�G� St (� �1i PHONE:
MAILING ADDRESS: I5515- 31"-4 40, ,,L)o L CITY: vu &l ZIP: SSYy
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) :
ZSc� + 1 R 1 1
1 L A O=ZZ,z
STORIES: SQ. FEET OF EACH FLOOR:
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 City and with the State Building Code; that I
understand this is not a permit and s not to start without a permit; and
that the work will be n corda e ' th the approved plan.
APPLICANT'S SIGNATURE::'' DATE:
4f '
CITY of OiRONO
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
•
On the North Shore of Lake Minnetonka
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 to review private
data on yourself.
6 . Your full name is required to process this application or
permit.
First Middle n Last
73-
Address
City State Zip
P one
I understand my rig stated above.
Sign ture
BUILDING& ZONING—473.7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING
Ory OF ORONO PERMIT PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 T
Permit Number:
Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357 L.
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY: ``````=i
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CONTRACTOR: r-::4
OWNER:
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THE UNDERSIGNED HEREBY REQUEST.-;-�, PERM I- SIC'.1N TO MAKE THE REAL IMPRCIVEMENt=-'
-'OMPLIANCE WITH ALL d,TY'1Z`OF ;
SPEC IF I ED AND AGREES TO DO ALI WORK IN sm.ic'r
ORONO ORDTNANC:ES AND STATE OF MINNESOTA BGILDING ,C01.')E REQUIREMENT.-,
APPLICANT/PERMITEE S)qATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR MECHANICAL PERNIIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, NIN 55323
GENERAL INFORMATION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within 2 working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Mechanical Designs - Complete calculations, details and specifications are required for each heating,
ventilation,humidification-dehumidification, and air conditioning installation including heat loss/heat gain
calculation, design temperatures, equipment ratings and identification as to type, manufacturer and model.
Data shall be presented on form provided. Identification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected (rough-in and final). Call 473-7357. 24-hour notice required.
7. House Heating Test Record must be submitted before final.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473-7357.
Please check one: New Addition Repair X Replace
Residential X Commercial
JOB SITE: 79�_SW14 YZA 7AA i�LVD Zip:
Owner's Name: y(IEsT TES/} Telephone Number: 4�73-7��s"
Mailing Address: B LPP City: GONG MO Zip: s',,, SL
Contractor's Name: ,�/T TER INC. TelephoneNumber: 4 79-JTff
MailingAddress: g:�6 7-6 We=R DI-K, City: tj AH1C1_- Zip: ,�'-S'34,f
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity:
Make: Gf}Ri? Eh'
Model: 4 9 TUE 067
Fuel: >Y/�
Flue Size:
Input BTUs: S�Q 00 d
Output BTUs:
CFM: 2¢00
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add-on
Factory fireplace with flue
Factory Fireplace (s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand Name Model No.
Mfgr's Min., Clearances, side rear min. flue dia.
Total
VENTILATION
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
Total
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
Installation Removal
Fuel oil: gallons underground inside outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
':: 74 7 x .0125 $ ,-6/1 /9
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. 4-7,3:S-, 0 G x .0005 $ 3 7
(contract price)
or $.50, whichever is greater
3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��s
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
customer for the work done. If any material, equipment, labor, or installation are furnished by the owner,
tenant or any other party the reasonable market value of such items must be added to the estimated cost
or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
the City may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
State Building Code, and certifies that all statements made on this application are complete, true
and correct.
Applicant's Signature: .C� Date:
Approved By: Date:
PERMIT
CITY OF ORONO PERMIT TYPE: ; f-i
2750 Kelley Parkway- PO. Box 66
Permit Number:
Crystal Bay, Minnesota 55323 Date Issued: i C",A.
(612) 473-7357
SITE ADDRESS:
L"31V
DESCRIPTION:
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REMARKS: =.7- rii- ;l-,Ma'!
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FEE SUMMARY:
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THE UNDERSIGNED HEREBY REQVEST S-PERM I'i-i-SION TO, MAKE THE REAL 'IMPROVEMENTS
SPECIFIED AND AGREES TO 00 ALL ,WORK IN STRic'r COMPLIANCE WITH ALL CITY OF
ORONO ORDINANCES AND STATE .OR MINNESOTA BUILDING CODE REUIREMENTS.
L
APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
x CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee• $ Date Received:
Date Approved:
Entered By: ' ��I� Permit#: �P 7
ALL INFORMATION MUST BE SUBMITTED IN FULL. BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
----------------------
THE APPLICANT IS: --------(circl1e'' one) OWNER o CONTRALTO
JOB SITE ADDRESS: Z7Z.5 W#lyz,4-zX L«D , ZIP:
946- (work)
NAME OF OWNER: _ - PHONE: (home)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: x,115L�O�tda'11 �-d/1 i 171/��� 69 PHONE: �50 B`�G
MAILING ADDRESS: Z 1O5 W- �ll� V,D , CITY: RUD MSV/aE AAI, ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION tt
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) : {Ct-1. yr- _VA
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 4Q0P
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:
QVr'-'1-4V i i
CITY of ORONO
CITY Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
OF
_O On the North Shore of Lake Minnetonka
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 to review private
data on yourself.
6. Your full name is required to process this application or
permit.
*-V
A pS
First iddle Last
Address
-hJ1z4s V► AL- .� — S 337
City State Zip
� l z-gam ggD3
Phone
I un rstand my rights as stated above.
S gn ure
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—47 3-7 35 9
ASSESSING
513.0.4 RIGHTS OF SUBJFZn OF DATA
Subdivision L Type of data. The rights of individuals 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
in the collecting state agency,
PP Y
purpose and intended use of the rbe informed of: (a) the
eq tem;d datawhether he may refuse or is legally
political subdivision, or statewide sys , known consequence arising from his
required to supply the requested data, (c) any
supplying or refusing to supply private or confidential data; and (d) the identity of
state or federal law to receive the data. This.
other persons or entities authorized by supplyinvestigative data,
requirement shall not apply when an individual w enforcemenis asked t t offier. g
pursuant to section 13.82, subdivision 5,
The ctice rell—
ommissioner of revenue is
ma lent tax reound instructionsuinsteadder hof
subdivision in the individual income tax or r•
on those orms. -—
Subd. 3.
Acem to data by individual. Upon request to a responsible
d data on
authority, an individual shall be informe heublic,ther hpr vatee is eor confidential.subject of Upon his
individuals; and whether it is classified P public data on
further request, an individual who is the subject of stored imriand, if hdesires, shall
individuals shall be shown the data withoutany
t data. after an individual has been
Se informed of the content and meaning the data need not be disclosed to
shown the private data and informed of its eanuute tion pursuant to this section is
him for six months thereafter unless aP
ending or additional data on the individual h been
public datarupon arequest by
ted. The
P require the
responsible authority shall provide copies o the p compiling the
The responsible authority may
the individual subject of the data. certifying, and comp g
requesting person to pay the actual costs of making, Yi g�
copies. if possible, with any request
The responsible authority shall comply immediately,
made pursuant to this subdivision, or within five days of the date of the request,
d legal holidays, if immediate compliance is not
excluding Saturdays, Sundays an
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 ly
request, excluding Saturdays, Sundays and legal holidays.
_ Subd. 4. Procedure when data is not accurate or complete. An individual may
contest the accuracy or com leteness-of public or private data concerning
himself. To
Y P• in writing the responsible authority
exercise this right, an individual shaII notify nsible authority shall within 30
describing the nature of the disagreement. The respo late and attempt to
days either: (a) correct the data found to be inaccurate or incomplete
ng Tents named by
notify past recipients ononacc�h�tindividual
i�vincomplete�t�e believes data to be correct.
the individual; or (b) y Bement is
Data in dispute shall be disclosed only if the individual's statement of disarm to the
• included with the disclosed data. be appealed pursuant
The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z ?ZS �- ' Rcyl) PID:
DESCRIPTION OF WORK: / F/'2E w A�LC
------------------------
ZONING REVIEW BY: /V DATE APPROVED:
BUILDING REVIEW BY:
DATE APPROVED: l ' Z 2-
------------------- ---
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,/ No
PLAN REVIEW Yes J No SEWER CONNECTION
STATE SURCHARGE Yes p/ No WATER CONNECTION
INVESTIGATION FEE Yes No 'PARR FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------
ZONING CHECK LIST Zoning Di trict:
Fire Department: Post Office: School D strict:
Lot Area: Width: Depth:
Survey Submitt Yes No D to of urvey:
Proposed Setba s:
Front (La ) : Right S de:
Rear (Str a ) : Left S de:
Adjacent t uctures: Wetland:
Building Heig Def. Hgt. Peak gt.
Avg. Setback: Lot Coverag
Existing Proposed
Hardcover: 0- 5 '
75-2 0 '
250- 00 '
500-1 00 '
Hardcover V riance R quir d: Yes No Date of Council proval:
Grading: St ff Appro al ate: B Council Appr val Date:_
Septic: St ff Approv 1 D te: By:
Zoning File:#
RV
ion #: Resolution ate:
REMARKS (inn house) :
z:
BUILDING REVIEW CHECK LIST
UBC: ®• -Z CONSTRUCTION TYPE: -
Sq Footage $ Per Sq Ftg
Basement x =
1st Floor x -
2nd Floor x =
Garage x
x =
TOTAL
Estimated Construction Value:
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic -Water Connection
Insulation Fireplace Sewer Connection
rinal
ll Board (Masonry) Lawn Irrigation
(Mf g.) Other
OtherWell (State Permit)
Electrical (State Permit)
----------------------------------------------------------------------
REMARKS (IN HOUSE) :
-----------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------
REMARKS (TO BE NOTED ON PERMIT) :
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2725 Wayzata Blvd. West
Orono, Minnesota
12,'1,904 Square Feet
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CITY, ",;
QU1Ll ING r.-,wRZjT,, PLAN R
INSPECYOR
DATE F'EF2A*IT NO.
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