HomeMy WebLinkAbout1994-006708 - Permits/inspections , PERMIT
' � CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number. _.
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(612) 473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE [y�,
-^ CITY OF ORONO - BIIIZ,DING PERMIT APPI�ICATION
Total Fee• $ Date Received: / ,';j�{/�'� _
Date Approved :
Entered By: permit tt: .1�,'JC �
AT•T• INFORMATION MUST BE SIIBMITTED IN FIILL BEFORE PLAN RE�7IEW WILZ B$ STARTED
(See Check-off List Encl.osed)
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THE APPLICANT IS: ( circle one) �OSdNER �'or CONTRACTOR
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' " ZIP: ���-� %�
JOB SITE ADDRSSS: � `� �_i /���`�//��� �'�� ,-�
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N�ML OF OWNER- ���/'1 / , i �/� PHONE: (home)���� /���
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�.�� ���—� CITY:f��%��%����� zIP: �.5�/
MAILING ADDRESS: ��/� /�,'��/i�" �
PHONE:
CONTRACTOR:
MAILZNG ADDRESS: ��`�"?'i%''_ CITY: Z IP:
STATE LICENSE: #
ARCHZTECT/ENGINEER: pH���
MAILING ADDRESS=
CITY: ?.IP:
NAME: REGISTRATION �
TYPE OF WOR.R: New Addition Accessory Structure Niove
Demo Remodel/Alteration Renovate Land Alteration
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PROPOSED WORR (describe in detail) : J,���� � -��°�"�2`" C
/� �� � ! /• (/ ,5�� -_.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $
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 wi�ha�hl
ordinances and codes of the City and with the State Building Coermit-; and
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE: �•'` ��l ,"N%� ��� DATE•�i� ��� �
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(�I'1'Y Of ORONO
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Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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� _ � � On the North Shore of Lake Minneta�ka
DATA PRIVACY A�VISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
license f rom the City
of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2, You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be snared with oth�ocesscthe permit or
federal agencies to the extent necessary to p
license.
4. If your requested permit or license requires Councii ac��or.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6 , Your full name is required to proc�ss this application or
permit.
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First
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Address , :
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City State Zip
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I understand my rights as stated above.
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ignature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING
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PERMIT ,
CITY OF ORONO PERMIT TY�E: �=._��;,;{
1335 Brown Rd. South P.O. Box 66 S �� �=��-��-
' Permit Number: �"`��-°�-'-°
Crystal Bay, Minnesota55323 Datelssued: t-3`,J�.•'=,%'=?{}
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: '�',' , p ^ E�: -- ���=�1 ac�tEt. __..
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r ���LI!,'A�� �. ��� ' , ��� � ��" ISSUEDBY�SIGNATURF
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� ,� CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ ,3�� C C Date Received: � / - �"!!�
Date Approved: ,�f�/' �D
Entered By: _ ��y�
Permit#: ���'���,�� i
ALL INFORMATION MIIST BE SDBMITTED IN FIILL BEFORE PLAN REVIFs'W WILL BE STARTED _
(See Check-off List Enclosed )
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: � �) %��-i .��� �1 iL, %` �G`/_ - ZIP: �J �_� y�
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NAME OF OWNER: ��,,,� �: ''� �'�'C���.�;�;' ���!1 PHONE: (home) �- �'� '�� ���'�c�
MAILING ADDRESS: :����'' i- = �`ij. ��h. s`�'G� � CITY: �'�' �'� .� ZIP: _i:i '�/� �
✓,���'vL��•...r�l.��;J
CONTRACTOR: ��/�`�.1� ;�r ;'`F; L ✓ PHONE: �'� // ' �` /�`)
MAILING ADDRESS : --� =%'%��� ��,"����/fJ'4�� ,r��U�� CITY: �'.�'//i-�--i•-`r ZIP: ���,a`i/
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : / E ��,-'�'��<'��-�=; �`' r•1� C%�-�;�
J+_L��i._�v' L�..' l L�: .��': r���- ����r./ u� ``,.�••�1/•'•^ �L,�i�:.�.'k.��c'\� C_���\.c,�--i�� G-:4(.
��..L�L�-"l�i.� i.Z� ���J'
STORIES: SQ. FEET OF EACH FI�OOR:
NO. OF BBDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTROCTION VALIIATION (egcluding land) : $
I hereby apply for a building permit and I acknowledge that the informatic
above is complete and accurate; that the work will be in conformance with t�:-�
ordinances and codes of the City and with the State Building Code; that e
understand this is not a permit and work is not to start without a permit; a�ci
that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATURE: � I ,� � �,����_' -_..�� DATE: ,� S
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�� � CITY of ORONO
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��;• Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Officea
3
� - � � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
Iicense 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 licensee
3. The information may be shared with other Iocal, state or
federa]. agencies to the extent necessary to process the permit or
Iicenseo
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5o You have certain rights under M.S. 13.04 to review privat�
data on yourself. -
6. Your full name is required to process this application or
permit.
�� ���`��l�' ��'�j/�C%F� f ��`�, Y�/?/..�/�'�,/�
First Middle Last
l7 r���i; � _J .;� r„ �,t,,`- J ��`;,�ip �
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Address
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City State Zip
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' �
Phone
I understand my rights as stated above.
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Si ature
BU[LDING&ZONING—473-7357 • ADMIN[STRATION&F[NANCE—473-7358 � PUBLIC WORKS—473-7359
ASSESSING
� __ �
�.04 RIGH15 OF SIIB.TECTS 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.
gubd, 2. Information required to be g��� ����' An.individuel asked to
� 1 rivate or confidentiel data concerning him`slelfin the collect g state agency,
supp y p
purpose and intended use of the req em;d �b�Whether he ma� refuse or is legally
political subdivision, or statewide sys �oWn consequence arising from his
required to supply the requested dat8; (c) any
su 1 in or refusing to supply private or confidentiel data; and (d) the identity of
PP Y g
other persons or entities authorized by statu��e�ke�to supplyeir►vest gat ve dat8,
requirement shall not apply when an individ
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individual income tax or ro ert tax re und instructions instead o
on those orms. . --- - _
Subd. 3. Access to �ata by individusl• Upon request to e responsible
authority, an individual shall be informed whe b�c hprivate or confident al•e UP°n his
individusls; and whether it is classified as p � ublic data on
e to him and, if he desires, shall
further request, an individual who is the subject of stored private or
individuels shall be shown the date withou�fan�y ��a. �,fter an individu8l h�s been
�e i n formed of the content and meaning t he data need not be �isclosed to
shown the private data end informed of its u���8ction pursuant to this section is
him for six months thereafter unless a �SP n request by
ending or additional data on the individuel h� 8te or public �atarupoeated. The
� P require the
responsible authority shall provide copi�The responsible aut�rgy maY �in the
the individuel subject oftrie actual.costs of making, certif n , and comp g
requesting person to pay - re uest
copies. immediately, if possible, with anY 9
The responsible authority shall comply S of the date of the request,
made pursuant to this subdivision, or within five �f immediate compliance is not
excluding Saturdays, Sundays and legal holideys,
� within which to comply with the
ossible. If he cannot comply with the requese within that time, he shall so inform t e
P have sn additional fi Ys
individuel, and maY �d le al holidays.
request, excluding Saturdays, SundaYS g
Subd. 4. Proced�e �►hen dats is not accurate or complete. An individual may
himself. To
contest the accuracy or completeness of public oinr WTiting tthe�responslble authority
exercise this right, an individuel shall notify �ible authority shall within 30
describing the nature of the disagreement. The respe
days either: (a? correct the data found to be i te dataeincludingreec pients named by
notify past recipients of inaccurate or incomp
the individuel; or (b) notify the individual that he believes the data t� beementcis
Data in dispute shall be disclosed only if the individusl s statement of �a� to the
• included with the disclosed data• be agpe8�ed pursu�t
' The determination of the responsible authority may
provisions of the administrative procedure act relating te contested cases•
CITY of ORO�TO _
Buildin Permit PERMIT NO. 61�5 �
g D- �
AND APPLICATION FOR CERTIFICATE OF OCCUPANC;Y �ATE ISSUE�
P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357
ZONING DISTRICT ����'" � ' �, ����
SITE ADDRESS ..- �
PROPERTY IDENTIFICATION NO.(PID) ,_..J / r ���' c-r��' ��J ��0.�--
FIRE DEPARTMENT LOT BLOCK SUBDIVISION
POST OFFICE OWNER (Name) ( �d�d,�re�s�s) �i/ (Phone)
. G� � ��f 3� ��-T//'��- ,,"" c�G�C� ' �i i" ���ei.�
VAR. DATE RCHITECT/ENGIN E - Must Certify Multi-Family, Commercial& Indust I Construction Plans
(Firm) (Address) (Phone)
COND. USE DATE
LOT AREA \ BUILDER (Firm) (Address) (Phone)
`t
WIDTH TH
TYPE OF WORK Addition cRemodel � Renovate
PROPOSED B CKS: -��" � �.� /�e�
FR T E �--�f1 - <�t-ef
CONST.TYPE BUILDING SIZE Estimated Construction Valuation
REA L. SIDE
L. W. Ht. ������ C`�f�
LAKE WETLANDS
OCCUPANCY PERMIT FEES
� CLASSIFICATION �
AC ESS DWELL. STORIES B 1 2 3 BLDG. PERMIT �' �
UNITS STATE FEE � �
NEW XISTING GAR. STALLS NUMBER OF BEDROOMS
AGENCY-A ROV. DATE ATT. PLAN REVIEW
TY DET. SEPTIC SAC CHARGE
APP. DATE
U TY PROPOSED USE SEWER UNIT
ATE PARK FEE
PENALTY
PRIVATE EASEMENT COUNCIL
APP. DATE OTHER
TOTAL DUE !}� ��
REMARKS: �-�`
INSPECTION REQUIRED WORK REQUIRING ACKNOWLEDGEMENT
SEPARATE PERMITS THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE
❑ . . . . . . FOOTING before pour
❑ . . . . . . FRAMING rough-in PLUMBING ......................... ❑ THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES
❑ . . . . . . INSULATION MECHANICAL....................... ❑ UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT-
❑ . . . . . . WALLBOARD before taping ANCE OF ALL INFORMATION. CONDITIONS AND REQUIRE-
WELL............................... ❑
❑ . . . . . . FINAL before occupancy
❑ . . . . . . SITE INSPECTION SEPTIC.............................. � MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER-
WORK BEYOND OR WITHOUT A RE- SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM-
SEWER..............................
QUIRED INSPECTION WILL BE SUB- PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE
JECT TO PENALTY. WATER..............................
OF MINNESOTA BUILDING CODE REQUIREMENTS.
GRADING&FILLING ............... ❑
INSPECTIONS MUST BE CALLED-IN
24 HOURS IN ADVANCE. FIRE................................. ❑ ;
Signature [L� s Date ��
COPY:WHITE-FILE GREEN-FINANCE
CANARY-INSPECTOR GOLD-RECEIPT
PINK-ASSESSOR Approved City of Orono
Brooklyn Prtg.&Adv.Co.Inc. (672)S61d470
,
'1 �I�� I CITY UP OF20F70 �
, N
P IIUILDING PERA�IT APPLICATION
BUILDIt:G PI:RMIT APPLIG'fI019 RCQUIRf:MENTS ,_ � _
Requiremente to ba handed in vith Duildinq Pcrmit Application: Conatruction Plnna ohould includes I
1. Building Permit npplication - to be filled ou� 6 signed. i
2. Energy Calculutiona - filled out. 1. Piret floor plan. ��,
3. Purnish Septic Aeport i Design. 2. Footinq and foundation pinn. �
4. Purnlsh n Certificete of Survey, includinq hardcovez 3. Elevationa (of nll sides). •
calculations and qreding and drainage plana aa required. �. wall sections 6 crosa sections.
5. Furnish 2 sete of Construction Planst 5. Details - etairs and any special connectione.
a) 1 set foz City to keep on file - - ----
b) 1 set for builder to u�e on eite
- T8S ABtri/S I�E2l9ATION MDST $B SIIBKI"iTED BL�PORE PLAN RS�/IEW I3 DONB
Work Beyond or without a required inspection will be subject to a penaltyl
ZONING DISTRICT sirE Ao�AEss '— '�» �>���,��- � '� � , � �' �
5 ,t< _ �;E,� ,�.,_ i
PROPERTY IDENTIFICATION NO.(PIO)
FIRE OEPARTAAENT LOT BLOCK SUBDIVISION
POST OFFICE OWVNER {Name► (AdcSress) (Phone)
"j>c r.•ra��� _1�. �'�c �,rt•;'"> l 3?�� l�"C�w1I4 �>L��.� 1,f14�yZ+1�+� �tZl Y 7k�
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VAR. DATE ARCHITECT/ENGINEER- Must Certify Multi-Family,Commercial 8 Industrial Construction Plans �
(Firm) (Address) (Phone) �
COND.USE DATE ��� +�'c �
BUIL�ER (Firm) (Address) (Phone) �
LOT AREA .
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. �
W1DTH DEPTH 7ypE OF WORK �h� Addition Remodel Renovate
PROPOSED SETBACKS: ��� � �,.t�� <'_�- :. ,:,� ��_ `- =,�,t� v� ;s . •
FRONT R.SIDE
ti CONST.TYPE BUILDI�fG SIZE Estimated Canstruction Valuation �
REAR L.SIDE �
L. W. Nt.
IAKE VYETLANDS
STORIES B 9 2 3 PERMIT FEES
ACCESS New Existinq DWELL. SQ. FT. B�DG. PERMIT �
I UN(TS STATE FEE �
AGENCY: City Cty State � GAR.STALLS NUMBER OF �EDROOMS
ATT. PLAN REVIEW
APPROVAL DATE(S) : I DET. SEPTIC SAC CHARGE
APP. DATE
HARDCOVER � PROPOSED USE QCCUPANCl' SEWER UNIT
Existfng e; � , CLASSIFICATION PARK FEE
Proposed 8:
PENALTY
GR.ADING COutvC►�
❑Staff App. Date _� OTHER
❑CUP Apo. Date APP. DATE
TOTALDUE
REMARKS:
INSPECTtON fiEOUIRED WORK REOUIRING
SECARATE PERMITS
❑......fOOTINQ Detore Oour
❑......FRAMING rovp�•In PIUMBINO.........................❑
0......�Nsu�ar�or+ MECMANICAI.................. ❑ Tho undersigned hereby makes application for a building
.....
❑......WALLOOAHDDefOr�faD��O � permit for the work deacribed, agreea to do all work in strict
❑......FINAL Wfore occu0oney �lL.......................
❑......bITEINSPECTION searic..............................❑ accordance with the ordinances of the City of Orono and ruling
of the State IIuilding Code Division, and declares that all
WORK OEVOND OR WITHOUT A RE- yEWEp••••••••••••••••••••••••••••••� facta and representations stated herein a e true and correct.
OUIRED INSPECTION WILI BE SUB� WaTEN..............................❑
JECT TO PENALTY. / /J
ORAOIN68FIlLINO...............❑ �C � � �y� �`f//�.
INSPECTION3 MUST BE CnLLED-IN m / jti�: .(.��
ZG HOURS IN AOVANGE. fIRE................................❑ ��.�_
Date Signature
i