HomeMy WebLinkAbout1997-009185 - addition - PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: %1 T�._i i T Ni-
Crystal Bay, Minnesota 55323 Date Issued: t37 r �'t
(61 ) 473-7357
+
SITE ADDRESS:
4 WILLOW OR S
_ G
DESCRIPTION:
_;::_u 1 t d z vig Pe r ro}t Type SF-AD-/REMt_#O L
t-:c'0=T.r i i f t.j o,,-i Type VN
4 3: €L i :s=_.Trip a!T AI
REMARKS:
SEPARATE STATE ELIrC:T R T CAL PEn°11.i T T RE},Et_ T RE D
FEE SUMMARY: f _
ICIN
It 17i D
Total Fee
CONTRACTOR: — :�''='l ;= ,�t• - r:T • f_Tt
T�'tfl_TION L"+, i 4+i OW : t l�•t•.
LITLLI-W DR
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APPLICANT,'PERMITEE fgfiATURE ISSUED BY:SIGNATURE
' Total Fee: $ S-� 3S Date Received:
Entered By: Permit#: 311F�;,
CIT 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) WNER R CONTRACTOR
JOB SITE ADDRESS: `��V �OgTY 64,tU-40W ZIP:
NAME OF OWNER: fLc=R 0—,4 :TAZ. PHONE: (home)
t (work) q 3 - '48q6
MAILING ADDRESS: 4'(y 50uy Wuw) CITY:GoK(r, 4s K45, ZIP: sus- _$zp
CONTRACTOR: –+�� PHONE: q70` $e Z40
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: y 2-1g 7"j"t 6() CITY: 01 a! ZIP: S'S3 LQ L/
STATE LICENSE: #
_CHITEC� GINEER: G�G{��j2l�t=J'�F PHONE: �j(ya�
ADDRESS: CITY: ZIP:
NAME: —)�� REGISTRATION#
TYPE OF WORK: New Addition X Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail): 2 X 2L4 Z
To 0 w it
STORIES: SQ. FEET OF EACH FLOOR: Z S e
NO. OF BEDROOMS: _jC> GARAGE STALLS: ATT. -- DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 464
'
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: l Cl( /Y u� DATE:
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
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§tate 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 disput_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.
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.
all/ jG�fGLe(l�
First Middle Last
iVSz
Address
City State zipPhone
I understand my ri s as stated above.
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESSOR LEGAL: q'?10 Com.,t(o ,•: ,O/L _-5o, 77-+
PID: 63 • 117-23 32- 00((
DESCRIPTION OF WORK: A00(-rlyr-f
-----«-_---
ZONING REVIEW BY: - -- � DATE APPROVED: ~-7-f 6-- ---
7
BUILDING REVIEW BY: 0 DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓` No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes t/ No WATERCONNECTION
INVESTIGATION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
____ __------------------------ _ -------------------------------------
ZONING CHECK LIST Zoning District: r
Fire Department: v^ Post Office: - School District: C)/l e^jD
Lot Area: Sq.ft. 3y,1 A Y Acres = 7 Width Depth
Survey Submitted: Yes . No Date of Survey: -Z/ -'7�$
Proposed Setbacks:
Front (Lake): Z►s Right Side: Z9.L
Rear (Street): 11`b% - Left Side: .Zb ,
Adjacent Structures: 47779 M-CVP Wetland: N 03-
Building
3Building Height: Def. Hgt. Peak Hgt.
Lot Coverage: ' K-
Grading: Staff Approval Date: N'F/t By: Council Approval Date:
Septic: Staff Approval Date: N (A- By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland Dist.-ict: NLI)
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
26
BUILDING REVIEW CHECK LIST
UBC: 3 CONSTRUCTION TYPE: V&
Sq Footage $ Per Sq Ftg
Basement Z ed x 13, St 3, 1 Z
1st Floor $ x i `��96f, 7-
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 3 7 y
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
,x Footing Septic Sewer Connection
_ Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
_4 Wall Board (Mfg.) Well (State Permit)
—,Z 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 TIME
CITY OF ORONO CALLED IN 8 49 Y
INSPECTION NOTICE SCHEDULED 3
PERMIT NO. G1/9- COMPLETED /
ADDRESS 4416 Z04
OWNER CONTR.
TELEPHONE NO. 47 3 •
QION
W 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
Q 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:
cc
W
a
cc
J
O
cc
O
W
Q
Z
W
Z
W
cc
J
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LU "WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
rc
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
11 CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner►Co actor s
Inspector.
White Copy/inspector's File Canary Copy/Site Notice
D TE TIME
CITY OF ORONO CALLED IN // >j
INSPECTION N TIC SCHEDULED /
PERMIT NO. '71,/§ COMPLETED /f N
ADDRESS "�
OWNER CONTR.�
TELEPHONE NO. 'I 3 - X17'7
DESCRIPTION
LAj 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y INSULATI 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z LL 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES_NO
o COMMENTS:
W
a
cc
O
O
cc
O
W
W
CC
Q
Z
W
Z
W
cc
j
d
W E!WORK SATISFACTORY:PROCEED PROJECT COMPLETE
CC CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
Q ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73557
Owner/Contractor on 'te:
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTIC SCHEDULED / ! " /3- 60a
PERMIT NO. COMPLETED
ADDRESS
OWNER q73-q7--71 CONTR.
TELEPHONE NO. q 7 3"y7.7 I
DESCRIPTION
W 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
W 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
4 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q O5�INAL 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
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES NO
COMMENTS:
cc
W
a
cc
d
O
cc
O
W
W
Q
2
W
Z
W
cc
Z)
d
W ORK SATISFACTORY:PROCEED PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C, PHOTO TAKEN
INSPECTOR WILL RETURN
17, CITATION ISSUED
ElSTOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnedContracto
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
DATE /
CITY OF ORONO CALLED IN /9r4
INSPECTION NOTICEA., / SCHEDULED �1 32�
PERMIT NO. COMPLETED
ADDRESS
OWNER CONTR.
TELEPHONE NO. `l77/
DESCRIPTION
01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q2 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 ON 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
Z
COMMENTS:
cc
W
C
ac
O
W
O
W
W
CC
Q
Z
W
z
W
cc
O
W WORK SATISFACTORY:PROCEED 1-1PROJECTCOMPLETE
cc
W ❑CORRECT WORK&PROCEED ElISSUE CERTIFICATE OF OCCUPANCY
Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nqxtans ction 24 hours in advance.473-7357
Owner/Contract n site: }
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice