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CITY of ()ROAN <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66. CRYSTAL BAY. MN 55323 473-7357 <br />ZONING DISTRICT <br />LR-1B <br />FIRE DEPARTMENT <br />Mound <br />POST OFFICE <br />Mound <br />Vi. R DATE <br />5/11/87 Resol <br />CCND. USE DATE <br />LOT AREA .45 aC <br />WIDTH DEPTH <br />1271 ' PROPOSED SETBACKS <br />FRONT411 R SIBS str e� <br />REAR L. SIDE <br />63' 31.23 <br />LAKE WETLANDS <br />NA <br />ACCESS <br />NEW EXISTING <br />AGENCY-APPROV.DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />REMARKS <br />PERMIT NO. 64001 <br />DATE ISSUED 6/8/87 <br />SITE ADDRESS 4160 Forest Lake Drive. <br />PROPERTY IDENTIFICATION NO (PID) c, 7 — // .d 3 3 <br />LOT 4 BLOCK 1 SUBDIVISION Forest Arms Country <br />OWNER IName) (Address) (Phone) <br />Bert Norman <br />ARCHITECT/ENGINEER - Must Certify Multi -Family. Commercial & Industrial Construction Plans <br />(Form) (Address) (Phone) <br />BUILDER (Firm) (Address) <br />(Phonel <br />Dave Rod Const. 17335 13 Ave N. Plymouth 473-7157 <br />TYPE OF WORK New Addition Remodel Renovate <br />New -Res <br />CONST TYPE <br />BUILDING SIZE <br />ood Fr <br />64.5 32 <br />L W <br />Ht28 <br />OCCUPANCY <br />CLASSIFICATION Single Family <br />res <br />DWELL <br />STORIES B 1 2 <br />3 <br />UNITS <br />GAR STALLS <br />NUMBER OF BEDROOMS <br />3 <br />ATT <br />DIET. <br />SEPTIC <br />APP DATE <br />PROPOSED USE <br />COUNCIL <br />APP DATE <br />INSP CTION REQUIRED <br />WORK REQUIRING <br />FOOTING before pour <br />SEPARATE PERMITS <br />V i r t 14 C <br />.... FRAMING rough -In <br />PLUMBIN <br />Y INSULATION <br />MECHANICAL <br />//.... WALL bOARD before taping <br />WELL <br />T7 <br />L!7 <br />I/7 ...... FINAL before occupancy <br />❑ <br />❑ ...... SITE INSPECTION <br />SEPTIC <br />WORK BEYOND OR WITHOUT A RE- <br />SEWER <br />09 <br />QUIRED INSPECTION WILL BE SUB <br />WATER <br />❑ <br />JECT TO PENALTY <br />GRADING d FILLING <br />❑ <br />INSPECTIONS MUST BE CALLED -IN <br />FIRE <br />❑ <br />24 HOURS IN ADVANCE <br />COPY WHITE FILE GREEN FINANCE <br />CANARY -INSPECTOR GOLD <br />RECEIPT <br />PINK ASSESSOR <br />M.o.lrn My • •d. Co Ina 161216914410 <br />Estimated Construction Valuation <br />130,000 <br />PERMIT FEES <br />BLDG. PERMIT <br />508.00 _ <br />STATE FEE <br />_65.00 <br />330.20 <br />PLAN REVIEW <br />_ <br />525.00 <br />SAC CHARGE <br />SEWER UNIT <br />225.00 <br />430.00 <br />PARK FEE <br />PENALTY __.-_ <br />OTHER <br />TOTAL DUE 2083.20 <br />ACKNOWLEDGEMENT <br />THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED AND DECLARES <br />UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br />ANCE OF ALL INFORMATION COND;TIONS AND REQUIRE <br />MENTS REPRESENTED ON THIS DOCUMENT THE UNDER- <br />SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM- <br />PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br />or MI 'OTA BUILDING C E REQUIREMENTS <br />r <br />dtur Da 1, <br />Approved ` of Orono <br />