HomeMy WebLinkAbout1996-008334 (lift residence) PERMIT
•CITV OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: �'�-�'���-���'"`�
Crystal Bay, Minnesota 55323 `'`";����''-�-
(612)473-7357 Date Issued: �-y Yj�s;�:;,��.
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: -- �;����� i��,,-�t. —
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APPL ANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ -�'.�'�;��- '�`� Date Received: �j'����"j�.
Entered By: �', Permit#: �� � '�'��
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CITY OF ORONO - BUILDING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � � '�; ��`Y�--%���% ,� %��' ZIP• �,5.>'J�
NAME OF OWNER: �t%�'-�'�✓ `�� �/✓,(,� ���S i-�`v%PHONE: (home) j�������5�
(work) ��'���, _ � �� �
MAILING ADDRESS: _�+2�� CITY: ZIP:
CONTRACTOR: �� �iC '/`�== PHONE:
CONTACT PERSON: MOBILE/PAGER:
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 detain: �'/� �'��" �';,�.5;�f'l l�� d �i /
�"� .� � /--�1 %,- � i C��/=f� j��l= S '� �,�'��' � �"- C�li � i' 61.�/_',/ l.��./^'G
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ '�-' : , ` �
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE:��/ �L�,ti-t--�� -C��-�t'�7 DA'TE: `�' " � - i �
i"
NOTE! Parade of Homes events require separate perntit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
. �
Sec.13.04 RIGHTS OF SLJB.TECTS OF D,�TA
Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forrh in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a) the purpose and intended use of the rEquested data wi[hin the collecdng'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legaliy required to supply the requested data;(c)any Irnown consequence arising firom his supplying or refusing to supply
private or confidenrial data;and(d)che idenary of other penons or endaes authorized by state or federal law to ieceive the data. This requirement shall
not apply when an individual is asked to supply invesrieaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav pface the nodce required under this subdivision in the individual income tax or propem tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individuaL Upon request to a responsible authoriry,an individual shall be informed whether he is the subjec[
of stored data on individuals, and whether i[is classified as public, priva[e or co�den[ial. Upon his further request, an individual who is[he subject
of stored private or public data on individuals shall be shown[he data wichout any charge to him and, if he desires, shall be informed of the conten[
and meaning of that data. Afrer 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 authoriry
may require the requesting person to pay the actual costs 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 legai holidays,if immediate compliance is not possible. If he cannot comply with the reques[
within that time,he shall so inform[he individual,and may have an addidonal 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 pubiic or private
data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing[he nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correc[[he data found to be inaccurate or incomplete and attempt to norify past recipienrs of
inaccurate or incomplete data, including recipients named by the individual; or(b) notify the individual tha[he belizves the data to be correct. Data
in dispute shall be disc(osed 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 admuustra[ive procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we wouid like to inform you that your request
for a pernut 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 pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. The information may be shared with other(ocal, state or federal agencies to the extent necessary to process
the pemut 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 Las[
Address
C�n, State Zip Phone
I understand my rights as stated above.
Signa�ure
� ^ CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3`t l(� ���ys� ��= iZ-�.:��
PID:
DESCRIPTION OF WORK: (�;���'vt�,ti.� ,— �;,'v,�,t V�-.�t 5,-�:Lt, ���'.�-(
-----------------------------
ZONING REVIEW BY: � � �.,{,,._ DATE APPROVED: �;- Y'-�C.
BUILDING REVIEW BY: c � ,. �, .,,,�...� DATE APPROVED: y -y-��,
-----------------------------------------------;- ----------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �" No
PLAN REVIEW Yes ✓' No SEWER CONNECTION
STATE SUR`�-IARGE Yes ✓ No WATFR CONNECTTON
INVESTIGA'I'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST zoning District:
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:
� t
�; Adjacent Structures: Wetland:
�v�
� Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By�
Zoning File: #i Resolution: # Resolution Date:
Shoreland Dist:ict:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
i
Hardcover: 0-75'
d 75-250'
� 250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): �`"N+� cti�s,r�i� f,,�.9 s o!:�G iN'��y �/lo�1C 5�c� Cr�✓1J�'. �r vr�i �'
J
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26
BUILDING REVIEW CHECK LIST
UBC: �` � CONSTRUCTION TYPE: V�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ �CJ,C��
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)
� Final Grading/Filling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERMIT):
27
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTI 3�L SCHEDULED ��� ���
PERMIT NO. � COMP ETED �l� �_
ADDRESS � C> � �
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTINd 11 MECHANICAL RI 18 EXCAV/GHADING/FILLING
y 02 FRAMING 13 MECHANICAL FINAL 19 IAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TFiEE REMOVAL
Z p4 Wql(.Bp. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWEFi HOOK-UP 06 PROGRESS
~ 07 DEMa—SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
I
v 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d ;WORK SATISFACTORY:PROCEED - PROJECT COMPLETE
W
� C CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY
W
O G CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
C7 CORRECT UNSAFE CONDITION WITHIN HOURS. -, pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTEO.CALL INSPECTOR —CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the xt' ction 24 hours in advance.473-7357
OwnerlContract sit •
Inspector. � �
White Copyllnspector's File Canary CopylSite Notice