HomeMy WebLinkAbout1996-008360 (add/remodel) PERMIT
- �ITY�OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �:.�:��.[�L?_(yf�
Permit Number: t-,;';;;:_;;_,�_;
Crystal Bay, Minnesota 55323 _� =-
(612) 473-7357 Date Issued: 4_���;i f�;�°i�:,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPUCANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE �"��-
Total Fee: $ I i_�>• �' ' Date Received:
Entered By: ��,� Permit#: �; h�. �
CITY OF ORONO - BUILDING PERMIT 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: j � �� ,�c{ �i s� ��- �c� ZIP: �'��3 S �
NAME OF OWNER: 7ct,�'r V �/s ���� PHONE: (home) �`7 3 ����W
7 � . (work)
MAILING ADDRESS: ��-��(`'i ,�'!�c-r �� s;c ti f1�!CITY: C'9,��'�� r' ZIP: f� 'S'
CONTRACTOR: j'������ �� l�'�i''o��-T C�����; f� �� PHONE: ��;'c� — ?c{9'�;"
CONTACT PERSON: ,l�,�� �/ /S'�� o �•-� MOBILE/PAGER:
MAILING ADDRESS:S`t?��� � ��F' d{'.� CITY: �i`� .'/'r �'/i,', ,_ZIP: > •% >>'�'
4�c°�, i�
STATE LICENSE: # l 7 5-'�� `��
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�: /��Q�,r� .� �� ��<�c� �L���
�^l=�' -''r �� ,�= � � �f �� 't��� r �,� N �S y� /'z" �" i� �to
,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �c��'�-
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: � �.-y� C.�/'��G��'�-� DATE: %<.�/,� I, �,i, '`�f��
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.
6
Sec.13.04 RIGHTS OF SIJBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set fonh in this secrion.
Subd.2. Information required to be given individual. �.n individual asked ro supply private or co�dendal data concerning himself shal]
be informed of: (a)the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required[o supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
priva[e or confidential 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 invesrigative data, pursuant to secdon 13.82, subdivision 5, ro a law enforcement o�cer.
The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or provertv 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 subject
of stored data on individuals, and whether it is classified as public, private or co�dential. Upon his fur[her request, an individual who is the subject
of srored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the concent
and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need no[be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending o�addidonal data on the individual has been co(lected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible au[horiry
may require the requesting person to pay the actual costs of making, cettifying, and compiling the copies.
The responsible authoriry shali 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 hofidays, 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 addidonal five days wi[hin which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure wheu data is not accurate or complete. An individual may contest[he accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall notify in wri[ing the responsible authoriry describing the nature of the disagreemen[.
The responsible authoriry shall within 30 days either. (a)correcc the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, inc(uding recipiena 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 stacemen�of disagreement is included with the disclosed data.
The detzrminacion of the responsibie authoriry may be appea(ed pursuant to the provisions of the admuustrative 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 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 che City deny the permit or license.
3. The information may be shared with other local, state or federal a�encies to the extent necessary to process
the pernut 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 �tiddle Last
Address
Cih, State Zip Phone
I understand my rights as stated above.
Signature
�'
.
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3�`l,v f�� S� �—l'
PID:
DESCRIPTION OF WORK: c„>�,v,��,,.,, t2..c�r-����vv-�-�` F S!-1i��� r� G�i4-�'1�i��
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ZONING REVIEV�J BY: � +/� DATE APPROVED: j- (u �'�:
BUILDING REVIEW BY: DATE APPROVED:
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes No 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 CH�+CK LIST Zoning District:
Fire Dep ent: Post Offce: School Di�dtrict:
,,
Lot Area: q ft. Acres� Width � Dept
� �
Survey Submi ed: Yes i No Date of Survey(�'�
i �
Proposed Setb s: �
Front L e): I Right Side:
�
Rear (�tree : � Left Side: i
�� I
Adjacey'ht Stru ures: ' We;iland: ;�
�� i
Building Height;, Def. H�. � Pea�c Hgt. !
i
Lot Coverage: \
Grading: Staff�Approval Date• � y: Council A ate:
( � �
Septic: Staff � proval Date: � � By:
Zoning File: # ', Resplution: # Resolution Date:
Shoreland Dist ict: �
Avg. etback: � Bluff Setback:
Existing Proposed
Hardc ver: 0-75' �� �
75-250' 1, �; �;
250-500' � � �
500-1000' ��'; 1
�
,�'I
Hard over Variance Required:11.Yes No Date of Council Approval:
f `
REMARKS (in house):
10
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,
. , ,
BUII.DING REVIEW CHECK LIST
uBc: ��-3 co�vs•rxuc�o�r �r�rnE: v�
Sq Foota;e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ S�(�U 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):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERNIIT):
27 �
. WORK INCLUDES
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1 . Excavating ��'�'�� �
a) demo and haul away old garage and foundation
b) demo and haul away concrete driveway
c) dig footings for new garage
d) haul away excess fill
e) backfill with clear 3/4" rock over 4" drain tile with
sock after block walls are finished
f) cover clear rock with 4" to 6" of dirt
2 • Cement work
a ) install 8x24 footing with rebar
b) 5 coarses 16" frost footing block
c) 12 coarses 12�� block above floor
d ) bombeam around center and top perimeter with corefills 4 ' o. c.
_ e) 4�� concrete floor with rebar mat 2 ' o. c.
f ) expansion joist around perimeter and floor sealer
g) pour 26 'x34 ' driveway 4�� thick wi�th wire mesh and sealer
3. Retaining walls
a ) remove and haul away old block retaining walls
b) install new retaining walls that start at new garage go
west to bank, south to steps, returned west along steps .
Start at south side of sterG an� go alor�g existing wall
line south to existing wall line, then west along exsiting
wall line, then stop where existing wall stops .
4 . Overhead doors
a) install two 9x7 raised panel steel insulated doors
with openers
5 . Lumber
a) supply all materials to install roof and garage doors
on new garage
b) supply materials for soffit and gable end, siding to match house
6 . Carpenter labor
a ) supply all labor for constructing roof and overhead
doors on new garage
7 . Electrical
a ) rehook electrical to new garage
b) wire for two lights , two receptacles , and two garage
door openers
8 . Supply one 9 yd . dumpster for trash
,r.
BY OTHERS: ���.:� - � � w-�
1 . building permit �'*��� '�� ���'``.
� ��
.,
2 . painting ����
3 . landscaping and seeding ,��,��� -� ��_� -
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