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� � CITY OF ORONO PERMIT NO.: 2010-00007
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUEn: OU06/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1535 BOHNS POINT RD
PIN : 08-117-23-44-0023
LECAL DESC : DNISION #050376
: LOT 001 BLOCK 001
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE;:
SGWER DISCONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPA[R 50.00
PETE'S WATER&: SEWER, INC. STATE SURCHARGE SEWER& WATER 0.50
800 LOWRY AVE NE
MINNEAPOLIS, MN 55418- TOTAL 50.50
(612)789-6162
OWNER
DNA PROPERTIES
1535 BOHNS PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
"I'he work for which this permit is issucd shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Quilding Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separatc
pennits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void it�construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days t any time atter work has commenced.
The applicant is respoi3sible f r suring required inspections are
requested in con r�nce w� the StaE" uilding Code.This permit may be
revoked at an�y/,��e for d ause.,: ; t
/�` "; `/7:%`' :f � l (�'J l �v �`��I/L�.�.� � l l L7
Applicarit Perq'iit�e Signature Date Issu d By Signature Dal
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Fou c�Tv�JSF o�v�v
�� CILy Of�l'0110 Datc Received: Pcnnit#
�� � '` P.O.Box 66
�
�� � ' 2750 Kelley Parkway ❑In House SAC Detennination Porm Completed
G� �N
�t;� � �-!� Crystal Bay,MN 55323
�!� ''� � o`�' (952)249-4600 Approved By(If Rcquired):
`:��:exoQ$
CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by the[3uildine Ofticial and/or Public Works Depaitment*)
(ALL P6:RMITS- A9av be subiect to further revicw and mav not be issucd when the aoolication is received)
GENERAL INFORMATION
l. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built]ocations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of'the Public Works Department. (ssuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All wark must be inspected before it is covered. Call (952)249-4600,24+hour notice required.
TYPE OF PERMIT
Check All That A 1 )
�Residential (May Require Approval) ❑ Commercial (Approval Required)
❑ New Connection ❑ Additional Connection �Re-Connection ❑ Repairs „�isconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site/Owner Information:
� �.J ���_�__ ��;1
Site Address: ,� `� �`� _._� � � � /� � �G%�
-' C V�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor�Information:
��
Contractor: �,�L''�'t'S �i%'� I �����5���``��C:ontact Person: ( / �t � � `"� S ���> ���
—r—
Address: ���e':� �_,p�✓l'y ,���Z'%�'�tate License #:
City: �-� � Zip: �V Expiration Date:
Phone: ��/;� � �G3��T L'��� Alternate Phone:
DETERMINING PERMIT FEES
�SAC Charge(2009 Rate=$2,100.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
❑Sewer Connection/ Disconnect/Repair($50.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; cast iron
❑Water Connection/ Disconnect/Repair($50.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
❑Water Availability For Futurc Hook-Up to Water($50.00) $
Water Availabilitv Explanation:
Contractor installed line to inside of house for future hook-up.
T'his line will be inspected by the Public Works Department.
Required Before Water Connection Permit is Issued:
1. [ssue Water Meter&Horn Permit
2. Any Additional Connection Fees Paid(If Applicable)
[ssue Water Connection Permit:
1. Collect Permit Fee& Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned hereby applies to t11e City of Orono for issuance of a Utility Permit, agrees to do
all work in strict accordance with the ordinances�of the City and the regulations of the State of
Minnesota, and certifies that�11 stat�ents mac�e on this application are, true and correct.
�
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Applicant: �'"G" Date: j L�
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CITY OF ORONO CALLED IN �! / '����
INSPECTION NOTICE SCHEDULED / �l� -�
PERMIT NO. ���0-�O�b�COMPLETED �� �
ADDRESS �-.�3 � ��D � /�7`r �
OWNER CONTR. ���`ls �/✓N`-S
TELEPHONE N . ��` �� 3 � � � �
� DESCRIPTION ��'lJ�► �G��L�
� � FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PIUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W��WORKSATISFACTORY:PROCEED f� PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call tor the next inspection 24 hours in advance. (952� 249-46��
OwnerlContr ite:
Inspect .
White Copy/lnspector's File Canary CopylSite Notice
CITY OF ORONO PERMIT 1Y0.: 2009-00898
2750 KELLEY PARKWAY
� ORONO, MN 55356— �ATE ISSUEu: 12/23/2009
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1535 BOHNS POINT RD
PIN : 08-117-23-44-0023
LEGAL DESC : DNISION#050376
: LOT 001 BLOCK 001
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO- PRINCIPAL STRUCTUEZE
ACTIVITY : 645-SINGLE FAMILY HOUSES(ATT& DET
NOTE:
I. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND& DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. INSPECTIONS DONE BEFORE BACKF[LLING.
DGMOLITION OF PRINCIPAL STRUCTURE
APPLICANT DEMOL[TION-PRINCIPAL STRUCTURE 75.00
RACHEL CONTRACTING STATE SURCHARGE DEMO 0.50
4125 NAPIER COURT NE
ST MICHAEL, MN 55376- TOTAL 75.50
(763)424-1500
OWIVER
DNA PROPERTIES
1535 BOHNS PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according[o
the approved pians and specifications,applicable Ciry approvals,and the
State Building Code. This permit is for oniy the work described and does
no[grant pennission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced wi[hin 180 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time after work has commenced.
The pplicant is responsible for assuring all required inspections are
req sted in conformance with the State Building Code.This permit may be
rev ked at any time for due cause.
� _ y[6� � `� ` `� C``~
� p�.� '4.�. ',� ()�7'1(c � , / / �
pplicant Permi ee ignature Date [ssued By Sig ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�
' f�4:0``�� City of Orono FO CI SE ONLY n(�Q
�� P.O.Box 66 Date Received: Pennit# �� 7 / V
�����r;,., ���� 2750 Kelley Parkwa}� ' �� �
� ��' �- � Crystal Bay,MN 55323 Amount: $ � ✓ SAC Credit:
��A � {�o�% (952)249-4600
�'rraso8..
Homeowner(s)Signed: ❑Yes
Resolutions(ifany)Signed:❑Yes ❑None Required
7onin Disclosure Si ned: ❑Yes ❑None Re uired
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the 13uilding Official and/or Zoning Department)
Job Site/Owner lnformation;
Type: ��Residential � Commercial
Site Address: � � 3-� ����'�� �L''�/V/ ���
Owner: �IJl1 ��'Qi�{�� I�S Mailing Address: ��3� ��.�b�1S �1�J'�_
City: ��6�Y� Zip: ��3� j
Home Phone: �7Cr3- �Iv2�{- (�� Alternate Phone: N{�i
Contractor/Applicant Informatton.'''
Contractor/App.: 1��C,�4�� � 'AT�1A�-i �/�-'(s Contact Person: �; (^/� �L�f"�F/r'� ) �
Address: �� IaS ��C�I`: Ct���•f�/��.- State License #:
City: �I•�YY�IC.e�(2L Zip: S�3"1� Expiration Date:
Phone: ��7(�;a3� ��k'�S� Alternate Phone: �������"�;�`��I�C` ��
SPECIAL CONDITIONS & HOLD HARMLESS AGREEM�NT
General Instructions:
l. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24-48 hour notice is required for all inspections. Call (952) 249-4600.
4. Sewer must be discontinued at the City service by qualified contractor before demo permit is
issued.
Demolition by means of: � Manual Disassembly �Heavy Equipment ❑ Other
Permit(s) Issued: ❑ Sewer Disconnection � Well Abandonment#
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as follows:
1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is
complete.
�
.
2. Demolition debris will be kept off adjoining property and/or the public rights-of way unless
� specific prior approval is obtained in writing for temporary use thereof.
3. Foundations shall be completely removed from the ground.
4. All demolition debris shall be completely disposed of off site in accordance with all
applicable PCA requirements.
5. Water wells must be abandoned in accordance with State Health Department regulations.
6. Inspection required when all debris has been removed, before backfilling.
7. Within 5 working days of superstructure removal, a final inspection shall be requested. The
site shall be left clean and clear of all debris, with any excavation filled with earth level with
the adjacent ground elevation (except when such excavation is to be used as part of a new
building and such new building is actually under construction).
8. Septic systeins must be abandoned per Minnesota Rules Chapter 7080. All septic tanks
must be pumped, crushed and filled with native soils. An inspection is required after the
tanks are pumped and before the tanks are crushed and filled.
9. The undersigned owner shall and hereby does indemnify and hold harmless the City of
Orono, its agents, employees and assigns from and against all claims, damages, losses or
expenses, including attorney fees, against the City, its agents, employees and assigils arising
out of or resulting from the demolition described herein as performed by the property owner,
his employees, agents, subcontractors or assigns.
PERMIT TYPE AND FEE CALCULATION
� $75.00—Principal Structure
� $50.00—Accessory Structure (how many) (what)
1. Subtotal of above permit requested $ ��� ��
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $ �S . ��
The undersigned herby applies to the City of Orono for issuance of a Demolition Permit, agrees
to do all the work in a strict accordance with the ordinances of the City and the regulations of
the State of Minnesota, and certifies that all statements made on this application are complete,
true and correct.
Applicant's Signature: Date: Iol /'-/
Owner's Signature: Date: �c. �
Approved By: �'� '��-- Date: �Z -i� - O y
' (Building Official)
* Zoning Disclosure Required�?� 1"ES ❑ NO
*This must be filled out by Zoning �part�a�ent—For either answer,a Zoning Official must sign all applications.
* Approved By: Date: �
(Zoning Official)
Reset Form
12-22-'69 12: 07 FROM-�achel Contracting 763-424-9938 T-518 P002/002 F-292
. �
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O���p
Principai OwelUng Demolition Perrrtit •
� � �ONIIVC DISGl�OStJRE � D�CLAR�ITION
To the property cwner. �emolition of the prinoipa! dwal�ng structure on a properly may
automa�cafy terminete certain rights which may have accrued 4o the properiy by�irtue oi thc continued e�dstence of
lhet buiWing.
• Rebullding an�9ubatandard lot df recond(),a,a tot t�t daes nnt mest t�e zoning d�strict required lot anea orwtdth
standards)wIN,wfth few exaeplions,rEquire veriance apprwal by th�Cfty Council,and such appraval is neither
sutomaUc r►�guargnteed but requires Ihat a hardshlp be demonetrated.
. Additivnally, all current zoning standards will have to be mmt by tha new principal dwelting includiny setbacks, lot
ooveraae by siructu�es, hardcover(impervious surface),height limits, etc.
• Where munldpal seu+er is not avafiabis, prpv�sion oi two (2)sites for a �onforming on�site sewags treatrnent
system ia mendatory.
• Unfess specificauy approved by t�e City, aI►acoeesory structures must be remaved at the um�of pr9nclpal dwelllr�q
tfemalftton.Thls�Iso applles to seasonel ahd permansnt docKs.whlch may nai be re-installed unlil a new prinoipal
dwelling�aa r�ach�d th�framing stage.
7he foAowing)nferm�ion is pream�ted far the purposes of ad�rlsfng the property owner ofthe Implicallon�of removal o(
. the inc+ I dwe(Iln on ti�� ro s :
�. Froperty Address: 4�38 Bohns Polnt Road PIN� ae-ii7-23-4�•Oq�3
2. 7_oning Distrlat: 1R-18 Required Lot Area: 1 acras Required Lot Widt� 1�10'
Aclu�l L,ot Area A.89 dry e�ores` Actual Lot Widlh 486�"
•according to a survey an 1'lle dated 12-10�09
Lot�rea variance I /I no required. Lot width wariance Is is not quired,
3. Required Setbacka• F�ront -- __
�ekeshore I.ot: Lake ront) 7'!S' 3treet Rear) 3a' Sidee; 10'
Average Lak�shore 8elb� � u be et n f a 1 bl .
A, Lot Coverage by Structures; 1 1 ea a � �pt >z o
6. Hat+dcover limitations� lic Are not��lioable. 0-76'z�one� a% allowcd
�&2S0'zone�25g6 allowed 260-800'zone�3096 aAowed 600•1000'zone T 369�b albwed
6. �� Municipa�sewer is available.
Municipal sewer is not avallaWe; on�site system tesling and design must be provided confirming thAt Nvo
oonfvrming drai�ield$ites are availeble,
7'. fand(s)present. Wetland is clessifled as" ". A 'buHerfrom the eclgo of wetland and a 20'
siructure setback from the buffer ia raquir�d. '•Taik to Plannin De ertmerst Ateff for additlonal re ulremente.
The utxEersigngd property reby � es receipt o#t �bove ln ation. 8t�ff Inili�ls
�
liZ rQ �1��--�-
Prope ne s 8iqn ture pace
Form ZDO-Revlsed 5-23-05 (Oriplhal: Street Fil�; Copy: Properly Owner)
►vla�ree!fllesl�ohns pt rd�15391zanfnp oleclosure and deda�allon fort►Ldoc �
T ' d Xd.� 13C213Sd� dH WdEZ �S 600Z ZZ �aQ
O�O
�O Principal Dwelling Demolition Permit
�:�.,.�_
� t�'���- ZONING DISCLOSURE & DECLARATION
�, ��o-��'11.,��. �
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To the property owner: Demolition of the principal dwelling structure on a property may
automatically terminate certain rights which may have accrued to the property by virtue of the continued existence of
that building.
• Rebuilding on a substandard lot of record(i.e. a lot that does not meet the zoning district required lot area orwidth
standards)will, with few exceptions, require variance approval by the City Council, and such approval is neither
automatic nor guaranteed but requires that a hardship be demonstrated.
• Additionally, all current zoning standards will have to be met by the new principal dwelling including setbacks, lot
coverage by structures, hardcover(impervious surface), height limits, etc.
• Where municipal sewer is not available, provision of two (2) sites for a conforming on-site sewage treatment
system is mandatory.
• Unless specifically approved by the City, all accessory structures must be removed at the time of principal dwelling
demolition. This also applies to seasonal and permanent docks,which may not be re-installed until a new principal
dwelling has reached the framing stage.
The following information is presented for the purposes of advising the property owner of the implications of removal of
the rinci al dwellin on the ro ert :
1. Property Address: 1535 Bohns Point Road PIN# 08-117-23-44-0023
Required Lot Area: 1 acres Required Lot Width 140'
2. Zoning District: LR-1B Actual Lot Area 4.89 dry acres* Actual Lot Width 466±'*
"according to a survey on file dated 12-10-09
Lot area variance i / is no required. Lot width variance is is not r quired.
3. Required Setbacks: Front -- --
Lakeshore Lot: Lake ront) 75' Street Rear) 30' Sides: 10'
Average Lakeshore Setba : must be met not a licable.
4. Lot Coverage by Structures: limited to 15% of lot area does not a I lot area > 2 acres
5. Hardcover limitations are applicable are not applicable. 0-75' zone = 0% allowed
75-250' zone = 25% allowed 250-500' zone = 30% allowed 500-1000'zone = 35% allowed
6. X Municipal sewer is available.
Municipal sewer is not available; on-site system testing and design must be provided confirming that two
conforming drainfield sites are available.
7. etland(s) present. Wetland is classified as " ". A_' buffer from the edge of wetland and a 20'
structure setback from the buffer is required. **Talk to Planning Department Staff for additional requirements.
The undersigned property owner hereby acknowledges receipt of the above information. Staff Initials
Property Owner's Signature Date
Form ZDD— Revised 5-23-05 (Original: Street File; Copy: Property Owner)
w:�street files�bohns pt rd\1535�zoning disclosure and declaration form.doc
PERMIT
CIT�Y OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: p11252
Crystal Bay, Minnesota 55323 Permit Type: Fixtures
(952) 249-4600 Date Issued: 7/25/2007
SITE ADDRESS: 1535 Bohns Pt Rd Unit#
Wayzata, MN 55391
PID: 08-117-23-44-0023
DESCRIPTION:
Proposed Use: Residenhal
Permit Class: Plumbing
Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 106.25 valuation: $ 8,500.00
State Surcharge Fee: $ 4.25
TOTAL FEE: $ 110.50
APPLICANT: Peoples Plumbing,Heating&Air OWNER: Adam&Kathy Lafavre
18833 Everton Ave.N. 1535 Bohns Pt Rd
Forest Lake,MN 55025 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
��'� �'� �� ---
/----' � � ��'
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, ; ; ;
�'-�--�"'� APPLICANT PERM[TEE SIGNATURE [ SUED BY SIGNATURE
Copies: 1-File(Signatures Xequired), 1-Applicant, 1-Monthly Reports, I-Assessing,(If Septic, 1-Septic) Page 1
�
w � FOR CITY GSE 01LY
' City of'Orono
¢O� P.O.Box 66 Date Received: Permit#
��;;,,, � 27�0 Kelley Parkway
a ]�'���'�,�,-' � Crysta}Bay,IvIN 5�323 Approved By: Amount$:
�?�( ,-U",�.a (952)249-4600
��K�$
CITY OF ORONO –PLUMBING PERMIT
(All Comtnercial permits must be approved Uy the Building Official or Inspector)
GENERAL IN�'ORMATION
1. You may apply for plunzbing pernuts by mail or in person at the City offices. Applications will be
� reviewed and a pemut will be issued within two working days.
2. Peimit 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. Plumbing pernuts may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
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 State Code requirements.
6. All work must be inspected and air tested before it is covered. Call(952)249-4600.
(24-48 hour notice required)
TYPE OF PERMIT
(Check All That Apply)
�Residential ❑ Commercial(Approval Required)
❑ New [�Additional ❑ Repairs ❑ Replace
,�
❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code, Chapter 78,Article IV)
Job Site/ Owner Information:
Site Address: �s�S" !� A f�-t� �OJ=i�'T- \Z r� � Q 0�/1 �
Owner: ,��f�� L,4-��[J�� Mailing Address: �S3 S ���'t 61 ��/. f�f�
City: �(� Zip:
Home Phone: ���„���� �' `l�((� Alternate Phone: ��2— ,3 �S ' � Z g�
Contractor Information:
�
Contractor: Qe�,^ � Contact Person: .S er�rni�, �
Address: 1���3 L"'V��� ��/V State Bond #:
�
City: �tX�S'� �� Zip:Ss��S Expiration Date:
Phone: �9S 1'�/ZZ�'�Yo`y Alternate Phone:
❑ Insurance–Current:
1
i
PLUMBING FIXTURES BEING INSTALLED �
FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2' OTHER
TYPE FL FL TYPE FL FL
Water Closet � Floor Drains
Lavato;y U� Sewer Ejector
�"
Bathtub Laundry Tray
Shower �.` Washer
�.�
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar � �
Sillcocks Miscellaneous
PEP.I`,�IT FEE CALCULATION(S)
BASED OFF - 2002 STATE STATUE `
❑ Yes, this section applies
The replacement of a Residential fixture or ap�liance that meets all tlu•ee of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$�00.00 or less; excludin�the cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeowner or licensed contractor.
Skip next section, if this applies; Cost of Permit $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 1.50
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
PERMIT FEE CALCULATION(S)—JOBS OVER$500.00
If above does not apply; follow guidelines below:
1. CONTRACT PRICE * is 1.25%of conri�act price with a(Minimum Fee of$35.00)
��j��f �4 x.0125 $ 1 C�(�� � .�j
, (contract price) (minimum�35.00)
2. �STATE SURCHARGE ** Add the State Bldg Code Div. Surcharge(A7inimum Fee of$.50)
��(�(' � x .0005 $ y, Z5
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��� �
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
pernutted 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 installations 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 pernut fee puiposes. 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 Building Department at(952) 249-4600 for the price.
PLUMBING PERMIT APPLICATION AGREEMENT
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
Applicant's Signature:���� � Date: �� �
3
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�� ���� ��� CITY of ORONO
��', ,� � �, -� �► '
' �, ' Municipal Offices
�,"�''� � �� G'ti ,;
,, ` Street Address: Mailing Address:
� �9 '�'����� 2750 Kelle Parkway P.O. Box 66
�_,kE38��,=;��� � Y
��—_�=- Orono, MN 55356 Crystal Bay, MN 55323-0066
February 28, 2007
Adam Lafavre
1535 Bohns Point Road
Wayzata, MN 55391
RE: Permits
Dear Mr. Lafavre,
On January 8, 2007 the City notified you of an unpaid permit fee and the requirement of a
permit and inspections for work done in the lower level of your home at 1535 Bohns
Point Road in Orono. A deadline of January 22, 2007 was established for paying the
permit fee, submitting an application for the basement finish and arranging for
inspections.
On February 6, 2007 we met on site to discuss the basement finish. As of this date these
issues remain unresolved. A new deadline of March 12, 2007 has been established for
paying the permit fee and submitting an application.
Corrections on the basement finish must be completed before May 1, 2(J07. If these
deadlines are not met, the City will proceed with legal action. If you have any questions,
feel free to contact me at my office.
Sincerely,
� ����
Ly e Oman
Building Official
LO/bgs
Telephone(952)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
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PERMIT
i,ITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p10866
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
5/9/2007
SITE ADDRESS: 1535 Bohns Pt Rd Unit#
Wayzata,MN 55391
PID: 08-117-23-44-0023
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit T e: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair
YP
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Fireplace Electrical(state)
NOTICES/REMARKS:
Finish Basement
FEE SUMMARY: Permit Fee: $ 3,803.75 valuation: $ 620,000.00
Plan Review Fee: $ 2,472.44
State Surcharge Fee: $ 310.00
Misc.Fee: $ 3,803.75
TOTAL FEE: $ 10,389.94
APPLICANT: Douglas Miller Home Repair Inc. OWNER: Adam&Kathy Lafavre
3413 116th Ln.NW 1535 Bohns Pt Rd
Coon rapids,MN 55433 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUfLDING CODE REQUIREMENTS.
r�
f!
f,
P L PERM TEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page I
C '�- D 7
Total Fee: $ �D/ ��1 � • � DateReceived: �
Entered By: �� ����/�j�;� Permit#: /�/UB�o�o
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(�ilease print al!information)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �535 Bohn Point Road Orono MN ZIP: 55323
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes ❑ No Ifyes, a special event permit is required with Police Department and Ciry Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
suffcient on-site parking is availab/e. Non permitted events will not be allowed. � �
NAME OF OWNER: Aaa'T'LaFa�r� PHONE: (home) (9s2�a�t->>s6
(wOCk� �952)345-0289
MAILING ADDRESS: �535 Bohn Point Rd CITY: Orono Zip: 55323
CONTRACTOR: Douglas Miller Home Repair Inc. PHONE:
CONTACT PERSON: Troy Miranowski MOBILE/PAGER: (612)282-1256
MAILING ADDRESS: 3413 I 16th Ln NW Cj'j'Y: Coon Rapids Zjj�; 55433
STATE LICENSE: # 20390897 EXPIRATION DATE: 03/31/08
ARCHITECT/ENGINEER: N�A PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows) ✓
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detai�: F'"'sh Base"'e°t
STORIES: 1 SQ.FEET OF EACH FLOOR: �loo
NO. OF BEDROOMS: ° GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 6zo,000.00
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 permi±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: 3 - 3C���4 )
31
Sec.13.04 RIGIiTS OF SUB.IECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom[he 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 conceming himself shall bc
informed of' (a)the purpose and intended use of the requested data within the collecting state agency,pol itical subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any kno���n 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 imestigative data,pursuant to section I3.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mayplace the notice required under this subdivision in the individual income tax or pro�ertv tax refund
instructions instead of on those forms.
Subd 3. Access to data by individual. Upon request to a responsible authoriq�,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classified as publ ic,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 notaccurate or complete. An individual may contest the accuracy or completeness ofpublic or private data
conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe 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 corcecL Data in
dispute shall be disclosed only if the individual's statement of disagreement is included Nith the disclosed data.
The determination of the responsible authority may be appealed pursuant[o the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance���ith M.S. 13.04,Subd.2,"Rights of subjects of data",���e 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.
Douglas Fredrick Mil ler
First Middle Last
3413 1 16th Ln N W
Add ress
Coon Rapids MN 55433 (612)598-4677
City State 7ip Phone
I understand my rights as stated above.
C'''(.l.0 � -�
Signature
Reset Form 32
�
. �CHEC� OFF i.,IST FOR ISSUANCE OF PE�'VIITS
FOR OFFICE USE ONLY
�ppRESS ORLE�GAL: lS 3S �30µ-Ns o�N �
PID:
T3ES CRIP'I'IO�T OF WORK: � s e r+�.� n� � � n►�s�+
ZOYt�i 1G REVIEtiV BY: ------�-_____.___ �A'�E APPFOVED: —
BUII�DING REY�tiV BY: DATE APPROVED: H -�-0`1
FEES TO BE CHA�GED:� Misc, Fezs Calculated By:
PERMIT Yes ✓ No
PLAN REVIEtit1 � Yes i/ No SEtiVER CONNECTION
STATE SURCHARGE Yes r/ No tiVATERCONNECTTON
�INVESTIGATION FEE Yes _� No PARK FEE
SAC Yes No SITEINSPECTTON
Number of SAC�Units OTHER (sgecify)
----------------------
ZONi�iG CHE.CK. LIST Zoning Districc: /U � C f-t�_6� ,
Fire Department: Post Office: School District: �
L,ot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: -
Front (Lake): R.ight Side:
Fcear (Streztj: Left Side:
Adjacent Structures: �Vetland:
Buil�lin� Hei�t: Def. Hgt, Peal:Hgt.
Lot Coverage:
Grading: Scaff Approval Date: By: Council Approval Da[e:
Sepcic: Staff Approval Date: By: �..Cl.�
Zoain� File: # Resolutioa: n Resolucion Date:
Shoreland District: Lot Coverzge:
Av�. Setback: Bluff Secba k:
Eciscing Propased
Hardcover, 0-75'
7�-tib'
2�0-560'
500-1 GY;O'
,- t� � D nui-��• V �iQ �i3'._ OF CC�.11CL ���=�Y�;
Li2:C��0'�ZC a 2.:1cuC.. i.�.l�.i� . ZS
F.E�L�.R�iS (in h o u.s e): (�Q►Z 1< ��V� �. (�.; � T� O�S � PC� R.N^�1 —
BUII�DIlYG RE'�IEtiy CHECg LIST
USC: R • 3 � CONST'RUCTION TYPE: �(/v
Sq Footage $ Per Sq Ftg
Basemen[ x = ,
lst Floor x � _ .
2nd Floor x = .
Garaoe X _
z _
TOTAL
Estunated Co�struction Value; $ (oZ���U� �°
Inspections Required: �Vork Requiring Separate Permits:
5ite >( Plumbing Fire
Hardcover Removal �( Mechanical Water Connection
Footing ` Septic Sewer Coaaectioa
� >C Framing _�Fireplace Lawn Irrigation
x Insulation 7C (Masoary) Ocher
� Wall Boazd (Mfg.) Well (State Perm.it)
� Fl°al Grading/Fillin, X Electricai (StaCe Peccnit)
O ther
R.EMAR.K� (TN�TOUSE): ' -- --
-----------------------------------------------------------------------------------
REVIE�V BY OTHERS: DA'I�E:
Access: Existing New
Access Approval: Date By:
----------------------------------------------------------------------------------------
REI�LARKS f,'�'O �E NO'?��'n n�I PEF,� � :
8
� , ,
Scope of work for:
Adam LaFavre Residence
1535 Bohn Point Road
Orono,Mn. 55323
Electrical room-electrical only
Exercise room - framing of exterior walls and soffits, electrical (outlets and lighting), drywall, paint,
flooring, trim
Gym-finishing of drywall,paint and flooring
Furnace room#1 -no work to be done
Main stairway-paint only
Bath/shower-Framing of walls and ceiling,plumbing tied in with existing, electrical (outlets and lighting),
drywall,paint,tile,flooring and trim
Locker room - framing of walls and ceiling, electrical (outlets and lighting), drywall, paint, flooring and
trim
Tanning room - Framing of walls and ceiling, electrical (outlets, lighting and power for tanning bed),
drywall,paint,flooring and trim
Bar and Dance floor - framing of walls and soffits, electrical (outlets and lighting) , plumbing tied into
existing,drywall,paint, masonry around fireplace,flooring and trim
Furnace room#2-no work to be done
Storage rack area-framing of walls,drywall and paint
Billiards room - framing of walls and ceilings, electrical (outlets and lights), drywall, paint, flooring and
trim
Kitchen - framing of walls and ceilings, electrical ( outlets and lighting), drywall, cabinets, paint, flooring
and trim
Batting cage-drywall and paint wall adjacent to storage rack area
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PERMIT
CITY OF ORONO
2750 H:elley Parkway- PO Box 66 Permit Number: p1o144
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249-4600 Date Issued:
5/9/2007
SITE ADDRESS: 1535 Bohns Pt Rd Unit#
Wayzata,MN 55391
P��� 08-117-23-44-0023
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Permit Type: Accessory Structures Permit Sub-type(s): Accessory Structure
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 979.75 valuation: $ 98,000.00
Plan Review Fee: $ 636.84
State Surcharge Fee: $ 49.00
Misc. Fee: $ 979J5
TOTAL FEE: $ 2,645.34
APPLICANT: Owner/Self OWNER: Adam&Kathy Lafavre
N1N 1535 Bohns Pt Rd
Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNE TA BUILDING CODE REQUIREMENTS.
v
• ���/"L.J�fi��--
L[CA1 PERM[TEE SIGNATURE SUED BY S[GNATURE
�
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
� 7_Z��O�
.
.��
Total Fee: (� I� �� � Date Received: �'z��6
Entered By: Permit#: �/D/S��
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before �lan review will be started.
(please p�•int all info�•mation)
-----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (ci�•cle one) OVVNER OR CONTRACTOR
JOB SITE ADDRESS: !s �� ,1�d hrl.s ��`��"(p'C� ZIP:
Will this be a Parade of Homes, Remodelers Show�case Home or other Display Home?
❑ YeS �NO If yes, n special ever7t per•mit is f•eguir•ed tivith Police Departrr�ent and City Cozrncil app�•ovaJ
60 days prior to the event. Shuttle bus se�vice wil/be regi�ir•ed z�nless appllcant dernonstrates
si�cient on-site park-ing!s available. Non-per»��itted evet7ts will not be allol�ved.
NAME OF OWNER: ,��"���f j.�'�'��'�i PHONE: (hon�e)
�/ �� (wock)
MAILING ADDRESS: ��,�.S ��n;S P'�'�ko',CITY: Oh ZIP:
1 LrS�I .1�A��� UjK�I: rSJFTtt�
^,���CONTRACTOR: _ PHONE: �1 Z-�Qp —�j1,,3�
�;� CONTACTPERS N: • '� "& c ;;;� OBILE/PAGER: �(Z- �Qo —/03�
� MAILINGADD - __----____ ����� CITY: ZIP:
STATE LICENSE: �4� Z p c� / '7 6 t�,� � PIRATION DATE:i�� �3 � ���
ARCHITECT/ENGINEER: ��G�l�' qt�on� L1��`. PHONE:
MAILING ADDRESS: � CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure �
Move Home RemodeVAlteration ���� �
�--.
�ROPOSED�WO�(��ribe i�detai�: v l.�n.�cc,�rn S� l.•i�.��S, �oS. ��r�� i(,�
� ' °� , . �rtii�r-GEyt�c �
S'TOI�I�S: SQ.�'�E"�'OF Et�CH�'�,OOI�:
NO. O�'BEDROOMS: GARAGE STALLS: ATTACI�EI9 DE'I'AC�IEI�
�S'TIIVIA�'ED COI��'TR�JQC'TIOIl�VA�,�1��'I�I�(exeluding land): �- _` g � ��. d f�
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate;
that the�vork will be in conformance with the ordinances and codes of the Ciry and with the State Building
Code;that I�inderstand 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.
ap��ic�vT'S SIGNATURE: �� . � /S�
�
DATE. D,�
31
1
Sec.13A�1 RIGHTS OF SUBJECTS OF DATA
0
Subd. L Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in diis section.
Subd.2. InY'onnation required to be given individual. An individual asked to supply private or confidential dataconcerning himselfshall be
infonned ot`. (a)the purpose and intended use of the requested data�vithin the collecting state agency,political subdivision,or statewide system;(b)
whether he may reftise or is legally required to supply 8�e 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 mayplace the notice required under this subdivision in the individual income tax or property taa 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 whethe�he is the subject of
stored data on individuals,and whether it is classified as public,private or ca�6dentiaL Upon ltis further request,an individual who is the subject of
stored private or public data on individuals shall be shown the data�vithout 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 infonned of its meaning,the data need not be disclosed to him for six
months thereafter unless a dispute or action pursuant to d�is section is pending or additional data on the individual has been collected or created. The
responsible authoriry shall provide copies of the private or public data upon request by the individual subject of[he 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 ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canno[comply with the reques[
within that time,he shall so infonn die individual,and may have an additional five days�vithin which to comply with the request,excluding Saturdays,
Sundays and le�al holidays.
Subd.d. Procedure when data is not accurate or comple[e An individual may contest die accuracy or completeness of public or private data
concernine himself. To esercise this right,an individual shall notify in��Titing the responsible aud�oriry describing the nature ofthe disagreement. The
responsible authority shall���ithin 30 days eithec (a)correct the data fowid to be inaccurate or incomplete and attemp[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 tlle individual's statement of disagreement is included with tlle disclosed data.
The determination of the responsible authority may be appealed pursuant ro the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2,"Ri;hts of subjects of data",we would like to inform you that your request
for a pennit 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 infomiation you furnish wifl 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 Ciry 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 Nliddlc Last
AdUress
Cih� State Zip Phonc
� unde tand m rights s stated abo��e.
i ,
�gn t rc
,�
CHEC�K OFF i�IST FOR ISSUANCE OF 3?E�2.i.'VIITS
FOR OFFICE U ONLY
ADDRESS OR LEirAL: /53S �oNN.S a,�% �'�
PID:
DESCRIPT�ION OF WORK: u,vr�h•�s � eyvt ��` �3 G¢•�s �.v
------ --- ------ — -----------------
ZOV�IG REVIE`V BY: _.-- AATEAPPROVED: 7-l�i�D6
SUII�DING REVIEtiV B DATE APPROVED: -�-�y-Ob
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIE`V � Yes �,��/ No SEtiVER C0�INECTION
STATE SURCHARGE Yes ___,/_�L No `VATERCONNECTION
INVESTIGATION FEE Yes ✓ No PARK FEE
SAC
Yes No -�� SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�tI�1'G C�CK LIST Zoning District: �,
Fire Department: Post Office: School District: �
I,ot Area: Sq.ft. Acres Widch Depth
Survey Submitted: Yes _ L No Date of Survey: (- 6-�S'
Proposed Setbacks:
Fron[ (Lake): Ri�t Side:
Rear (Screet): Left Side: � ��
Adjaceot Structures: bVetland:
Buildin� Hei�t: Def. Hgt, /lJ (�}- _ Pea.k Hgt.
Lot Covera�e: N l t/1
Gradino: Scaff Approval Date: (� �4�-- By:�_ Council Approval Date: '
�
Septic: Scaff Approval Date: /�! (,� �Y� .
Zoain� File: n -- Resolution: # Resolution Date:
Shoreland District: .
Av�. Setback: � ��C Bluff Secback: /J (/� L.o[Covera�e: /J ��
E�istina Proposed
0
Hardcover: 0-75' D
75-25Q' -��.�
2�0-500' �Y
500-1000'
Ha�dcover Variance Required: Yes No � Da�e of Council Approval:
RE1L�4R�iS (in house):
BUII..DING REVIE�V CHECK LIST
�C� �- CONSTRUCTTON TYPE:
Sq Footage $ Per Sq Ftg
Basement X _
ls[ Floor x � _
2nd Floor x _
Garage x _
z =
TOTAL
Estimated Construction Value; $ cj pjfQ�p °�
Inspections Required: �Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Coanection
Footing � Septic Sewer Connectioa
Fr��g Fireplace Lawn Irrigation
Insulation (Masonry) Ocher
Wall Board (Mfg.) Well (State Permit)
�F�� Grading/Fillin� Electrical (State Permit)
O ther
REMARKS (IN HOUSE): ��.=K � �,�- ��� � - --
---------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By;
, -----------------------------------------------------------------------------------------------
xEtiz�s cro s�rro�� Q�PE��r�;:
�
�
8
(1�+�€� F'a t�/5 L.ct�.r t��+.R�r�►G- , �y,� ��, p:�+r r �, r l i�.�c.� s
� '�'� �k
� • ' �Jl ����J � �� ; � y �1�1'�iQ�irL�'j'
�� . ,�I'�41.��= � ,-�ri�t.✓�r..i- �����t� 1,� �; �_6 oS
HAItDCOVLR CALCULA1IUN 1�VURI{S�IEET
• S�;TIiAC;K ZOIVE: (CIl2CLE ONE) 0-75' 75-250' 250-500' S00-1000'
E,Y.IS'I'JNG HARDCOVER IN ZONE
A, i-iouse x = 5.F,
Length � Width
_ x = S.F.
x = S.F.
... � = S.F.
B. Gorage x = S.F. ..
C. Dnveway x = S.F. '
� — � S.F.
D. Sidewalk �c = S.F.
'� = S.F.
E, Patio/Deck x = S.F.
..... . . � = S.F:. .
F. Landscape x = S.F.
Underlain x � S.F.
� By Plastic x = S.F.
Or Fabric
G. Ocher x = S.p,
TOTAL HARDCOVER IN ZONE - O S.F. A
TOTAL PROPBRTY A�tEA IN ZONE - Sl�,� O�D S.F. B
.. A = B _ x 100 = Q %
PROPOSED HARDCOVER IN ZONE' .,
A. House x = S.F.
Length Widch
x = S.F.
x — S.F.
.. X = S.F.
B. Garage x . = S.F.
C. Driveway x = S.F.
._... . . _ _ . x = S.F.
D. Sidewalk ;� = s,p.
x = S,F.
E. Patio/Deck x = S.F.
x = S.F.
F. Landscape x = S.F.
Underlain � = S.F.
_ By Plastic x = S.F.
Or Fabric
G. Other � x = S.F. ..
TOTA1.�-U�.F2UC.OVER IN ZON� - � S.F. A
TOTAL PROP�RTY AREA IN ZONE - �'�;�??� S.F. B
A - B x 100 = � %
�
�
Ju1-10-2006 OB:36am From-CITY OF ORONO +9522494616 T-583 P.002/002 F-328
.. � �tSs�e'� �'�'1`",�k�M� �s�+�1 i�;�{'3 8�F�� � ��� �� �.�..�t,'.� 3
� � g�t� t �����
� �TAIZDCOV��2 Cf�LCU1�A�Tl.ON �VURI{S�EE'�' �- �' °5
� ' SET1iA.CTC ZOIVE: (CT�tCLE OI�) 0-�5' �-z�U' 250-50u' 500-l000'
EXIST]NG T-T�.�tl�C4'V�Tt IN ZOI�'�
A. House _ x = lOf ZSD S.F. -Nov;�
l.�nsch W idtt,
.. ;� = S.F
x = S,F.
._. � 3 x �, D = S� S.F. -SN��
� H. Garagc x - S.F. -
C. DrivzwaY X = S.F. -.
x = S.F,
T�. Sidewalk x = 11�' S,r, �R�2+Gi� �hr�is.z'
`� = S.F.
E. Pa[io/Deck x � I ��/(,� S.F.-�'2{cK ��'�`�
...__.. , . . .. , . � . = Ih�G7-. �.ur.Gi,�
S.F.
�oci< aN
F. Landscape x � = 5 q B p S.p.- �.�g���
Unde;lain x - 5,�,
.. $y Plasiic x � - S:F.
Or Fabric .
G. O�hzr x - S F.
1'dTAI.I-�ARDCOVER IN ZOh� • S.P. A
.. TOTAL p�C7�'E�TY f�A TN ZONE - 5.�. B
... � ►�.�,�� �° � ,��'l3� � i oo - 2� ,q.�q.�la _°io
0
�'$:4��'�.s��A K_�,a�R��?v�R IIY�,OIYE� ..
A, I�ouse x - l j .� K S F
... Lsn�th Width ( 'P„J' l'� ��qtS.F.�� o��rP� ��°,9�"f,S�'f�
x � ,�`
X = s,�.
_ . x � s,�.
8, =��e I'cA�f s,�f-�ziip' Zl s� x ��"1 S�T"�=�l9D s� .� �D� , ir�YY s<�fi��
d�S��_ 5 J876.5 P�1acr✓ SP�i�'�-�T.'
C.'L?' +�y �,,�,,.. � I s��,s-sF x I'�f`"c.�°�'�+-��q.t�,_ �`a.s�:¢ 9� s�.r ��C.�"'�.
...... , , �7)32ir:'I�f.F}'L�.2�91nE-f c �S�• JG — ' jQ P�J70�`J,�','�32��f?L/{�c.!'
/ o� vv�au�M'o: 3 sF -f- sF+- 62 P�ocs� �
D, Side�vatk r� ���--X 1� P��'`�- 3�'� = 324 o S.�'.
� ��;1°,d7�..� �i�--
... � �1��1 S x $ 4�" _Eyf�,�'r�,�.
�, �6418/DEGk �° ��? �ygSP x S S4 „�,�"?.��_. ,�'.
��j'9�te�i�4.� %�',5'� X = 5���.�. 1�L7;F"l�1
,r F. Lar�dscape ��3�l���=1 l�.s1� x _ _ ��S''?�t��.''.�'•
Underlain ""Q'� � = S,F.
_ .. Hy:�lastic , x � S.�',
Or Pabr[c
_ _- -- - --
G, t�ther • x = S,F. ..
—------
�raTa�t-t�a�c.ov��rnr.zo� . �S$��°�� :s.F, �
� ror�,p�op���r�a�,a�r�or� • � �,t�,� s,�. s
� A ...,�,�,�.,5 t� + � �1�,._..._, x I OC� _ %
. ,��r,��
—I i���Z �,�ws L�►���.a������ z..ar ar �.��:� �
� ' B�:�i-� �
��t�',�7
� r HARDCOVER CALCULATIC)N �VOI2I{SEIEE'T ��'��
SETBACK ZONE: (CIRCLE ONE) 0-7�' 75-2�0' �0-500' S00-100U'
EXISTING HARDCOVER IN ZONE
A. House x = (S7 Fi I S.F. ��-+��'���
Length W id�' C OV�t2 E 1�
� = 5 S I s.F. - v,�r��i�w.�y
x = S.F.
� �� 9 _ x I o.u- = 1 1 3 S.F.-Pw� Ha�sE
B. Garage x = S.F.
_ p�1v+��
C. Driveway x = f/-k;7�i-Z SF. --'��r,�,���r�r
�; = SF.
D. Sidewalk x (0�2.35�- 2�S� _ �� S.F.-ss�F��
.� _ �� S.F. -giz�G�
S1Gtop
E. Patio/Deck x = S.F.
._.. _ _ x = S.F..
RouL �r�
F. Landscape x = Z�}-�j S.F.- F',n,�q�s�
Underlain x = S.F.
Bv Plastic x = S.F.
Or Fabric ,
� 5 to�F g��� ,
G. Ocher i3p1c " Z�� ;� w.��.�.s = 3��" = 3�� S.F.
TOTAL HARDCOVER IN ZONE - ZZ, 87y- S.F. A
TOTAL PROPERTY A�2EA 1N ZONE - Sb, I 9 D S.F. B
._ A 2�_B7�' = B � I D x 100 = 26.5�1" %
PROPOSED HARDCOVER IN ZONE� -
A. House x = � 7�Q� S.F. �l/yt��
_. Length W i dth ��/ LO�'�f��
X = S.F. ►v�t,�cu+a^l
���,u��� �,�,o = 38�-ri�o = 5r� S,� = 5i� s.F. �+,+���.,,y
. qu- (�ooc,�Foun.t�1N= �03 8 SF x _ _ �D 38 S.F.,h,r.:po���
t3�t5inrs � Arowu�� MA+r.v�u= `{5° "'"r�""`�ee-",°�
B. Zr�e IVIi1�'411,LW���Dr� = x`r5a�` 35s� - �5 ixo�✓v,ne,vrS.F.�^��
o ON o�
P 2n /9;250 �
C. Driveway = �4�250 X SPo�Ceu�'= 01 72,5 s� - I o72,5 �+�rS.F.
_..._ __ - x �wM�c-r-arLca<�= 3osF = �ao �+'�S.F Gouax'
�IS 5� G 4-S�cr/
D. Side�valk ��J = fi1Ss� � P�^ � s�rturr�-y = �F = �p �'es°`'�S.F. �i Snh+titR�
W�y� 4-se+tsoN= 56 s�_ X = �(v1 wm.u�MS.F.G�-s�itae�v
E. Pa eck w��bI��A'Y = 13� x _ 1.30 �'A+a-� S.F.�"�✓�?'
X S.F.
F. Landscape x = S.F.
� Underlain ,� = S.F.
_ By Plastic - x = S.F.
Or Fabnc N�✓� (c��s1; SP-�u� ,f.[.�.t1►�c. R�C.
l�c"`��-tk.i ' N��'�l.f1;
G. Ocher �`-�hzl�gdk' ZOS+� x 3 s�- - 354 S.F. gpactc g,�,rtfr�
TOTAL HARDGOVER IN-ZONE
����,5 s.F. _�
TOTAL PROPERTY AREA IN ZONE - � IO S.F. B
A Z GJ,'l 2�i S = B �v I O x l 00 = ��."��_%
' �'�-738--�826 CF&l l :,....,
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' ? �`� C ITY of ORONO
��
/ i'�'�e� A- ;I
,'�, � r rr
� 'y il i !� MunicipalOffices
� � � G~ Street Address: Mailin Address:
S
`9�tEggOg'� 2150 Kelley Parkway P.O. Box 66
_ _- � " Orono, MN 55356 Crystal Bay, MN 55323-0066
May 3, 2006
Bever Landscape
David Sonka
7309 Lake Dr.
Lino Lakes, MN 55014
RE: 1535 Bohns Point Road
Dear Mr. Sonka,
Late last year you were involved with work being done at the Adam and Kathy LaFavre
residence at 1535 Bohns Point Road in Orono. The work included extensive landscaping and
entrance gates. The gate issue was resolved with The City but a permit has not been issued for
the work. The City needs the improvements shown on a survey with hardcover calculations to
detennine if the project is within allowed setbacks and hardcover limits. Please submit the
survey and hardcover caiculations before iviay 15, 2006. ti review will be completed and if
found in compliance a permit can be issued and the matter can be closed. Please feel free to
contact me at my office if you have any questions.
Sincerely,
�
� ����---
Lyl�Oman
Building Official
LO/dml
Telephone(952)249-4600 • Fax (952j 249-4616
�i'W�i'.Ci.orono.rnn.eas
� o�
0 0�
� � � �� - �'� CITY of ORONO
,I '�� r r�� ,�;i
, r��,, }�ti�' '� ''f�`' � !4/� Municipal Offices
�'\� �I� �� �j;; I9� ti/
� .� ��� ,��'��G/ Street Address: Mailing Address:
�`��CEggO�/ 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
June 22, 2006
Bever Landscape
David Sonka
7309 Lake Drive
Lino Lakes, MN 55014
RE: 1535 Bohns Point Road
Dear Mr. Sonka,
On May 3, 2006 this office notified you of information needed to complete the review of
work that has been completed at the LaFavre residence at 1535 Bohns Point Road in
Orono. As of this date the information has not been received. Since this work has long
been completed the City must require you to submit the information before July 10, 2006.
If this deadline is not met the City will initiate legal action. Please feel free to contact me
at my office if you have any questions.
Sincerel ,
�
Ly e Oman
Building Official
LO/bgs
�nc, 5/3/06 letter
Telephone(952) 249-4600 • Fax(952)249-4616
www.ci.orono.tr�n.us
PERMIT
�,IYY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Po9o56
CryStal Bay, Minnesota 55323 Permit Type:
User Defined
�952) 249-4600 Date Issued: 8/16/2005
SITE ADDRESS: 1535 Bohns Pt Rd Unit#
Wayzata,MN 55391
PID: 08-117-23-44-0014
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Lawn Sprinkler
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Able Sprinkler OWNER: Jacob Holdings of Bohns Pt LLC(A&K LaFavr
1034 E.2nd Ave 1535 Bohns Pt Rd
Shakopee,MN 55379 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORD[NANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
, � ��\
�^� � �;, �--C �...,!�1�'�'G-�_(� J
;
APPLICANT PERMITEE SIG TURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, l-Septic) Page 1
, . �o�o��
- ��5�
i
Please check one: New Addition '' Limited Energy Technology y �
Systems License #_/�"(�r� i;L ;� ,.: �
JOB SITE �,;.� �j S ��G� 1'},�l S ,��- ��-
Owner's Name_ �O'�I� ��'/��(I r� Telephone Number
MailingAddress /--5�.� �� G; �S / �� /\ G'�� � �'� ti p
Sprinkler Contractor's Name �'���:t- ;��'%'���J��(��. �r�` Telephone Number ��-=' :� ���-' � ° ���
Contact Person �;/�c 4��_�� �-����`���
� / _.��� ,
Mailin�Address , j��%.;� ��� .�'�.�,;; „�./��� , ��� __ � �� ��_ � ,�' :, _. �r,' � � ,�J .� i �
`VATER SUPPLY
Lake� Well City
BACKFLOW DEVICE
AVB PVB " S�t-"��j �- --
` �' '��S' ►
'� Year of
Make Model Manufacture uantit
Sprinklers
TOTAL
HYDRAULIC CALCULATIONS Design Data:
Area of Application: Sq. Ft.
Coverage per Sprinkler: Sq. Ft.
No. of Sprinklers:
Total Water Required: GPM
PERMIT FEE CALCULATION
1. Permit Fee $ 35.00
2. State Surcharae $ .50
3. Mail-In Fee $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $
The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to do
all work in strict accordance with the ordinances of the City and State regulations, and certifies that
all statements made on this application are complete, true and correct.
�..�� � . �' ,, .
. �„ �
Applicant -��% -/-%'� . ��� Date 'r - _ ;�/
� �,
******��*********�**:�*x�*********************�************************************
Approved `'� �/ p ved w' � 'ons �"' Denied
���C./�.1.�� ��C�;,� �
� - f S �� S
Reviewed By: Date
CITY OF ORONO
APPLICATION FOR LA`VN SPRINKLER SYSTEM PERIVIIT
GENERAL INFORIVIATION
1. You may apply for sprinkler system permits by mail(P.O.Box 66, Crystal Bay,MN 55323)
or in person at the City offices (2750 Kelley Parkway). Submit plans for revie�v with this
application.
2. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT
BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE.
3. When any new construction or remodeling is involved, a separate building permit must be
obtained.
4. All work must be done in accordance with City and State Building Code requirements.
5. T�vo (2) sets of working plans shall be submitted for approval to the authority having
jurisdiction before any equipment is installed or remodeled. Deviation from approved plans
will require permission of the authority having jurisdiction.
Workin�plans shall be drawn to an indicated scale on sheets of uniform size with a plan of
the site so that they can easily be duplicated and shall show the following data:
a. Name of owner and occupant.
b. Location, including street address.
c. Point of compass.
d. Location of septic system if applicable.
e. Source of water supply.
f. Pipe size.
g. Pipe location.
h. All control valves, check valves, drainpipes.
i. Name and address of contractor.
6. All work must be inspected (final). Call (952) 249-4600.
24-Hour Notice Required
INSTRUCTIONS Complete all items on this application. Incomplete applications will not be
processed. If you have questions, call (952) 249-4600. You will be notified by phone when the
permit review is complete.
.- PERMIT
�i-rY. O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Pos4i2
Crystal Bay, Minnesota 55323 Permit Type: Mechanical Permits
(952) 249-4600 Date Issued: 2i4i2oos
SITE ADDRESS: 1535 Bohns Pt Rd
Wayzata,MN 55391
P I D: 08-117-23-44-0014
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Mechanical Permits Permit Sub-type(s): Multiple Mechanical Items
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 212.50 Valuation: $ 17,000.00
State Surcharge Fee: $ 8.50
Misc.Fee: $ 1.00
TOTAL FEE: $ 222.00
APPLICANT: Owens Companies, Inc. OWNER: Jacob Holdings of Bohns Pt LLC(A&K LaFavr
930 E. 80th Street 1535 Bohns Pt Rd
Bloomington,MN 55420 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
.
—/�'�1W—"� i(/►�' ���,�'�L.�K �
APPLICANT PERMITEG SIGNATURE UED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports. 1-AssessinQ, 1-Finance Page 1
, CITY OF ORONO APPLICATION FOR MECHAIVICAL PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 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 two 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 Desi�-Complete calculations,details and specifications are required for each
re`�tl!1g>YPIIt:l�ut:0:1, �2;:21224;f C?atiGii-u��llilTlliilf CAt10I1�3T]Q 11T COI1d1t10111Ilg 11]Stal�$t10I]
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(952)249-4600.24-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 (952)249-4600.
Please check one: New �,,f�
Addition Repair _�___Replace
. Residential Commercial
JOB SITE: \'��`'> ��o��v� � �
5 \ v . ;� ,,__ _� ` Zip: `1� `1 �
Owner's Name: �JS1��.v� �c,�=�;.. °; , - ' Phone Number: e, � j,- ,�C, �- 1 1 S:h
Mailing Address:��'�� ��ch,nti ���� � 12i) City:�,;� .,�t�� Zip: `.��
Contractor's Name: (,�,����5���� �r��t � phone Number: �' "� '
Mailing Address: �) -,C �= w� ,. � �`�� `">> \� ��'�C'��;
`� ��� �
CitY��\oc,n«.� � � Zip: ��`;y,�L,
�
' SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity: �;,
Make: \S'Gv�L
Model: \v.��'� y l% �.'`'t V_�'iL
FueL ,v [^� `—
� J
Flue Size:
Input BTUs: �1� �,� ��,
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
Gas factory fireplace
Wood burning factory fireplace with flue
Wood Stove
Wood stove with flue
Brand Name Model No.
VENTILATION
No. Kitchen Exhaust duct recalculating cfm
No. Bath Exhaust(must have duct outside) cfm
No. Other Fans:Locations cfm
FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL)
Installation or Removal
Fuel oil: gallons underground inside or outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION(S)
,
2002 State Statute Yes This Section Applies
The replacement of a Residential fixture or appliance that meets all three of the following
requirements:
1) Does not require modification to electrical or gas service.
2) Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance:
and
3) Is improved, installed or replaced by the homeowner or licensed contractor.
Skip next section; Cost of Permit $ 15.00
Sta�e Surcharge $ .50
Mail-In Fee $ 1.50
If above does not apply, follow guidelines below:
1. Contract Price* is .0125%of job with a Minimum Fee of($35.00)
I i UCC� . �b x .0125 $ -� � � _(. (�,
(contract price) (minimum$35.00)
2.State Surchar�e. ** Add the State Building Code Division a Minimum Fee of($.50)
\1�C G C C��I_; x .0005 $ L� '��.
(contract price) (minimum$.50)
3.Posta�e and Handlin�(On[y mail-in applications) $ 1.50
4.TOTAL PERMIT FEE(Add lines 1-3 above) $ �,��� C..?(\;
'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 is 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
:he ac.uu:coctract.
**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 undersib ed 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:��;��E.. _ -�����v�v�,ti- � Date: � �� �' �
Approved By: Date:
' Reset Form
Company Name Owens Company SYstem Desifln ����, �= .
Company Address 930 e BOth � Design Temperature �
Company Phone 952 854 5800 �,.,,,��z ? � Indoor Outdooc
Customer Name Adam LaFaver Summer 75 95
Sales Person al/owens Winter 70 -12
City Minneapolls/St.Paul AP 50 °/RH 33 Grains _
Dall Ran e M ,
o e ouse o e ouse
Ceiling Height z0
Room Area
Area or BTU Dir. Lg[h. Area BTU Dir. Lgth. Area BTU
Component Type Bullding Component HTM BTU Dir. Lg[h. Area .
Lnth
Ht CI Heatin Coolin Heatln Coolin Heatin Coolin Heatin Coolin
Net Ex osed Wall
asonry a s oc or nc
Flnished or Unfinished 2' -5�
Below Grade Below Grede 8"
or 12"Block+R-19 2.788 0 528 1472 0 E 48 528 1472 0
2,788 0 324 903 0 N 36 324 903 0
2.788 0 324 903 0 S 36 324 903 0
2.788 0 432 1204 0 W 48 432 1204 0
0o rame x erior a s
with Sheathing&Sldi�g
Above Grade R-19 1/2"
G sum Brd R-0.5 4.92 1.416 1628 6010 2305 E 48 1628 8010 2305
4.92 1.416 706 3a74 1000 N 48 706 3474 1000
4.92 1.416 806 3966 1141 S 48 806 3966 1141
4.92 1.416 1352 6652 1914 W 46 1352 6652 1914
Window&Glass Doors
Standard Wlndow Single Pane
&Storm Wood Frame No
. .. Extemal Shading Clear Glass -�
Dra erfes or Venetlan Blinds 38.95 46 100 3895� �4600 E 0 100 3895 4600
38.95 16 42 1636 672 N 0 42 1636 672
38.95 25 22 857 550 S 0 22 857 550
38.95 46 140 5453 6440 W 0 140 5453 6440
ing ass oor ou e
Pane Wood Frame No
External Shading Clear Glass
Dra erles or Venetlan Blinds 45.18 16 80 3615 1280 N 0 80 3615 1280
45.18 46 200 9036 9200 W 0 200 9036 9200 .
Doors
Metal Door Fiber lass Core 48.36 13.92 36 1742 501 N 0 36 1742 501
48.38 13.92 36 1742 501 S 0 36 1742 501
48.36 13.92 36 1742 501 W 0 36 1742 501 , ,
Ceilin s
ei ings n er a ent�a e
Attic Space-Dark Color R-44
Insulation 1.886 1.012 1200 2263 1214 40 1200 2263 1214
Floors
Basement F oors or More '
Feet Below Grade ,1.968 0 1920 3779 0 48 1920 3779 0
Infiltration 71 8 692 49456 5361 49456 5361
Sub 7otal Heatin BTU's 111798 111798
Duct Loss HTG 1 � �
7otalHeatin BTU'S 111798 111798
CFM Heatin 0 0
Peo le and A liance 2400 2400 ,
Sensible Gain BTU's 39582 39582
Duct Gain CLG 1 � � .
Total Sensible BTU'S 39562 39582 .
latent Coolin BTU'S 6388 6388
TotalCoolin BTU's 45970 45970
CFM Coolin 2117 2117
Created using Comfort Op[Imizer 2.0.Opportuni[y Interactive Inc.,www.Opactive.com
Company Name Owens Company System oesign
Company Address 930 e 80th Design Temperature
Company Phone 952 854 5800 Indoor Outdoor "
Customer Name Adam LaFaver Summer 75 95 •
Sales Person al/owens Winter 70 -12
City Minneapolis/St.Paul AP 50 %RH 33 Grains
Daily Range M
o e ouse o e ouse -
Ceilin Hei ht 16 '
Room Area
Component Type Building Component HTM Area or gT� Dir.Lgth. Area BTU Dir. Lgth. Area BT� Dir. Lgth. Area BTU
Len [h
Ht CIg Heating Coolin Heatin Coolin Heatin Coolin Heating Coolin
Net Ex osed Wall
asonry al s ock or ric
Finished or Unfinished 2' -5�
Below Grade Below Grade 8"
or 12"Block+R-11 4.182 0 192 803 0 5 48 192 803 0
asonry alls ock or nc
Finished or Unfinished 2' -5'
Below Grade Below Grade 8"
or 12"Block+R-19 2.788 0 360 1004 0 E 36 360 1004 0
2.788 0 480 1338 0 N 48 480 1338 0
2.788 0 360 1004 0 W 36 360 1004 0
0o rame x erior Wa Is
with Sheathing&Siding
Above Grade R-19 1/2"
G sum Brd R-0.5 4.92 1.416 598 2942 847 E 36 598 294Z 847
4.92 1.416 688 3385 974 N 48 688 3385 974
a.92 1.416 804 3956 1138 5 48 804 3956 1138
4.92 1.416 404 1988 572 W 36 404 1988 572
Window&Glass Doors �
Standard Window Singie a- �
&Storm Wood Frame��, �
External Shading Clear Glass
Dra eries or Venetian Blinds 38.95 46 50 1948 2300 E 0 50 1948 2300
38.95 16 60 2337 960 N 0 60 2337 960
38.95 25 60 2337 1500 S 0 60 2337 1500
38.95 46 88 3428 a0a8 w 0 88 3428 4048
i ing ass oor ou e
Pane Wood Frame No
External Shading Qear Glass �
Dra eries or Venetian Blinds 45.18 16 80 3615 1280 N 0 80 3615 1280
45.18 46 120 _ 5422 5520 W 0 120 5422 5520
DOOrS
Me[al Door Fiber lass Core 48.38 13.92 36 1742 501 N 0 36 1742 501
48.38 13.92 36 1742 501 W 0 36 1742 501
Ceilin s
Ceilings Under a Ventilated �
Attic Space-Dark Color R-44
Insulation 1.886 1.012 1200 2263 1214 40 1200 2263 1214
Floors
� Basement Floors 2 or More
Fee[Below Grade 1.968 0 1920 3779� � 48 1920 3779 0
Infiltration 76 7 530 40490 3527 40490 3527
Sub Total Heatin BTU'S 85520 85520
Duct Loss HTG 1 0 0
Total Heatin BTU'S 85520 85520
CFM Heatin 0 0
Peo le and A liance 3000 3000
Sensible Gain BTU'S 27883 27883
Duct Gain CLG 1 0 0
Total Sensible BTU's 27883 27883
Latent Coolin BTU's 4978 4978
Total Coolin BTU's 32861 32861
CFM Coolin 1334 1334
Created using Comfort Op[imizer 2.0.Opportunity[nteractive Inc.,www.Opactive.com
Company Name Owens Company System Design
Company Address 930 e 80[h Design Temperature
Company Phone 952 854 5800 Indoor Outdoar
Customer Name Adam LaFaver Summer 75 95 '
Sales Person al/owens Winter 70 -12
City Minneapolis/St.Paul AP 50 %RH 33 Grains
Dail Range M
o e ouse o e ouse
Ceilin Hei h[ 16 �
Room Area
Componen[Type Building Componen[ HTM Area or g7� Dir.Lgth. Area BT� Dir. Lgth. Area BT� Dir. lgth. Area BTU
Len h
Ht CI Heatin Coolin Hea[in Coolin Hea[in Coolin Heatin Coolin
Net Ex osed Wall
asonry alls oc or ric
Finished or Unfinished 2' -5�
Below Grade Below Grade 8"
or 12"Block+R-11 4.182 0 192 803 0 5 48 192 803 0
asonry a s oc or nc
Finished or Unfinished 2' -5�
Below Grade Below Grade 8"
or12"Block+R-19 2.788 0 360 1004 0 E 36 360 1004 0
2.788 0 480 1338 0 N 48 480 1338 0
2.788 0 360 1004 0 W 36 360 1004 0 _
0o rame x erior al s
with Sheathing&Siding
Above Grade R-19 1/2"
G sum Brd R-0.5 4.92 1.a16 598 2942 847 E 36 598 29a2 847
a.92 1.a16 688 3385 974 N 48 688 3385 974
a.92 1.416 804 3956 1138 S 48 804 3956 1138
4.92 I.a16 404 1988 572 W 36 404 1988 572 _
Window&Glass Doors -
Standard Window Single Far:.�
&Storm Wood Frame Nc �
External Shading Clear Glass
Dra eries or Venetian Blinds 38.95 46 50 1948 2300 E 0 50 1948 2300
38.95 16 60 2337 960 N 0 60 2337 960
38.95 25 60 2337 1500 5 0 60 2337 1500
38.95 46 88 3428 4046 W 0 88 3428 4048
liding ass oor ou e
Pane Wood Frame No
External Shading Clear Giass
Dra eries or Venetian Blinds 45.18 16 80 3615 1280 N 0 80 3615 1280
45.18 46 120 5422 5520 W 0 120 5422 5520
Doors
Me[al Door Fiber lass Core 48.38 13.92 36 1742 501 N 0 36 1742 501 _
48.38 13.92 36 1742 501 W 0 36 1742 501
Ceilin s
eilings Under a Ventila[ed
A[[ic Space-Dark Color R-44
Insula[ion 1.886 1.012 1200 2263 1214 40 1200 2263 1214
FloOrs
.asement Floors 2 or More
reet Below Grade 1.968 0 1920 3779 0 48 1920 3779 0
Infiltra[ion 76 7 530 40490 3527 40490 3527
Sub To[al Heatin BTU'S 85520 85520
Duct Loss HTG 1 � �
Total Hea[in BTU's 85520 85520
CFM Heatin 0 0
Peo le anA A liance 3000 3000 _
Sensible Gain BTU's 27883 27883
Duct Gain CLG 1 0 0
Total Sensible BTU's 27883 27883
Latent Coolin BTU's 4978 4978
TotalCoolin BTU's 32861 32861
CFM Coolin 1334 1334
Created using Comfort Op[imizer 2.0.Opportunity Interactive Inc,www.Opactive.com
Company Name Owens Company System Design °
Company Address 930 e 80[h .�Design Temperature ,
Company Phone 952 654 5800 Indoor Outdoor
Customer Name LaFaver Summer 75 95
Sales Person al/owens Winter 70 -12
City Minneapolis/S[.Paul AP 50 %RH 33 Grains
Dail Ran e M -
W o e House o e ouse '
Ceilin Hei ht 18
Room Area 1
Component Type Building Component HTM Area or BTU Dir. Lgth. Area BTU Dir. Lgth. Area BT� Dir. Lgth. Area BTU
Ht CI Heatin Coolin Heatin Coolin Heatin Coolin Heatin Coolin
Net Ex osed Wall
0o rame x enor a s
with Sheathing&Slding
Above Grade R-11 1/2"
G sum R-0.5 7.38 1.416 432 3188 612 E 48 432 3188 612
7.38 1.416 342 2524 484 N 38 342 2524 484
7.38 1.416 342 2524 484 S 38 342 2524 484
7.38 1.416 432 3188 612 W 48 432 3188 612
0o rame x erior a s
with Sheathing&Siding
Above Grede R-19 1/2"
G sum Brd R-0.5 4.92 1.416 787 3872 llla E a8 787 3872 1114
4.92 1.416 593 2918 840 N 38 593 2918 840
4.92 1.416 618 3041 875 S 38 618 3041 875
4.92 1.416 733 3606 1038 W 48 733 3606 1038
1h indow&Glass Doors
Standard Window Single Pane , -
&Storm Wood Frame No
External Shading Clear Glass
Dra erles or Venetian Blinds 38.95 46 77 2999 3542 E 0 77 2999 3542
38.95 16 55 2142 880 N 0 55 2142 880
38.95 25 66 2571 1650 5 0 66 2571 1650
38.95 46 110 4284 5060 W 0 110 4284 5060
Doors
Meta Door Po ystyrene ore
&Storm 25.994 7.481 36 936 269 N 0 36 936 269
25.994 7.481 21 546 157 W 0 21 546 157
Ceilin s
ei ings n er a en i a e
Attic Space-Dark Color R-38
Insulation 2.132 1.144 1824 3889 2087 48 18Z4 3689 2087
Floors
Concrete S a on Gra e 1
Ed e Ins+ilatio��R= 5.0 33.62 0 155 5211 0 � 155 5211 0
Infiltration 136 13 365 49456 4825 49456 4825
Sub Total Heatin BTU's 96895 96895
Duct Loss HTG 1 0 0
TotalHeatin BTU's 96895 96895
CFM Heatin 0 0
Peo le and A liance 3000 3000
Sensible Gain BTU's Z�SZ9 z�529
Duct Gain CLG 1 � �
Total Sensible BTU's z�5Z9 Z�SZ9
Latent Coolin BTU's 6301 6301
Total Coolin BTU's 33831 33831
CFM Coolin 1317 1317
Created using Comfort Optlmizer 2.0.Opportunity Interactive Inc.,www.Opactive.com
Company Name Owens Company System Design
Company Address 930 e BOth Design Temperature
Company Phone 952 854 5800 Indoor Outdoor
Customer Name LaFaver Summer 75 95
Sales Person al/owens Winter 70 -12 -
Ctty Mlnneapolis/St.Paul AP 50 %RH 33 Grains
Dail Ran e M .
o e ouse o e ouse '
Ceilin Hei ht 18
Room Area 4
Area or BTU Dir. L BTU
Component Type Building Component HTM BTU Dir. Lgth. Area BTU Dir. Lgth. Area gth. Area
Ht CI Heatin Coolin Hea[in Coolin Heatin Coolin Heatin Coolin
Net Ex osed Wall
0o rame x enor a s
with Sheathing&Siding
Above Grade R-il 1/2"
G sum R-0.5 7.38 1.416 432 3188 612 E 48 432 3188 612
7.36 1.416 342 2524 484 N 38 342 2524 464
7.38 1.416 342 2524 484 S 38 342 2524 484
7.38 1.416 432 3188 612 W 48 432 3188 612
0o rame x enor a s
with Sheathing&Siding
Above Grade R-19 1/2"
G sum Brd R-0.5 4.92 1.416 787 3872 1114 E 48 787 3872 1114
4.92 1.416 593 2918 840 N 38 593 2918 840
4.92 1.416 618 3041 875 5 36 616 3041 875
4.92 1.416 733 3606 1038 W 48 733 3606 1038
1f�indow&Glass Doors
Standard Window Single Pane ,
&Storm Wood Frame No
External Shading Clear Glass
Dra eries or Venetian Blinds 38.95 46 77 2999 3542 E 0 77 2999 3542
38.95 16 55 2142 880 N 0 55 2142 880
38.95 25 66 2571 1650 S 0 66 2571 1650
38.95 46 110 4284 5060 W 0 110 4284 5060
Doors
Meta Door Po ys[yrene Core
&Storm 25.994 7.481 36 936 269 N 0 36 936 269
25.994 7.481 21 546 157 W 0 21 546 157
Ceilin s
ei ings n er a en i a e
Attic Space-Dark Color R-36
Insulation 2.132 1.144 1824 3889 2087 48 1824 3889 2087
Floors
Concrete Sla on Grade 1
Ed e Ins�.ilatio��R= 5.0 33.62 0 155 5211 0 `0 155 5211 0
Infiltration 136 13 365 49456 4825 49456 4825
Sub Total Heatin BTU's 96895 96895
Duct Loss HTG 1 � �
Total Heatin BTU's 96895 96895
CFM Heatin 0 0
Peo le and A liance 3000 3000
Sensible Gain BTU'S 27529 27529
Duct Gain CLG 1 0 0
Total Sensible BTU's 27529 27529
Latent Coolin BTU's 6301 6301
TotalCoolin BTU's 33631 33831
CFM Coolin 1317 13ll
Created using Comfort Optimlzer 2.0.Opportunity Interactive Inc.,www.Opactive.com
System Design
Company Name Owens Company Desiyn Temperature -
Compa�y Address 930 e 80th Indoor Outdoor
Company Phone 952 854 5800 Summer 75 95 ,
Customer Name LaFaver Winter 70 -12
Sales Person al/owens SO %RH 33 Grains,
City Minneapolis/St. Paul AP Daily Ranfle M .
o e ouse o e ouse
18
Ceilin Hei ht 1 4
Room Area BTU
HTM Area or gTU Dir.Lgth. Area BTU Dir. Lgth. Area BTU Dir. Lgth. Area
Component Type Building Component Len th Heatin Coolin
Ht CI Heatin Coolin Heatin Coolin Heatin Coolin
Net Ex osed Wall
0o rame x enor a s
with Sheathing&Siding
Above Grade R-19 1/2"
G sum Brd R-0.5 4.92 1.416 787 3872 1114 E 48 787 3872 1114
4.92 1.416 593 2918 840 N 38 593 2918 840
4.92 1.416 618 3041 875 S 38 618 3041 875
4.92 1A16 733 3606 1038 W 48 733 3606 1038
Window&Glass Doors
Standard Window Single Pane
&Storm Wood Frame No
External Shading Clear Glass
Draperies or Venetian Blinds 38.95 46 77 2999 3542 E 0 77 2999 3542
38.95 16 55 2142 880 N 0 55 2142 880
38.95 25 66 2S7tY , 1650 S 0 66 2571 1650 ___ '
38.95 46 110 428-x 5060 W 0 110 4284 5060
Doors
Meta oor Po ystyrene ore
&Storm z5.99 7.481 21 546 157 W 0 21 546 157
Ceilin s
ei mgs n er a en i a e
Attic Space-Dark Color R-38
Insulation L132 1.14a 1824 3889 2087 48 1824 3889 2087
Floors
oncrete a on ra e 1
Edge Insulation R= 5.0 33.62 0 155 5211 0 0 I55 5211 0 _
Infiltration
136 13 365 49456 4825 49456 4825
� 85471 854711
`,�b Totai Heatin eTU's � 0
Dud Loss HTG 1 85471 85471
Total Heatin BTU's � 0
CFM Heatin .
3000 3000
Peo le and A liance 25337 25337
Sensible Gain BTU's � 0
Dud Gain CLG 1 25337
Total Sensible BTU's 25337
6301 6301
Latent Coolin BTU's 31639 31639
Total Coolin BTU's 1212 1212
CFM Coolin
Created usin Comfort O timizer 2.0.O ortuni Interactive Inc. www.0 active.com
-f V
� DATE TIME
�CITY OF ORONO CALLED IN 5'�l'—US�
INSPECTION NO IC ']_,_ SCHEDULED �L�.�� �J•l1C.�A�1
PERMIT NO. +� COMPLETED
ADDRESS �S.'�'� ,���j i1 S �G7, .� t'
OWNER ,;�.�,��%'� L.�= C�.li',�� CONTR. � � �` � � �
-��-J
TELEPHONE NO. �� �'J�y..S��U� GS� y7/ �s2Q
� DESCRIPTION
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING MECHANICAL FINAL_ 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 4/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 1 BING FINAL 36 FOUNDATION/REMOVAL
� OWNE ONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
�
W
�
�
J
O
�
�
O
�
W
�
Q
�
Z
W
�
W
�
�
d
W WORKSATISFACTORY:PROCEED f� PROJECTCOMPLETE
� ❑ CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
W
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �� pHOTOTAKEN
INSPECTOR WILL RETIJRN
❑STOP ORDER POSTED.CALL INSPECTOR J CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (952� 249-4600
OwnerlContra i e:
Inspector. ���
White Copylinspector's Fil Canary CopylSite Notice
PERMIT
LITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2ss9
Crystal Bay, Minnesota 55323 Pe►'mit Type: UserDefined
(612) 249-4600 Date Issued: 6ii4ioo
SITE ADDRESS: 1535 Bohns Point Rd
WAYZATA,MN 55391
P I D: 08-117-23-44-0014
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu y
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
LAND ALTERATION-2ND DRIVEWAY
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: JYLAND DEVELOPMENT OWNER: RICHARD A BORN
150 SOUTH BROADWAY 1535 BOHNS POINT RD
WAYZATA,MN 55391 WAYZATA MN 55391
THE LJNDERSIGNED HEREBY REQUESTS PERMISSION TO MA.KE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUILDING CODE REQUIREMENTS.
l� , � ��lZ�l.s-t�
APPLI ANT PERMI'I'EE IGNATURE S ED BY SIGNATi.JRE �
Copies: City, Applicant, Assessor,Finance Page 1
f }
' Total Fee: $ Date Received:
Entered By: Permit#:
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) OWNER OR CONTRACTOR
JOB SITE ADDRESS: %535— ,�c�.�n.'�3 �,�,�;*— �<<,, � �3 �-
� ZIP: .S 5- � �
NAME OF OWNER: �i��� ����' PHONE: (home)
. (work)
MAII.ING ADDRESS: ��3� l���u�;'3 /'��.w';CITY: cI f�f�nlli ZIP: .�5�'�i�
CONTRACTOR: �/Gi�1r%t.� ;��LfE'L�-�`/I7F=r�,'�" PHONE: ����/� Dl�C}o
CONTACT PERSON: rS 1 elL (;;¢rf�i,.f v�'J MOBILE/PAGER: �S�+ • y pr)Z.
MAILING ADDRESS: l50 S , '�2��&:v�-�:/ CITY: W�����-- ZIP: S;; 3 /
STATE LICENSE: # z Ge 3��Y Z�{
ARCHITECT/ENGINEER: PHONE:
NIAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: NPw Addition Accessory Structure
Move Remodel/Alteration Land Alteration x
PROPOSED WORK(describe in detai�: ,q-��� s��2���c� ����yticc,+.2y'
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /V � IOr
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 accorda ce wit he pproved plan.
APPLICANT'S SIGNATURE: ��`� � 1�--- DATE: � / �CX2'i
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
� �
Sec.13.04 RIGHTS OF SUB.TECTS 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 confidendal data;and(d)the idendry of other persons or enddes 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 mav alace the notice required under this subdivision in the individual income tax or prooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request ro a responsible authoriry, 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 srored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed
of the content and meaning of that data. After an individual has been shown the privare 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 privare or public data upon request by the individual subject of the data.
The responsible authority may require the requesting person to pay the actual cosu 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 sta[ement of disagreement is included with the disclosed data.
The determinarion of the responsible authoriry 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 �ity 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 pernut 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
C�ty State Zip Phone
I understand y rights a ated above.
�t¢.-�(' '/% - r�
j�-
Signature
6
. ' CHECK OFF LIST FOR ISSUANCE OF PERNIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /� �3�- �ofn,�.rs (Jo ,.�r '
PID:
DESCRIPTION OF WORK: (i4-yv�/J 74�,.� — 2wc9- I�2�� w�
ZO�'G REV�`V BY: DATE APPROVED: G �� K 'o�
BUII.DL�;G REVIE`V BY: DATE APPROVED:
FEES TO BE CHA.RGED: �`'"'� '�`�T' Misc. Fees Calculated By: ~
PERMIT Yes t� No
PLAN REVIEW Yes No SEWER CONNECI'ION
STATE SURCHARGE Yes No WATF�ZCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZOYL�iG C�CK LIST Zoning District: N° C c�F�r�+`� _
Fire Department: Post Office: School Disuict:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Pro osed Setbacks: ��
P Front(Lake): Righ[Side: 3�0 r�L:J
� �
Rear (Street): Left Side: �� � S
Adjacent Structures: Wetland: .
Building Height: Def. Hgt. Peal:Hgt.
L,ot Covera�e:
Grading: Staff Approval Date: (s — 1`{—�� By: d"•U— Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: y�5
Avg. Setback: �v l�+ Bluff Setback: �(� L.ot Coverage:
Ezistin� Proposed
a
Hardcover: 0-75'
75-250'
2so-5oo' 29.YPS
500-1000'
Hardcover Variance Required: Yes No �'�— Date of Council Approval:
REVIARKS (in house):
7
BUII.n�G xEv�w c�cx LisT
�C� /`���- CONSTRUCTION TYPE: —'
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
z =
TOTAL
Fstimated Construction Value: $ �"
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Nlechanical Water Connection
Footing ' Septic Sewer Connec[ion -
Fram.ing Fireplace Lawn Irrigation
Insulation (Masonry) O[her
Wall Board (Mfg.) Well (S[ate Perm.it)
�F�� Grading/Filling Electrical (State Permit)
Other
REI�L�iRKS(ni T HOUSE):
REVIE`V BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
RE�IARKS (TO BE NOTED ON PERivIIT�:
8
PERMIT
C1TY.OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po234�
Crystal Bay, Minnesota 55323 Permit Type: Mechanical Permits
(612) 249-4600 Date Issued: ai»�2oo
SITE ADDRESS: 1535 Bohns Point Rd
WAYZATA,MN 55391
P I D: 0 8-117-23-44-0014
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Sub-type(s): Air Conditioniing
Permit Type: Mechanical Permits
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 68•75 Valuation: $ 5,500.00
State Surcharge Fee: $ 2.75
Misc. Fee: $ 1.50
TOTAL FEE: $ 73.00
APPLICANT: Kleve Heating&Air OWNER: RICHARD A BORN
13075 Pioneer Trail 1535 BOHNS POINT RD
Eden Prairie,MN 55347 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUILDING CODE REQUIREMENTS.
` �'v�.C�' -�yi— ✓�' �� t�,'%��j�'`� !�/
APPLICANT PERMITEE SIGNATURE IS D BY SIGNATi_JRE
Copies: City,Applicant,Assessor,Finance Page 2
INSPECTION RECORD
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po234�
Crystal Bay, Minnesota 55323
(612) 249-4600 Date Issued: a�l��z000
SITE ADDRESS: 1535 Bohns Point Rd
WAYZATA,MN 55391
APPLICANT: Kleve Heating&Air
13075 Pioneer Trail
Eden Prairie,MN 55347
Proposed Use: Residential „ �:� �__L .,,..
i i.iiiut.�uv-iyY�.�o/.All'CO11CI1t102111T1g
Permit Class: �eiiera�
Permit Type: Mechanical Pernuts
Separate uispections required:
Building: General: Mechanical-Rough Mechanical Final
Plumbing:
�, < � , ��, � ,;ti>., ,,;,.,�::::::.
`3 � " � ::�r>s' � �,x.;::::::E<:::>::
ALL INSPECTIONS MUST BE CALLED 24 HOURS IN ADVANCE. THIS CARD MUS1'13L POSTED INA
CONSPICUOUS PLACE ON THE PREMISES ON WHICH THE WORK LS TO BE DONE.
. . �� � 3 `�7
CITY OF ORONO APPLICATION FOR MECHAIVICAL PERMTT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 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 retum maii after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECENE 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. Ideatification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remodeling is involved, a separate building pemut 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 pernut fee. Sign and date the certification.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473-7357.
Please check one: New V Addition Repair Replace
� Residential Commercial �539/
.��� ��:_I� �S n'S P�i n�' �- �:�:
Owner's Name• TelephoneNumber: �py p�p�
Mailing Address: I�� �n��'hr(�rocad�c.� Qt�.v City: Zip: .�-�$�/_
Contractor'sName: f' ,� TelephoneNumber: y1- ����
MailingAddress: l,�n� r-`�,o r�„/ City: n% „•r,P Zip: 55�17
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantiry:
M�E:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS � �
Quantity: � PV 1Yl.r�x.
Make: ' � 11-�2�,r
Model: �-�Sa(..R-n 1 Sr ('�o19/YI- �i-a(p
Tons: �� � ��Z.%n
H. Power
WOOD BURNING EOUIPMENT
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 E�aust (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. 1.2�% of Contract Price�` or IVlinimum Fee ($35.Ot�)
55�.r� X .o�2s � L�g��S
(contract price)
2. State Surchar�e. ** Add the State Building Code Division
Surcharge to each permit. -�jS((� .na x .0005 $ a,-1S
(contract price)
or $.50, whichever is greater
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ '�3.�p
* CONTRACT PRICE or JOB COST means the actuai 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.
T'he 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 Signatur Date: '��"�
Approved By: Date:
DATE T�
CITY OF ORONO CALLED IN jo1'�� �
INSPECTION N I C�' SCHEDULED 2'� g .O
PERMIT NO. � `� COMPLETED `^ �� ..��r��
ADDRESS I��JS � �h�� 1T���� �
OWNER CONTR. ������
TELEPHONE NO. �`� a - �L./ "y�I
� DESCRIPTION
t� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULAT�ON CE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS 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
4Qi 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINA� 36 FOUNDATION/REMOVAL
J
� OWNERICONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS: ��-'�-i 1� 1'�1�' �-� Sl�t�"�-�•
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GW �JORKSATISFACTORY:PROCEED PROJECTCOMPLETE
��❑ CORRECT WORK&PROCEED �ISSUE CERT�FICATE OF OCCUPANCY
W
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
Cl INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. 249-46�0
OwnerlContractor on site:
Inspector`���� U
White Copyllnspector's File Canary CopylSite Notice
. �
PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2326
Crystal Bay, Minnesota 55323 P@fllllt Typ@: Addition/Remodel/Repair
(612) 249-4600 Date Issued: an�ioo
SITE ADDRESS: 1535 Bohns Point Rd
WAYZATA,MN 55391
P I D: 08-117-23-44-0014
DESCRIPTION: UBC occupancy R3
Construction Type VN
Proposed Use:
Census Code 434
Permit Class: Building
Permit Sub-type(s): Single Family
Permit Type: Addition/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: riumoing iviec;nanic�i r,iecu�icai�siaiej
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 643.75 Valuation: $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.00
TOTAL FEE: $ 1,087.28
APPLICANT: Jyland Dev-inc OWNER: RICHARD A BORN
I50 South Broadway 1535 BOHNS POINT RD
Wayzata, MN 55391 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AN D AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MI SOTA BUILDING CODE REQUIREMENTS.
�l
,
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APPLICANT P ITEE SI NATURE ISS D BY SIGNATURE
Copies: City,Applicant,Assessor, Finance Page 1
. ' y /z"�
Total Fee: $ / p�7. Z.� Date Received:
Entered By: ,P� Permit#: � �, � a�j
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
---------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER O CONTRACTO
JOB SITE ADDRESS: ���,,�j �t'�IU�S �'c�r,,�r �� , ZIP:
;
NAN� OF OWNER: '�,� I�� ����� PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �y�./a,i,� PHONE: ����{-��'"�%^
CONTACT PERSON: p;�ul' ��r,� MOBILE/PAGER: 1�L� � cvC�;� �'
MAILING ADDRESS:�,5 0 .�✓`•� 1�.�c��w'� /��� CITY: �L�AY�%jT/� ZIP: ��3�
STATE LICENSE: #�;��'�5 7v���
ARCHITECT/ENGINEER:���rrh-�- M A��Naicl PHONE: �{74 'cj?S�
MAILING ADDRESS:a?� ta, A%�-�.. 5:r c� CITY: �(c.....�g�n�Q ZIP: sS 3/
NAME: �a �� Sc�.w.r►Z� REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED O (des ri indetai�: ��,v;,s� ..r,�,.���Y c;v� �,v,;� � '��j� '�ewl
� 7 �
�,�Kt ��c.i �c� I `KC-C�/�1 � d� ��>.�;t�,✓,-r �F�.JO� � Q
N�w
STORIES: SQ. FEET OF EACH FLO R:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
� c�-
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ � CJ ��d
I hereby apply for a building pernut 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 m cor nce 'th the proved plan.
. �� L/
APPLIC:�NT'S SIGNAT � ,{,QY 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.
5
Sec.13.04 RIGHTS 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 indiridual. An individual asked to supply private or confidential data co�cerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecring state agency,polidcal subdivision,or starewide
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 suppiy private or confidenaal data;and(d)the idenriry of other persons or entities authorized by state or federal law ro receive the data.
This requirement shall not appty when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement of£icer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or vrooertv 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 conf'idential. 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 noc be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this secdon is pending or addirional 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 cosu of making,certifying,and compiling the copies.
The responsible authoriry 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 authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy
past recipienu 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 determinaaon of the responsible authoriry 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 �ity 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 wfll 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
C(�y State Zip Phone
I understand my rights as stated above.
Signature
6
( i
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: !5�jS +(�C7F-1N S �o,�.r� (Za,�,�.�
PID:
DESCRIPTION OF WORK: /a ro�p i n o iv f L�.��c�c.
-------------------------------------------------- ------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: �-l-�y -�o
BUILDING REVIEW BY: DATE APPROVED: �-i�-v�
---------------------------------------------------------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/' No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes `� No WATERCONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: N� GC-F-wr�-e �2 D• l� ,
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetl d:
Building Height: Def. Hgt. Peal: gt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
,
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: ', Lot Coverage:
Existing I Proposed
Hardcover: 0-75 I
75-250'
'I
250-500' I
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
� �
BUILDING REVIEW CHECK LIST
UBC: ;�Z - �_CONSTRUCTION TYPE: �//�-�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
o�
Estimated Construction Value: $ `,j(> U�
Inspections Required: Work Requiring Separate Permits:
Site p� Plumbing Fire
Hardcover Removal � Mechanical Water 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: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
8
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/ �� /�. ���� BU{L fNG Rt T FLAN REVIE�111
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❑ P� .T APPROV��D..-CO�RcCT&�ESi��i�1lT
These c^mm2�is a;e for your i�tormet�on.AB wor!c shatl Ce don9
\ in(u� cc?rnplianc� with ati appiicabl� buiid:ng and zor.inc� cede,
R iramer.ts inc�ud;ng�tems no!spec�iicaf!y no?ed in ihi;ceview.
\ EP THIS PLAN SEfi ON SITE AT ALL T�MES
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� • BORN HOME — PORTE �OCHERE �
DRAWN AT 1/4'=1'-0'
SHARRATT/MACDONALD DES(GN 2T8 WATER STREET EXCELSfOR,MN 55331 470.9750
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N T (� SCHEDULED ��" b � 1I'-�
PERMIT N0. ���`� COMPLETED 7 �O—D� // `-UO�
ADDRESS 5 �S �"
OWNER CONTR. J W I�
TELEPHONE NO. �U��- ���
� �-1�lP�ON
� 01 F(�� 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
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
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 P�UMBING FINAL 36 FOUNDATION/REMOVAL
J
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� CO E TS:
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� 1�7r'WORK SATISFACTORY:PROCEED �'. PROJECT COMPLETE
W
� �� CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
Cl CORRECT UNSAFE CONDITION WITHIN HOURS. n PHOTO TAKEN
INSPECTOR WILL RETURN
1 CITATION ISSUED
C]STOP ORDER POSTED.CALL INSPECTOR
C INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContractor on site:
Inspector._/_,/�l �� ��CL� r
White Copyllnspector's File Canary CopylSite Notice
� - PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2�2o
Crystal Bay, Minnesota 55323 Permit Type: F�Xtures
(612) 249-4600 Date Issued: 4i12i2oo
SITE ADDRESS: 1535 Bohns Point Rd
WAYZATA,MN 55391
P I D: 08-117-23-44-0014
DESCRIPTION:
,-,--��_,
PTOpOSeC�USe: nc�iucu�iai
Permit Class: Plumbing
Permit Type: Fixtures Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
3 MISC-STEAMER UNITS
FEE SUMMARY: Permit Fee: $ >>8•75 Valuation: $ 9,500.00
State Surcharge Fee: $ 4.75
TOTAL FEE: $ 123.50
APPLICANT: Thompson Plumbing OWNER: RICHARD A BORN
15001 Minnetonka Ind. Rd 1535 BOHNS POINT RD
Minnetonka, MN 55345 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII,DING CODE REQUIREMENTS.
�;,?�"a,,�� � ;' �/���-- �'"�
PPLICANT PERMITGE SIGNATURE � ; SSUGD BY S[GNATURE
�-
Copies: City, Applicant,Assessor,Finance Page 1
� � INSPECTION RECORD
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po232o
Crystal Bay, Minnesota 55323
(612) 249-4600 Date Issued: ��i2�2oo0
SITE ADDRESS: 1535 BoluisPointRd
WAYZATA,MN 55391
APPLICANT: Thompson Plumbing
15001 Minnetonka Ind.Rd
Minnetonka,MN 55345
Proposed Use: Residential
,,,...._.:. �__w yY i�i:Single Family
, �.�...�uu.,-� c �
Permit Class: Ylumbmg
Permit T_ype: Fixtures
Separate inspections required:
Building: General:
Plumbing: Roughplumbing P'ii�al plumbing
'0 N. S:' � � �� -G T' �f �:�,J'�;� J
�r �
ALL INSPECTIONS MUST BE CALLED 24 HOURS IN ADVANCE. THIS CARD MUST BE POSTED INA
CONSPICUOUS PLACE ON THE PREMISES ON WHICH THE WORK IS TO BE DONE.
� CITY OF aRONO � 6122494b16 10/20��9 14:35 � :Oz143 N0:393
, . , n �� �
�`�i � --
C�'Y"Y OF ORONO APPLICATION F4R PLUM]�ING PERMl�'
Box 66 {2750 Kellty Parkway)
Crys'ta1 �ay, Mr�I �3323
S�'��'��?- I�FS?R��►'['�a�v
2. Ynu mRy apPly for plumb�ug��nnit� by rnail ar iA p�r�nn a! tYtic C�cy nl't"ic�s.
2. l�t�nlc caxds wiil be senc by ratw�p mail tfter a raviow is completed. PERM1"fS P►12E NOT VALIA
U1�T't'1L YOU REC�IYB A FBRMTt. �1�?R1��U�`t.�CyT �� UNTIL �'�tE PEgI►+�1'C CARD I5
3, Plumbia�pora�s t�b�iasucd OhIr.Y tfl licGunai plumbiaY contra�tors and io pmporty uwriere res�ding
�!►thd dWal�lA.gr
4. W'he� a;ay n4�v co►�struc[ion or rcmodeling 1: involvcd, a�epuace buitdissg�ermi[ raust ba nbtair►od.
S. AJI wotk tltrnust t� done in�rd�cx with thn State Coda require�-�onta,
b: All wotic a�st bc iqepecmd erd air tea[a!bePose it it covered, C�11 249-4600. 2�-hour notice requi�ed.
j��,�,(,g� Complete a11 icoms on this spplication. Gompute the permit fee. 3i$n and dac�
the cert3fGati�n. INCC�N�'L.ETE APPLICaTI�NS WILL NOT BE PROCESSED, If you have
questions, calt 249-4b00.
Plcase chec� arie� � New � Addition Ite�air Rcpince
�� Rcsidential Comme�rcial
J�}B 51TF: ���:� �,5�h <�'�� r�A__ �c�q r� Zip•
�----��- -- '
dwn�'a Na�me: �, ���nd l�cz}.,,�, - melephane 1'Vumber: �
MaEling Addt�s � _ C�': 7�P:
Coa�rau,�or's Nam.cs P1 �L� Telcpbone Number. °i�. �-� �'1
MaW�n�Ad�e: ,i�s �` _ - � ` s� �': �,x:�. ?�ip: r'�'S 3 Lt5
��LL}'MBIlY�,�'1'"�TR� SC�EDin,�:
FY�CTiiRB B�4lT IST 2ND OTTi�R FIXNRfi BSMT 1ST ZNU OTHIER
'CYPE FL FL TYPE FL FL,
Ws�er Closet Ploor Drains �
L.en+eWry � 5swker Ljector
aatt�tnb Laundry Tr�y
Shnwra Wa�ser
Kicchen Si�k wNtar Heater
Diuposai Wpta Sottcaer
piabwaehor Wet 1�t
s�r���, M�� a��� l � ...._._
���<<�.��—����
' GIT� OF ORONO � 6122494616 10120199 14:35 � :�3103 No:393
�',�i,��E CALC�LATTOI�i
L 1..25°�6 of Can�c, ic:e'" or 11�J ��L��1
f���— x .oi2s � //8. '75—'
{contrxet price)
2. 5� 5u a Q�, """ Acld che State $uils3iing Coci� Div�siot� �
5urcharge tc� �ch parmit. �,� a" x .Ofi►05 $ ���„�_
(eontract price)
or S,S4, whiche�r � greater
3. Pb$ta� ancl Handlina (Oril� mati-�Za �pplic�tions) � '�� .
4, '�OTAL PERMtT FEE {Add li�s 1-3 �buve} � f�� ; ,�_
+ OUNTKACT P�iCB ar K�9 COST means tbe actnai ar estlmat�d d�1lar amauna chargcd for t�e permitted
wotk ln�luding mateclale, labox, prot�t, nsid other fixod coats. Jt is the �r�t to bo charged to thr
cnasomer for tke work done. IPany matcriai,oquipment, 1�6or,ar installatlon s�re fixr�,t�ad hy�he awaer,
tetuutt as�ay otber perty the remonabin mukot value of eucb items muet be added to thc cstunatcd cxzsr,
or aratraet price foi permit fne purpc�s. In tb:e ovant th�t there is k cii�pute on thC tmount of d�c job coat,
the Crty �y request the submi�etoa of t aig�od cogy oi t�e Actual cantracc.
*'+ The STAT� S�'R�IiARGE is .0005 of the coatract pcica utxi�r �1,C�UO,OQO ar S.SO - whiohever iY
aroeter. F�ir v�luations aver $1,�Ob,p00 e�11 the Depastment of Inspocsianat Scrviccs for the price.
The underaigned hercby appl�es to the City for isauanca of a k�YtuYzbing Parmit, �grees to do �11
work in str�ct acc�ordance with the oz�inances of the City and the rc�ul�tior�s of t�ie State of
Mint�sota, and ecrti�es that atl stxtem�nts m8de an this application a�re cnmplcte, true and
cor.r�t.
� ,
ApPlicant's Sig,nature: � , ��j�,,��'t-, Dete;�-�c`,
DATE TIME
CITY OF ORONO CALLED IN J
INSPECTION NOTICE SCHEDULED �//� _`r °,
PERMIT NO. � 2� COMPLETED '� 7�J �d
ADDRESS '' ��-S ��
OWNER CONTR. � r���
TELEPHONE NO. �����I�
� DESCRIPTION
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP O6 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING 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 next inspection 24 hours in advance. 249-46��
OwnerlCont or on site:
Inspector.%�G�� - C'�"v J'�
White Copyllnspector's File Canary CopylSite Notice
ATE TIME
CITY OF ORONO CALLED IN a S'•
INSPECTION OTICE SCHEDULED I� -
PERMIT NO. �- a� COMPLETED �'�Q�'�/ ��-��
ADDRESS IJ� �S �� �, �
OWNER CONTR. `r'�j��� �IClr'YI�.
TELEPHONE NO. �J�J-71��
� DESCRIPTION
lu 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 7ff�PCOMBING FINAL 36 FOUNDATION/REMOVAL
Q NERICONTRACTOR TO MEET YOU:_YES_NO
Z
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W l C��.�, C ��
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W
��CORRECT WORK&PROCEED �C; ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN 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. 249-46��
OwnerlContractor on site:
Inspecto%��l.�G �L�/!�
White Copyllnspector's File Canary CopylSite Notice
� �� �
I � NOUSE /IE/1TING TEST RECORD
ADORESS ' W � AVT. fLOQR C111i SUSURv 9 ,_�
OCCUPAHt S � _, ON�NER
11FAt IOSS DATE HTG��}T.
SOIb RY _ �rIZ.�-�a /Y`"[ ,4 INSTALLEO !�Y
El.�h�eai wa4 e� C.. lin• d�
TYPE oF HEAT GA FA Nw STEAM SPAGE NTR. UNIT HTR. OTNER
GAS oESIGN CONVERS1oN
NAKE W1KE Of SURNER
Med�l ' '" MeMI
S�.IsI Ai��. 8TU R�fln�
INPUT MAKE OR fURNA�E
M.bl
CONTROLS �f �
THERMOSTAT N•al PI� t� V�n1 Slr•
Veiv• KIND OF LINER �"" � /� , SIZE NONE
L�^�+� d.eh Ne•1 RHul��sr
li�3t S7NIn� F111�►� SI�• Nur��►
Fen S�Nin� O�In�n�� lseell�n (n�IM Ovf�l�•
Pilel Trp� ��".1��,� Q�In�n�y Cen�f►vNl�n
Pllel Msk• � ` �
Pile� IAed�l ' � Sw�e�� Bs�w► �Nlrin� i��.
Pller Tin+l�� ds11 � t��l T��
L.Mi. Cvt Ofl bew P����u►• Li�hfin� In .
Pr��wr• �.+�.? i� P�rt�nl CO� " � DeN T�H�1 �
Ir��r CEN P�.e�n� 0 C.�.y.�� T••rt��
S►aek t�rnp. P«e�M CO� N�w» �1 T��1N
� ' PERMIT
`� CITY OF ORONO
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE: _ _ _ _
Crystal Bay, Minnesota 55323 Permit Number: _ Y e:`'-
Date Issued: ���'��
(612)473-7357 _ .:`�_'s ;'=i�
SITE ADDRESS:
€ :_ � _ _'_;E�:•i: �-�4 �°�",
,:�.i
i;:=;—i '_s � — —.�;:s.—iii:: :i.
DESCRIPTION:
��j-�:_; �=� !j=i't�f-`i ,�;t_:�
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E�;`�i�`�{f G.[�t ;i(i(_1
, REMARKS:
I FEE SUMMARY:
•..•'f-!�;�i-,� i I_�l�1i �i i , l!i_J;_:
... �._._ �=%=_ T•:.:.. . t_!i_l
-�{i?'-{�i-{}'`-Sc; �._.__........._..... .-.�,..' '-`(.�
, �;tt.Wa? `r•:{� ���-`=�!�f_:
CONTRACTOR: ._ �r:`,� ; _.:�a.��. ._ OWNER:
f ::'�I-��,_i•�(.?- _.F,''`J i t-.:-. . . _`�`; . - _. .... . . _ -..ih.=.
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L i i:-t tl S i :_!f-i:1_: i 3`s:�i;i;i,��,`_ i'•�":.? � i r: _. _ . _.. . ._._�I_: 3 r, _ _ i i_I t i�'.- _1__ __ . .__ ,k _. ..._ ..._ . _ . �
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APPLICANUPERM EE SIGNATURE �' ISSUED BY:SIGNATURE
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CITY OF ORONO APPLICATION FOR MECHANICAL PERMIT
Box 66 (2750 Kelley Parkway) � `a��,>- `? ``�
Crystal Bay, MN 55323
GENERAL INFORMATION
L You may apply for mechanical pemuts 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 RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Mechanical Desiens - 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 fmal). Call 249-4600. 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 249-4600.
Please check one: � New Addition Repair Replace
Residential Commercial
JOB SITE• 15 �5 �;In�� : (��- l�-� (� Zip:
Qwner's Name: Telephone Number:
Mailing Address: I535 ('��h�< l �� .�� I;rl._ City: �.; � ;� c Zip:
Contractor's Name: T G�e �r e n I u�r ���. � Telephone Number: 5�i S- 3��17
Mailing Address: IdybG wu�u•�� (3i��� _City: i�l+l4;, Zip: SS 3c;��
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity: �
Make: �,o�%�u�,
Model: ��/�—
FueL• «�,�i�. l
Flue Size: y'';�/ 7% cd
Input BTUs:
Output BTUs: y�/, ����(�
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
WOOD BURNING EOUIPMENT
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.
VENTILATION
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
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)
�, C;o �1 x .0125 $
(contract price)
2. State Surchar� ** Add the State Building Code Division
Surcharge to each permit. x .0005 $
or $.50, whichever is greater (contract price)
3. Posta�e and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $
* 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 pemut 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 conect.
Applicant's Signature: � Date: 'y j �Z �
Approved By: Date:
CITY OF ORONO CALLED IN D`� y TIMQ E
6�-
INSPECTION T C SCHEDULED ��-j 9 �Q.`3 v
PERMIT NO. COMPLETED
ADDRESS e �� �'�
OWNER CONTR. ` -'t- �-��- c
TELEPHONE NO. � S �-- =� 7 �
� DESCRIPTION
tL 01 FOOTING 1 MECHANICAL RI � 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECH NAL 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
Q 05 FINAL 14 SEWER HOOK-UP O6 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTflACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
�
W
a
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J
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�
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�
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d WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W
� ❑ CORRECT WORK R PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE COND�TION WITHIN HOURS. i, pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins o hours in advance.473-73�J7
OwnerlContractor on site:
Inspector.
White Copyllnspector's File � Canary CopylSite Notice
PERMIT
..CIT� OF ORONO PERMIT TYPE: . .: - -.-
2750 Kelley Parkway- P.O. Box 66 ``-.����'';`.r�=- '
Crystal Bay, Minnesota 55323 Permit Number: _;::i;_;
(612)473-7357 Date Issued: �;;:_;;t;� ;��,;;;
SITE ADDRESS:
i__� _ ���+����ti:M� _=�i {=�`�:;
_.�� .
. : �—= �;—;:':_;—.;��a_.��;iij,a
DESCRIPTION:
1.+�"tv � i��ir:.'� � i 1°.�i"
�. �r'i�i:�T T�w��.t�_f±�i !'ft':=.`�•.r_ _,��rj�-(i;,t,:,;i:_;-ji=�ti
_. �.:�}-1`�� _.._. .-- —:a'=�#-`:Y::� j�;�:s:,F __ '— T;;;h�#^`i_F-i(:t�:��
REMARKS:
FEE SUMMARY:
:�'�__(,'t}::��;;^ig'+.; �.i : ;t�_i�.i
�jW:•=:t.:: I-r.;�F= ��,.�.,-�� , :_i[_: i'ti-� ; �_ _"� �._�._._._.... ���..``�{:
- �=:;:� j,�F?'.._t? ` F-r_�a ��._�;� f iC�l
'�:E#i'��#'k•=t�'��;..= ____--._._ - - • - -
:�,Irf#�t�[.i,-i T.._i f . _ _ . `f 1
CONTRACTOR: -- i;���� i c:.,��j. — OWNER:
..._..`_4';�, i� I ;_ :"•;{ ;-{•:_ ��_i,-f��.�-r.�'1 � � _'.i'd .`*.!���'J i-ii�:i.:=
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fy:��" ifF�..�.�_�._?_ _.i`��.... �.__��',Tru . ._ ..._ . . ,_... _. . .. _ ... _ _. . _' . .. .. ._. �.€-.F, I..b�.}...i!_.. _. . . ._- . _. ..._. W
. . ._ . t. ��. . `
.-..�,�..�.,.�.�.r�_� . _ �,�,.�,—.-. _ .
-_�-•;_; t �- s t—t'� ,. .<<' %=`.:i�:������ '•. '_f .._ _ . ._'.._�.,_ s..i_�. .. . �.3 : _ �`.���[ — ��! t �-� �;l..� =��s`
�_�� . . , . _ _ _ . .
_i` f ;_:::`�:r.;q �-:'=� "' ' — ' — c y F' i t :Iw �- --t. _ ,r:
. _ . ._ _ �C' .____ I"i•, ._. _, . . . �'. i_4i f'v_ . ? ._."' ! �"' " '_.__ _. _ _ _ . . » , . , t_ _._ _.... . .. .
L - - - �
�--t���l�..� <<,a - JC�
APPLICANT,PERMITEE SIGNATURE ISSUED BY:SIGNATUR� �j `
Nt f!wny t���
^ . ��� �..�� �1
�;
��8 1 S 1999
CITY OF ORONO G�, r ;_;;_ ,`;, ,;, APPLICATION FOR MECHANICAL PERMIT
Box 66 (2750 Kelley Parkway) j�``''����
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for mechanical pernuts by mail or in person at the City offices. Applications will be
re•:iewed and a pernut 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 Desi�ns - 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 shali 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.
S. A:: wc:k r.tust b; �cn� ia accarda.-:�e �t,ith +hP TTn+f.,r,.� M��h?n�cai Cade!State B�ilding C�de
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 Replace
Residential Commerci
.ros srrE: - � �„ �:,�� �d. ziP:
Owner's Name: j��,�; Telephone Number:
Mailing Address: City: Zip:
Contractor's Name: �;' Telephone Number. 9 y/-�/� ��
Mailing Address: I�C�7 S �r o�e e� T��'. I City: ��e,J Pa�r�'eZip: S�-�y�
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity: �
Make:
Model: � �
FueL•
Flue Size: ,
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
`�OOD BURNING EOUIPMENT
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.
VENTILATION
No. � Kitchen Exhaust � ducted recirculating cfm
No. �� Bath Exhaust (must be ducted outside) 7Sr cfm
No. Other Fans: Locations cfm
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)
/I�DOs°`� x .0125 $ �S �
(contract price)
2. State Surchar�e. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $ S�
`
or $.50, whichever is greater (concract price)
3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� �
� -
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
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: � Date: � 9{
Approved By: Date:
DATE p TI2M^E
CITY OF ORONO CALLED IN � -/�o !/ ' �C/�
INSPECTION NOTICE SCHEDULED �o —�? �
PERMIT NO. �2,112�'C7 COMPLETED �' "'��
ADDRESS I S �J S �I'�►1,p P'� �
OWNER CONTR. �iG+�s��Q S�-�"yGb.3
TELEPHONE NO. �� � '" y2'��
� DESCRIPTION �'�� � � �l.��SL.
tL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 5 IN 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
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W RK SATISFACTORY:PROCEED -'CrPROJECT COMP�ETE
❑CORRECT WORK&PROCEED � ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �_-. PHOTO TAKEN
INSPECTOR WILL RETURN
i' CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
L INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance.473-73�J7
OwnerlContrac site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE c.� TIME
CITY OF ORONO r`�la� ��CALLED IN 3�� / ��' ��
INSPECTION NOTICE • b SCHEDULED --�=��� �"�, -� C�
PERMIT NO. ,��� COMPLETED
ADDRESS I.5 J� � ,�5� �� ��
OWNER � CONTR. � v�-Q
TELEPHONE NO. � -
� DESCRIPTION G��.C2 ��
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 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 COMPlA1NT
� 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
J
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� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ,=, PHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContra�n i :
Inspector. �
White Copyllnspector's File Canary CopylSite NoHce
PERMIT
�1TY OF ORONO PERMIT TYPE:
� 2750 Kelley Parkway- P.O. Box 66 Permit Number: • --='�°����"�'-'
Crystal Bay, Minnesota 55323 ;_;� � �;M
(612) 473-7357 Date Issued: _ _ _
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — ;-�T,�.�� �,.t;,x. — OWNER:
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APPLICANT;PERMITEE SIGNATURE � ISSUED BY:SIGNATURE
.
.
CITY OF URONO APPLICATION FOR PLUMBING P�RMIT
�SoY 66 (27�0 Kelley Parkway)
Crystal Say, 1VIN 55323
GENERAL INFORl�iATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2, Permit cards will be sent by retum 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. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing
in the dwelling.
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 State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 473-7357. 24-�our r.etice required.
instructioi�� Co:nplete all items on this application. Compute the permit fee. Sign and date
the certificatiaii. INCO:�7PLET� APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 473-7357.
Please check one: New Addition Repair � Replace ;
�_ Residential Commercial `
JOB STl`E: �L=�� ^�c's1r1r��5�C���;`���� �� —Z�p:
Owner's l�tame: �` t.: ,-��;, � ,., E-a ;�-�.��.-' Telephone Number:
Mailing Address: City: Zip:
Contractc►r'sName:1 L-�,�- TelephoneNumber: l,, - � -'1 /�
MailingA.ddress:l5 �r,\ `���o,.-� " � 'r=�y; Zip: �-��yJ
PLUMBING �'IXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory � Sewer Ejector
Bathtub � Laundry Tray
Shower � Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishw�sher Wet Bar
Sillcocks Misc (list)
�
DATE TIME
CITY OF ORONO CALLED IN -��'3�/`�
INSPECTION NOT E SCHEDULED �-'�`/ /9� /d: ..3�,
PERMIT NO. ���/S COMPLETED
ADDRESS /.��?� !�� i.f,��.�a{.�ft� t.�' �
OWNER CONTR. ��s1:� ,R.� �:i �.,
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TELEPHONE NO. � � � " 7 � / 7
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� DESCRIPTION ' . � ,- ,:<. . '�; E �>. > _�,.
LL 01 FOOTING 11 MECHANICAL RI EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q O5 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= UMBING RI �, 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 ING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL iNSPECTOR � CITATION ISSUED
❑ INSPECTION REQUfRED.CALLTO ARRANGE ACCESS.
Call for the next inspect' n 24 hours in advance.473-7357
OwnerlContractor on s'
Inspector.
White Copylinspector's File Canary Copy/Site Notice
PERMIT
CITY OF ORONO PERMIT TYPE:
275�elley Parkway- P.O. Box 66 _ ;;f�;�;�;�;,
� Crystal Bay, Minnesota 55323 Permit Number: ;:s�; _ �� �
(612) 473-7357 Date Issued: ._ _ _
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
4'�-i�._�:'r�;��'s�:r,{ �i '_.;. -:_,;::
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CONTRACTOR: — ;.:����.:� �r.�,;,T. — OWNER:
.,�-::a�-„����_�;l�t�v r-c�, -.:�,=,=:��i i - ;-;�;°fa h?�::�-��:;�;E:;
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF URONO APPLICATION FOR PLUMBING P�RMIT
}���x b6 (27�0 Kelley Parkway)
Crystal Say, 1VIl�1 55323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Pemut 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. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing
in the dwelling.
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 State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 473-7357. 24-hour notice required.
Instructioii� Co:nplete all items on this application. Compute the permit fee. Sign and date
the certificatiaii. INCO:��PLET� APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 473-7357.
Please check one: New _� Addition Repair � Replace
�_ Residential Commercial��,� ��� � M��1_�,6� h �-.
��� ��:�`���
JOB SITE: 1�� ���-,�'���; r� '�r�;c��C:� ZiP� _
Owner's Name: < ,�\c.�r��\ '��1�cr�, Telephone Number:
Mailing Address: ` ` City: Zip:
Contractr�r'sName: � _ ,��� TelephoneNumber:t,,�-9�-'7�i~�
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MailingA.ddress��-�,t�,��-� J(n � � �,�., City: �:+�.1�0, Zip: i ���
PLUMBING �,II�TURE SCHEDULE
FIXTUR.E BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet '� Floor Drains
Lavatory � Sewer Ejector
Bathtub � Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishws�sher Wet Bar
Sillcocks Misc (list) J—
. DATE ME
CITY OF ORONO CALLED IN "�� -� �' �G
INSPECTION N TIC SCHEDULED -�$- ` � E� ,3 fl
PERMIT NO. � conn LETED
ADDRESS S�� ���� •�'
OWN ER���uL'�� _.�' L''`'� CONTR�����`��Z -�Z�mC:�
TELEPHONE NO. �� 7 71,7
� DESCRIPTION 12,���^-t����'
lu 01 FOOTING 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
h 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Q .m_...____
�PLUM..�BING RI_� 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J
1' 0 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL iNSPECTOR �� CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73rJ7
OwnerlContractor o site:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice
DA`T/E TIME
CITY OF ORONO CALLED IN 3� r��
INSPECTION NOTICE SCHEDULED �3/S�i� // � O�
PERMIT NO. � COMPLETED �_ �_
ADDRESS '
OWNER CONTR. � � , _ �
TELEPHONE NO. ��3 � ��/�
� DESCRIPTION �r�-r�1,�/ �f.c.�• ����,.� �C�G�z��,/
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 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
Q 07 DEM.O_.-FIN_AL` 15 SEPTIC INSTALL. 22 FOLLOW-UP
? �.PI„�MRI�I 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEEf YOU:_YES_NO
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� BEFORECOVER�NG PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. C pHOTOTAKEN
�NSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the n xt inspection 24 hours in advance.473-7357
OwnerlConf��r n site:
Inspector. `
White Copy/lnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN � � �' Z �
INSPECTION NO I E SCHEDULED = �.�C� O
PERMIT NO. connP�ETEg, K �
�DJ��,.c�S .� � �� �J
WNER � �'�.'�'t.i CONTR. � �'j
TELEPHONE NO. 9 3 3 7 7 /�
,
� DESCRIPTION ___.�-�-�C��-✓�- ,4-�-� �'-' c�tkrQ.11p�
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 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-SfTE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Q
4�, 09 PLUMBING RI __3 23 SEPTIC FINAL 35 HARD COVER REMOVAL
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� BEFORECOVERING PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 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.473-7357
OwnerlContractor o
Inspector.
White Copyllnspector's File Canary Copy/Site Notice
PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �'�`-'�=_���`' ���='�
Cryst�l Bay, Minnesota 55323 Permit Number:
' (612) 473-7357 Date Issued: _
SITE ADDRESS:
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Fu . . _ ---� � —_..._—•;s.;a—•i?i�t 3 r:i
DESCRIPTION:
. �:: �::� -,�:�;
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REMARKS:
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FEE SUMMARY:
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APPLICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO � 6124730510 01/29/99 15:20f� ;02l�3 N0:257
Totai Fce: $ �'73. 3� Date Received:
,
Entered Bv: ,�t renmtt�: // �'�
r,r�rv n� n,,�n�vn _ nrrrT nnvc: pF.RMTT APPLICA'ITON
V.L� 1 Va va�v��v rvw+��..�. .�....�_ _.... .
All �ormation must be submitted in full before plan review wIll be started.
(viease print aii f�ornr�tio
__�e�.�_�------
.t•��• .++nT ����.�r �c►. �..;...►e .,..s� nur��R nR rnNTRACTOR
a au: r.,....�...�... �... �•.•,--- -••-i - --•--- - _ _ _.
JOB sI'rE AnDRF,ss: lSs�s' �i�/i✓_s f�i.v� /?o zIP: �:�g/
wr s� nF �1W1"F.R� �1 c �✓2•cJ _ PHONE: (home}
(work)
. _ ._
� ..... �... .�...T,n�no, /S3� �O/7N� � ✓� �'�Tv' W�6s�'! �i�:�
LVlAiL11�V t�t�Yiws�+�. —__ _- �� -- _
r�x�r�tACTOR: �ti��p �������.���L�,,�r� PHONE: �t o�1 � D�oa
�n�rs��rr v�rucn�T• �,�� � �� sor� MOBILE/PAGER; �'So � y � �
VV1����v . • . ..
. � ..... ...�.,rr�, �5� �. �` ��;� ,�-c��rrrv� ,�a � _ _ Z�: �5�i �
1�'i�l+it�v ns�a,s�,u.►�v. °� - —
51'A'1-L L1C:Ll�i3L: � 2 oc�:3�`t z�
sArur�,car�FNriNEER: 2uC� SC�1���_ _,PHONE:
--------- - - ... __
�,�i n �►rn A T1TD�'CC• CTI�Y; ZIP:
arJ-ra+s+y�v .�-����..�Y....�.. -_
_..._�, x�F.r_�r�TRATinN#
t�ruru.: --•----
. �
TYPE OF WORK: New Add'ttion Accessory a�u��u�v�
M�ve Remodet/t�Iteration >C Land P,lteratian
PROPOSED WOItK(descrlbe rn detat�: _ i2����t� ,�t�� r2�,r+e�Fc_ ru�,� ����►��'"
j�;1-�i 2�c.rZ �vr�t�L L s ' J�fl� 'Tl-t:r� f.�l ri)a c":5_
cTnRtr�c� SO.FEET OF EACH FLOOR:
,..r�n� u�n��• r.AR A(3� �TALI,S: A'i"I'. DET_
���/• V� Yu✓��v�� �� —__.. ..
U�
ESTIl4IATED CONSTRUCTION VALUATION (excludin�tand): S. =��%7����� �
I herebv apulv for a building permlt and I acknowledge that the information above is complete and
.,-M,�rr• rt�a�r rhe wQrk wiil be in conformance with tlu ordinances and coaes oi u�e �iry anu wi'�
.�.e c..,.� A,+.�.�:.,� f n�1.• .t,ar 1 �,��rTcran�t rt,ic is nQt� vecmit and work is not to start wimout a
w.. ...»... .-- ._...m - -• - - =
� .. .�.� ,,..�. .:�� �... ;.. ..�.....*.�.,.,�. .��:*1, ♦ �hnTnv�d Ula,ll, [/Qy OE7 00 /2/ <
pcnni�, muu tua� auc::"i�.:•.�. w ,., YVVV►M - ---- - -�r-- . � � _/-
�i�"��-SQ/V
APPLYCANT'S SIGNAT'tJRE: �ATE= 2�� �
NnT�� p�..,,�a �i Nnme.c evenrs reau�re senarate permlt approvai by Police Deparhnent and
..___. . - -
��... /�r.•...w�� �A ��s1r! „�r.,.,,, �hA o.,on► Nnn.np��ned�ven�s will not be allowed.
♦...� ..V»..... ..v �y.t..._. ._ . ._ ___._.. _ ,.
CITY OF ORONO � 6124730510 01/29/99 15:201� :03/03 N0:257
8ee.t3.Of R1GHT8 OF BUaJEC'iS�F AATA '
Sv1d. l. T�st doea. TLe�I�hu of tadivldual on�rhom tha d�ta i:uocad oc m be saortd thail Dc a3 ilet[oc�h la ihi�iecdon.
9ubd.2. Ialormtefen tyn�red to M Ri.ea ladirfdwl. .vi iadiridual uted ro suDD�Y Drirste o�coalldendsl dan wacetatn;almtslf shsl!
ba iolor�+sd o!: {al 8��purpo�e ta4 iamndsd we of d►a Rqvared dso w3�ia�dc aoli•cd»�ta�e�{�ory.PcU6e�1 fubdlvtsion.or sQtevv�d����am:
(b)wh�ds�r hs a�sr nl4ie or b.te=flly reqvi�sd w upply iLe requesud dasa:(c)�ay�nown coasiqu.acs aruia�isam oi,.vyp�ri��<«<Y.:���.,,�p�;r
� s. . . : , . ,., , ., . . , .. � .. . �. ._.._��........,...,....r..a,.. ,,.�.....,,1....,.�..�,r�
pn�sw oc co�uwenaa�ww:anu�u�m�w�us+p crc uwcr pssavw vr anuuw w�..v.u..v��-�_.___
,..�...__......- ._.^-..-—---- ----�------•----
_ ti.,..s...� t»wi,.�w,.,��...4.A. ...a.,o�.....i�,.r...a,� ,.....�.�,■.r�ie,n ii R2 st�fidivision S- m i Eaw�tltolCf�EOt 0(flCR[.
.._._��., . _._.. _.._-- •---- --- -- -=..--• — --- -- - -- �----
TAf CR�fUSS�ffIQiltf OI RYC(��,a1�Y pIACC G RO�G recuirQd undat Rtsis�`_'�witien ir eh� individval irtcAra��s_ot eroaertv nx nh�
j�ievedem in�tad Qfgp se lortni.
Subd.7. Aecw to dsta�r ladt+�[duat. Upon reques<<o s estpon�ibk w@soriry.an iadi�idua!sdall be inlonecd was�h�r�s b rAt aEjee�
�t.eersd�sa ew ie+divirlu�ls.u+d whether!c!s elaaslllaQ u ouDUc.orivsee or caMdsisd�. Upon hls f4nGo�tsque��,aa individusi who 1�dst s�Ajecc
ot�soted pchate or puMit dao�oA lndividwls tAt11 bc tbov�a tAa data without wy chat;e Oo ltim�aE:i[Ae d��icei, �halt ba infoc�e►ed ol du eoaunc
�ad�su�iaj of�at dan. Ahs��n indir(duat haa been shown d�e priva�a daa and info:mea oc�u meania;.me wo nsoa aoc oe dixiosca�aita iv�
,. „-_. � ..._ s._ .�a �.��„���..i w.�r�.R....t�a,,..w w..w.e.wA
ua osOn4Lt auttatur utua�s i disputs or g • Pe �s���.��w..�•r ••��•••• •.-.-.------•__.._... -�----•-----
udnn urwan�w uw sccnon n nuu - _ _
�" _"'� w� ,,, � ♦an ..:,�. ....t�.,.sa.��,c.,....,..�,..AI��J�.ti,�r.ww...,,:'.r Av�hw ir�r�+yict��i1�UbillCf oI tFIE 1��t1. T�0[ClObftllDta WtISOAtY
.......r......... -�...�..y..�.�.�.�����.._.._.��........_'r--•----- . --•-• . -• -•- _
,nok rema[ra+he*aou�+dnr oenwn u�asv rhe;cnaal coss�a���akLtiq,cardfvSn$.uid wmpilfnp�he copias_
� T1u nspo�uibls aud►orlty ehtit eompiy�mmrd�asaly.if ponfble.�EQi taY eequast made purs�ant to thi9 subQivision.or wifhtn itve Qays o�
t!►�dsu 6lrhs nquue.�xehrQil�j Sfeurdays,Sundays and lega!Sotldiy�.1(ilMltCltl6 C9R1pIUCCG t!IIO�p03Jlote. fi f1C cat�vc wmpi�w�iu�u�a cv�y�ca�
. . . .. . , . . .. .. . . . ...r .R a_, -..:h'.....lS.f..'��..l,,mirA.A.wew.•.w R��1nMnw ts�N'AaV�
WINY1 QYl OAU�cN+uau W unvcm��t�uivwvat.141Y li4ar N��s�i�uulw�w+u•..a.�a...rr.-.��..�.�...�.i ...�—' _'�_.'.,':_"'_-_�' - _
w.._•_...,.,.��.r.r�.u��.,. �
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Subd,4. �ecadur��.heo dats b no�accunte or eompl�ts. 11n iudl•�idual nay coneea�d►c aceuncy or eacpUeenaa o[pubik or yevace
das eonern�U��htnadl. To�:erciu dsls dgh�.�n iadividual�fiaJ!nolify Irt urtttftf�ttu responstoie wa�oriry dsscrioin�v�a oawn ui a�s w..r.v.�uvu�-
..e., ..1 . �.r«��...tA,w •�w�iwi�w��n/
�1710 Afa01UIDlt�uQ�otip�7nui wrtn[A iu uar�eiv��r. U!correc��cra u��r iuu�w w ira�r:.��.-.»t:�.:�:��.2:..__C�:�.�^__'. .�-----r----- --
-_',-+.�_'..._"..._ :�!••�c_^~.c..:...... ....: ►.,.�_:..�cy}a._,�-�,r��,.nA11.e1��inAiviA�i�l tlfa(he 6eliave�t11�d!a tO bt COTRtC Difi
wiiww.�:::.. . ..�..�.� . �.� ��.�....�«�...� �� r. - ' ' - -• .
Iw Ais.,��er•h*tl M Aiuloeed onlv if the ind[vidu�i'�smeemenc of a(ssaroement b Gxluded wiih the dlteto:ed daa.
� T1►s deuetnin�don of Ilae respomiblt au�hodry rtuy be�ppaslod putsuane eo tht pror�sfons of the tdmin[ea�dve procaduie tec rolada�to
coau�ad Cua. �
� a�r♦ MnTff�I►V ♦T'lI�C��V
���AL6Z7AVA ML��..r
Li��,rdarit� wtt,`.."•:.S. :3.C�,S:;b�.2, 'R:g:u�f aubj:�s�!Qata'.iM����uld t�t��r�i�fotffi y4u�td�a�yeur request
. . ,..�t. __ +t_�,..� 0���. :5.. T`:«.. ..i I'1.�...... �.� ...... ..i i•• .I.w��.n�Me rn7v r�nitir� VRII tA IllT►}1t}� ICRAl�1 nrivate or
�V� i yFiYY� Va •��w.�wr •vVw►u.. �...J v• v.....• �. ...y v. ._ __t.�'.._�..._ . ... ., � .. .._.._. . . ..
_'� _'y__' •
-rrt�-_'e-� t_P�..�....��
bVW�YYY►!W ����V���W���va�.
You an nodfkd thu;
t The in(nrm�i�ri VOt�filRilSh will 6e us�d[4 dCtC[IILtAe YOU[QUS11f�C8tfOII�Of tt1C�ttT�t O[�ICG[1St rQQtIG3tCt�-
� Yeu �$v r�ss co su�olv daca. buc retusa[ mav renuire that th� City dtny th� permit or licta�e.
�t 't�e In[4�s+s�iaa rnav be shared wi�s o�her locai, sca�e or fcderal aqencl�s co che etcenc necessary to proca9
►he eerr�ll pr 1�Cta9s.
a_ It vaux reauesced aecmit or licease requlru Couacil udon to apprave, some information snay becomt
v�sblic.
i. You have carcain ciahts under M.S. 13.04 {a�all�►ble upaa request) io r�viaw pdv�te data on yoursett.
6. Your tull nacti� is refluired to proeess tbis applicatioa or pertrtic.
/�i�y�a1z,r� L _ C,�,2 < �, �-.:
Fitu r .�.—�.. Mlddla Last
/5 v 5-- C�/'c�,giocti r9� ✓�✓�.-------
Addreaa
L�;vy--u�,�.'x�-_ �,�1 -s-.3i�'� Yo y•d����
Cip� Snee Zip Phoet
(understand cny rig ts as acaced ove.
---
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---- __ _
Si�nutsa
CHECK OFF LXST FOR XSSUANCE Ok' PER�I�ITS
� FOR OFFICE USE ONLY
ADDRF�SS OR LEGA.L: _ /S 3 S l�o t-� 5 . Qo,.,v� 12� .
� �'IID:
DFSCRIPTION OF ti'YORb'.: _ .Z�1Z�►2� a�2.._ (�vSy�,�-� .
ZOti' .3�i tG REV�ti� BY: c� ^ � M DAT'E APPROVED: Z -�'� `� �' �-
BITU,DPi IG REVIE�� BY: � � DATE APP�20VED: Z ��3- g g
FEES TO BE CHARGED: • � Misc. Fees Calculated By: N
PERNIIT _ _Yes ✓' No '
PLAN REV�W Yes ✓' No SEW�COYNECTION
STATE SUR`HARGr, Yes ✓ No ��ATHR CONNECTION
INVESTIGAZ'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTTON
Nu�ber of SAC Units � O'I'HER (specify)
ZONING CHECK 1.IST zoning Districc: �t/U C/���L - '-' ----__ . ___
Fire Deparm�ent: Post Ofrice: School District: '
Lot Area: Sq.fr. Acres �Vidth Depth
Survey Subm�itted: Yes No Date of Survey:
Proposed Setbacks: .
Front (La.ke): Righ[Si • -----_ . _ .. ..__;. __-
Rear (Street): Left Side
. Adjacent Structures: ti etland:
Building Height: Def. Hgt. P a.k Hot.
Lot Coverage:
Gradi.n�: Stafi Approval Date: - y; Council Approval Date:
Septic: Staff Approval Date: y• • � .
Zoning File: � - Resolution: � Resolution Date:� •
Shoreland Dis�-ict: �
Avg. Setback: Bluff Setback Lot Coverage:
� ' Eusting Proposed
Hardcover: 0-75'
75-250' . . � '
250-500' . •
SQO-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
�
REI�Z�.RKS ('in house): �
� - . • .
, • �t� .26 .
BUII,DIlVG REVIEti'Y CHECK LIST � � : - . . .
UBC: . fL• 3 CONSTRUCTTOY T'YPE: � . .
. Sq FootaJe S Per Sq Ftg
. Basemeat x . .
.. . . lst Floor . " • X � . . ^ � .
2ad Floor � - • , .z -. . . — . . . .'
Gara�e � , x . ' ' • _ - .
x —
� TOTAL
Estimated Con.struction Value• � �� � •
— InspectiorLs Required: • Work Re uirin�
Site q a Separate Permits:
. �C Piumbin� Fire .
Hardcover RemovaI Mechanical � '
Footin� tiVater Connection. _
Septic Sewer Connection
Fra.miag Fireplzce �
InsuIation �wn Irri�ation
��lall Boazd �M�o�Y) Ocher � � �
(11�if�.) WeII S
F�� Gradin�/Fillin� ( tate Permit) . �
Ocher .�_Electrical (State Permit)
REiI�.ARb'S (lN HOUSE): � -------------�` -- -
------------- �
----------- --
REYIEtiV BY OTHERS: DATE: � ' ----------
Access: Eziscin� New -
----__
• Access �Approval: Date .
-------------------------------- BY�
RE1l�A.R�iS (TOBENO�'ED ONPER�I�LXT): �� • -'- -
Y •
-_ .. :... � 27 , . _ . .
-� � - - - � -�---- .._ _ _ . . ._ ---- . - . - -- =
._ .__ ._ . . .
_ .---- . ..
_. __.._,.. � _._ . . .. . .
� -- �- - .�-_ --:— - _ .. . ..
� . . ._. . _
,i_�- .
� ,� DATE �.,n TIME�
CITY OF ORONO CALLED IN LJ -�%" �r ��(l���"i�"
INSPECTION NOTICE SCHEDULED ���� '� .D�
PERMIT NO. �1,� 1� f COMPLETED �� U ��
ADDRESS �� � v 2 /
OWNER CONTR. . ��=�cc.�e�r .
TELEPHONENO. yD� DG�C1T�
� DESCRIPTION
ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 W 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
W
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J
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a
�
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W
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Z
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d f�'�VORK SATISFACTORY:PROCEED I 1 PROJECT COMPLETE
W�
� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �� pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR C' CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor o i -
Inspector.
White Copyllnspector's File Canary CopylSite Notice
07/^<i/1994 14: 52 FROM GRIGGS ' � ��'C�10 - • `'`
GRIGGS CONTRACTtNG, lf�C.
Environment�l Contractors
530 Shor�view Park Road
Shoreview, Minnesota 55126
(612) 482•0444 • FAX (612) 484-6096
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Ah�veoround& Undergrou»d Tat7k Systems • Rem�"!i$tron Equipment& Services
07/21/1994 14: 52 r"P,UM uRIG�S TU 4i��510 P. ��
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�
, , PERMIT
,
- CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 �:`.`-;�����`u��..�r':`
Orono, Minnesota 55356-0815 Permit Number: :- - _
i'ii"i:-,�.�i-�;-;
(612) 473-7357 Date Issued: -� � -
�_J��.F ti:.Li��ww
SITE ADDRESS:
_:�t.-:�-t ��i�_!j"�;i�`., '-` { ���1
3=��J
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DESCRIPTION:
';!,�`; E =�'; _ . _;�;;�j(�i—
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i'i�'r %i� ="Giee6re
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1 i�G.i i..�L'L'V L�V �
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1Ji'J.71lVV1!V F
REMARKS: .;z --�; ; r�,
`vt 'v��r i,,:v
"%r r i r':i .:"' C-
7 V!rTL G.T 1+Ji�
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FEE SUMMARY. '`'t'tfl�:'_.3S.tJ4flh' �Y!!!f
lIL.I.+L17 t t!:RlTt� 1 Vf.f
SSi'• F " ' ' ' � e?iici'r'i.t} t'iiii is�}e Ti-six.
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=;t;�:•F.i t}.�?- ^ �..��i,>>.�_'�
CONTRACTOR: -- :'<�����. :. ;: .::����. — OWNER:
;-,:-:;,-.:_:, -- _ - -- ' _ - �. �. -
. . . : :-;.,;.,1,� °,a:: , �i = }:
" ,..i ;i�-' :;i;_ .'i'iii � ^�r�a
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APPLICANT PER�E SIGNATURE ISSUED BY SIGNAT �'��
�
i -
CITY OF ORONO APPLICATION FOR MECHANICAL PERNIIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 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 pemut will be issued within 2 working days.
2. Permit cards will be sent by retum 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 DesiQns - 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, equi�pment ratings and identification as to type, manufacturer and model.
Data shall be presented on form provided. Ideatification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remocleling 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 Elddition Repair Replace
X Residential Commercial
.i�� �i�: i s 3> ���-N�. PT R� z.�: �S3 i�I
Owner's Name: (�e� f�►SQ�� Telephone Number: �f-�/ - '�s O Y
Mailing Address: S�M�: City: Zip:
Contractor'sName: (c��.t,b Co S �ur. TelephoneNumber: �{-�Z -G'f� �f
MailingAddress• �30 �t-lvp...�V��%� PK RP� City: 5i�o/',xVl� Zip: �SSIZ�
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
�,�c�g
-• �
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 E�aust (must be ducted outside) cfm
No. Other Fans: Locations cfm
Total
l,�A=r-c-1'Z.
��STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
Installation Removal
Fuel oil: gallons � underground inside outside
LP Gas: gallons
� Other Z. - t�,o0 0 �a� �=6- "�-^��s Gas opening
PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($3�.00)
t g�i .ZS. u� x .0125 $ Z��O. S 6
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. (��i�� w x .0005 $ 9-� �
(contract price)
or $.50, whichever is greater
3. Postage and Handlin� (Only mail-in applications) $ �—'
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ Z y�o � � �-
* 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 fumished 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 conect. .
Applicant's Signature: �' - ��� �'�`S Date: 7 � �� � yy
Approved By: �� - Date: � -"�� va¢
ORONO ADMI]�IISTRATIVE OFFICES
INFORMATION DISCLOSDRE REQIIEST
MINNESOTA GOVER]!TI�NT DATA PRACTICES ACT
REQUESTER NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six months thereafter
unless a dispute or action is pending or additional data on
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of Request: ,j - ��' - i .2
Requester Name: 3� .� ,�'�i�t-�h�1 ����� c3 �.� ,�c2�-f �/�
Address: �5�.�� %�c3i�,,,� s' ��%� .-� J� �i r.� � City: ��°%� .,��
Zip: .�� � i � _
Home Phone: y �/ -�.T C� �; Business: ��,;., �
Description of Information Requested: �i?-,� �., ,�� � �u �,�f. •;
�:, �� �•t
.�, .�,, �dE�,- � ,� �,��� �
�,
, _
Requester' s Signature: � ,�_
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Department: Q f Z Handled By:
Request Type: In per,�on Mail Phone
Requested By: Subject c�f Data Not Subject of Data
Information Requested is Cla:ssified: �Public Private
Confidential Non-l?ublic Protected Non-Public
Request is: �Approved Denied Approved in Part
Remarks/Ca�ments:
�
Authorized Signature:
Fees: x = $
No. of Pages Rate per Page Total Due �
�'ERMIT �
CIT� OF ORONO PERMIT TYPE:
'�750 Kelley Parkway- P.O. Box 66 ; �;�;...;;�;
Crystal Bay, Minnesota 55323 Permit Number: , �-J _ _
Date Issued: ��" -
(612) 473-7357 t;>:i,`__, - .._
SITE ADDRESS:
�.L:=�,�_ _.;���-ii��°�� i=�# �°t�
rs S",=�i - - - - "—•t)!1 i�
DESCRIPTION:
�E�;=�L'. -.=�:�:r"; ��==.wT
`���I I �i.�t 1'=.�`-1 '=r=.'2,f�'t� " �1'�;}_` =�i'�^l�_:..� ��'E�_+!�_��'_s�'C��.
E-�S.i j �,t�1 :"l u �;�:_�'t,'F:: E j i�W' ��Ef_.�.�'.�,'��_ii_I`�.i� �-,��;`:�R, i
�_='1l'=f.�l': _�it:�;r ^ -::� �V°_;F',i;�;��3�j ��!�'t';.t_.I ,
I REMARKS:
� � ;;;:: - - - -, ,:� - - _ - ��,
. -�°�'4 c � . . ._..__. , �_�r. �1�-; � _ _ i�_. _ 1!-�ti;'iw!i_:i�;t; _t;...i r �i.: 7 '__ � .
FEE SUMMARY:
� ,S`-. } -_ ,
. ?'7S._�7'"i�?+�}?ij .-'�,v 1 ; (_I�j_i
� �.�..� �';.=r' r =i,(. , f�
`"� I ri i 3 i F-_ a' ';� � ��'�
f?%':`. _ 'b4' . ..__ . _.
=�3.1ti'3�f-tcii''��� _�.....__......_ 3'• . �t,,,„1
�t�t7..-��, t-=+%�' —�_.j....�.'�
CONTRACTOR: OWNER: _.. �:;�: � - : _ _
_ -. .;`•.{ hl;t��'�:
_ = _ �, r;i=s�:t;i:=: :'T �;f;
. :.ufs�,{-� :.it.,� - - - -
_�4�`.... _ - _ -
W "�� t ",'.� "� ,...!.e-,-.4 ii�h�`.��{� . ..._ .._.� . ._ j'"'.�.1°, I ._ .:.s. ._. . ..E.;_` . . . ...._ ...�•4 �.__ 't,��f-;� i ir;�-` �;i;`A-�"
. ., �L.., .._
: , _.. ._ _ .._ . � � ` -- - ._ .,_ . . ._
_. _..__--. ' . ' - - -'
. . . . -. T S� .
:�. = i E-�; :�i'v_� :..� �- ; f 'J':v; , _'•�-:; i .`,1 - -,'�t i s .... �' _ .. _._ 4�`!� . . +``-__ _ _ . . �_'.
; ' F `r �'-. :� .1 _�y. .t i i::. ... v 1•'1 E .. ..__ _ i �"' -;t_'3 t_�_ 1. .._ _.F___.. ..�_:1 _. ..._.. ,.._��{'� �`_ . I
:";.,� .�j",
i
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i _. . _ _ .
L_
/ \
C�1.il,M. ` • �"�.►
APPLICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE �
. �.a,`�` -�' �,
. ' Total Fee: $ _�`j 7, .�`� Date Received:
Entered By: ,C�, Permit#: /i 3�;�,k
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) OWNER .�K CONTRACTOR
JOB SITE ADDRESS: ��� �0}-{I� S i�Ql t�� ZIP: 5�'�� I
�Yz�T� , �l
NAME OF OWNER: �j IG� l2jU g N PHONE: (home)
(work)
MAILING ADDRESS: Z ZZ�A f-(U���T CITY: L(�S ZIP: SS 0
���'t5� S� F�dE1'I"�1eH�� �-�4xoc�T � SiTC 'P�.��
CONTRACTOR: : 4 l2• �`7�} •9� S$
CONTACT PERSON:�Q�p�� ��,1N1 S MOBIL PAGER: �iz •5 3$ •�Z S`1
� MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �e.c,� �-c-�t �'Si
�' �.-v �``' 1°t � � 50
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ i� `� `' �
I hereby apply for a building pernut 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.
� S
APPLICANT'S SIGNATURE: �.vt,c,,c� � • C.?.wkit DATE: 3 '31 ' 1'`�'
� �.5� C���`,°'.""`
NOTE! Parade of Homes ents require separate permit approval by Police Deparhnent and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
5
Sec.13.04 RIGHTS 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 conceming 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 IegaUy required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidenual data;and(d)the identiry 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
enfo�cement officer.
The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income tax or nrovertv tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request ro a respohsible authoriry, 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 hun 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 acaon pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
'I'he responsible authority may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry 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 wricing the responsibte authority describing the nature of the
disagreement. The responsible authoriry shall within 30 days either. (a)correct the dara 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 �ity 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.
�S� � �'1,.°�Y�.�,u !v+-c--�4-'�1-O IV S
First Middle Last
2 n z4,� �I�r��� /� • S •
Address �� � � � �t�_�� Q` �
r�t�L� � 4 4- �
Ciry State Zip Phone
I understand my zights as stated above.
� � ' \
� C�w� a �
Signature
6
• '� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESSORLEGAL: i53`j ��i-�r� � F��;,,v� ('c..z„�
PID:
DESCRIPTION OF WORK: TEvv��' -C���
-------------------------------------------------- --------------------------------------- � . y�
ZONING REVIEW BY: u�-- DATE APPROVED• Y- 2
��lEf$-$�� REVIEW BY: (�: I( t/1'l LY� DATE APPROVED: �i/- -2 � _ ci`j
i(Lc�C..r��� �
------------------------------------------------------------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes r/ No
PLAN REVIEW Yes � No SEWER COI�'NECTION
STATE SURCHARGE Yes ✓ No WATERCONNECTION
INVESTIGATION FEE Yes No ;.� PARK FEE
SAC Yes No �/ SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: N� c�-r�G c'
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: �
Front (Lake): � �v ''� Right Side:
Rear(Street): Left Side:
Adjacent Structures: �' � Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: #� Resolution Date:
Shoreland District:
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):
7
. . � , •
BUILDING REVIEW CHECK LIST
UBC: � CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ �C �y
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board � (Mfg.) Well (State Permit)
oC Final F�l-+�•� �� 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): p���T �,���,� �--�= r+�y i� �t�i2✓
J.>�� Il�
g
DATE TIME
CITY OF ORONO CALLED IN
INSPECTiON NOTICE Q SCHEDULED — —
PERMIT N0. coMP� TE�
ADDRESS � �
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTING 11 ME HANICAL 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL B0. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� EMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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