HomeMy WebLinkAbout1999-010977 (Remodel) „ r —— —
PERMIT
CITY OF ORONO PERMIT TYPE:
. 2750 Kelley Parkway- P.O. Box 66 Permit Number: ���`��������-�
Crystal"Bay, Minnesota 55323 i:��,t;�'��'f
Date Issued:
(612) 249-4600 ���''�;�f`�;__�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE -G��
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' Total Fee: , $ � �'� �, Date Received: // o?- ��
EnteredBy: Permit#: �(� -7
CITY OF ORONO - BUILDING PERNIIT APPLICATION �
All information must be submitted in full before plan review will he started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNE OR CONTRACTOR
JOB SITE ADDRESS: ����� �e 1oc�c` ZIP: ���"1 I
NAME OF OWNER: ��� �. �� r�� PHONE: (home) �����!
(work) �����0"� �'�'J�T�?�7
MAILING ADDRESS: �a70 (� �.'� CITY: � ZIP:��S,��/
���.�,� �1 �
CONTRACTOR: ��,r���� , PHONE: �(SS-���� �s,�d?77,6
CONTACT PERSON: �►�p„v`� MOBILE/PAGER: --
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: �#���p�7q�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detai�: �} ,GP�f, � �"o��
STORIES: � SQ.FEET OF EACH FLOOR: �'�D�
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ Q��,��
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 ccordance with the a roved plan.
APPLICANT'S SIGNATURE: DATE: � � �
NOTE! arad o H m e separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGHTS OF SiJBJECTS 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. InformaHon reqwred to be given indivtdual. An i�ividual 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,polidcal subdivision,or statewide
sysrem;(b)whether he may refuse or is IegaUy required to supply the requested data:(c)any lrnown consequence arising from his supplying or
refiuing ro supply private or confidential data;and(d)the idenriry of odier persons or entities authorized by state or federal law ro receive the data.
This requiremen[shall not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revemie mav olace the no6ce reauired under this subdivision in the individual income taz or nrooertv taz refund
insuucrions instead of on rhose forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who
is che subject of stored private or public data on individuals shall be shown the data without arry charge to him and,if he desires,shall be informed
of d�e 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 w him for six months thereafrer unless a dispute or action pursuant w this section is pe�ing or addidonal data on the individual has been
collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require[he requesting person to pay the actual costs of�naking,certifying,a�compiling the copies.
The responsible authority shall comply immediately,if possible,with azry request made pursuant to this subdivision,or within five days
of che date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
che request within that ume,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
privare data concerning himcelf. To ezercise this right,an i�ividual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authoricy shall within 30 days either: (a)correct d►e data fouad to be inaccurate or incomplete and attempt to nodfy
past recipiena of inaccurate or incomplete data,including recipients named by the individual;or(b)norify the individual that he believes the data
to be conecc. Dars in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The deternunaaon of the respoasible authority may be appealed pursuant to the pmvisions of the adminisua6ve procedure act relating
to contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your
request for a permit or license from the City of Orono or any of its departments may require you to fumish certain
private or confidential information.
You are notified that: �
1. The information you fumish 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 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.Q4(available upon request)to review private data on yourself.
6. Your full name is required to process this appIication or permit.
� � ����� �l����
First Middle Last
/a 7D r9��,r� �
Ad re �
Ciry . State Zip Phone
I understand my ' e a ove.
Si re
6
. ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: l 210 A R�30�Z S i
PID:
DESCRIPTION OF WORK: (���p� (L�P�t�.r�v�o�,,,�
ZONING REVIEW BY: /tl F DATE APPROVED:
BUILD�TG REVIEW BY: .� DATE APPROVED: ��- Y—g�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes t/ No
PLAN REVIEW Yes No z� SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes �.�No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: Nv C Gti`�r��
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: W tland: .
Building Height: Def. Hgt. P Hgt.
L.ot Coverage:
Grading: Staff A�pprqval,Date:, . _ y: Council Approval Date:
Septic: Staff Approval Date: y: � � �
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
BUII.,DING REVIEW CHECK LIST � 1
UBC: �- 3 � = CONSTRUCTION TYPE: V�
Sq Footage $Per Sq Ftg . , ..
Basement , x = '
1 st Fl�r x =
2nd Floor x =
Gazage x =
R =
TOTAL
Estimated Construction Value: $ Q��04� �"
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal •Mechanical• Water Connection
Faoting 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 PERiVIIT�: i3c:Or4,od,� w�•v�a�s rn,�9.- n.��T'_
[%C�3 R.t.� tJ►
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8
DATE TIME
CITY OF ORONO � CALLED IN � y'�
INSPECTION NOTICE���� SCHEDULED !� ��= �
PERMIT NO. COMPLEfED
ADDRESS �
OWN ER CONTR.
TELEPHONE NO. � 7 � � .3`�� � �
_������.�3 g2 ��
� DESCRIPTION ,�� ��
ly 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
O 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMB � � 36 FOUNDATION/REMOVAL
� OWN CONTRACTOR OMEETYOU:�YES_NO
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W� WORKSATISFACTORY:PROCEED �PROJECTCOMPLEfE
W O CORRECT WORK$PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
p ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFOflE COVERIPIG PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the ne t ins�ction 24 hours in advance.473 7357
Owner/Contr r ite:
inspector.
WhRe Copyflnspector's le Cenary Copy/SRe NoBce
DATE TIME
CITY OF ORONO CALLED IN �
INSPECTION NOTI � SCHEDULED �
PERMIT NO. COMP EfED
ADDRESS T2��� �- "�a Z- � ' .
OWNER CONTR.
TELEPHOIVE NO.
� DESCRIPTION � ` /J�a � �r2 ���
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q Oa FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �WORKSATISFACTORY:PRQCEED �ROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED I ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins ion 24 hours in advan 473-7357
Owner/Contr o n ite•
Inspector.
White CopyMspector's Flle Canary Copy/Site Notice