HomeMy WebLinkAbout1993-005474 PEI�MIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: ��:=T.�..`�%' �`v'=_
Orono, Minnesota 55356-0815 Date Issued: �-"s�''�`�`�
(612) 473-7357 c_:'=;i;',i ;��:=:
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — E��:��� i.r,�;�-�#. —
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
�-
CITY OF ORONO - BIIIZ.DING PER'�LIT APPLIC�,TION
Total Fee- $ 7 � S� Date Received: ��-L�` ���
Date P_��roved:
�, _ - -
Entered By: � ,�� �-��,j .
P e^*�i t Q: 7
AT•7• INFORMATION MIIST BE SIIBMIT'�� IN FITLL BEFORE PZ.AN REVIEW WII�L B$ STAR�ED
(See Check-off List Enclosed)
---------------------------------- --=�r---------------------------------------
THE APpZICANT IS: (circle one) WrIER �or CONTRACTOR
� ?�� �- C�` l� p S1�tJ 4_ ��D zzP- �� 5 ��� �
JOB SITE ADDRSSS:
(wcrk) ��,�j_-�.��, l�
• �� I L l� � �z L �„�, �_ f L kj � t4 rl.�� 1 PHONE: �home) 7 73_j"��f �
N� OF OWNER-
:�iAII,ING ADDRESS: � /�� N�Y S i� �-- IVJ CITY: /1��I�L.�..�C./� �yl.� ZIP: JS 3�`�
CONTRACTOR: PH��'
'cSAII.ING ADDRESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: PHONE:
�i�SLSNG ADDRBSS: CITY: ZIP:
�A�� RBGISTRATION a
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration ✓" Renovate Land Alteration
PROPOSF.D WORR (describe i.n detail) : ��%'�l �%� � j�d C� � d �t-1�- �-i"�C��
�-�"1 �."�'fi V- S t�c,��� S I � ,S �` �Y�"�
:aTORIES: SQ. FEET OF EACH FLO�R=
:a_ OF B$DROOMS: GARAGS STAI.LSs ATT. DET.
. �-' ,
��:STgSATED CONSTRIICTION VALIIATION (eacl.nding land) : $� ��% L��'
� hereby apply for a building permit and I acknowledge that the iaformation
bove is complete and accurate; that the work wil.l be in conformance with the
_:rdinances and codes of the City and with the State Building Code; that I
.nderstand this is not a permit and work is not to start wit:�out a permit; and
,'�at the work wiI 1 be in accordance with the approved plan. .
� �` �)
_?PZICANT`S SIGNATURE:
� l,�t,�(�,j,��. f7�,�` '�C�tnL� DATE:
'" "`� CHECX OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR I,EGAL: 3�16� (3 A�( 5 l 47 C (Z.p PID=
DESCRIPTION OF WORR: Oc_Ll� - ----------
----------------------------------------------- _ `
--------------
Z ONING REVIEW BY s ,,._ DATE APPROVED: �'�D '�-3
BDILDING REVIEW BY: � DATB APPROVED: � '�' rS1
------------------ ---
FEES TO BE CHARGED: Misc. Fees Ca1cul.ated By:
PERMIT Yes ✓� No .
PLAN REVIEW Yes (/' No SEWER CONNECTION
STATE SURCHARGE Yes �'�No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC � Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
------------------------------ /
ZONING CHECR LIST Zaning District: /1,�/13 _
Fire Department• � _ Post Office• � School District: JllD�o
Lot Area: � C�t�?�'�,� Width: Depth:
Survey Submitted: Yes� No Date of Survey: �
c���posed Setbacks: � ► •
Front (Lake) : � �O�� Right Side:�'� �
Rear (Street) : ,$�r� Lef t Side: 2�0�
Adjacent Structures: /3-'�1iActi� Wetland: N�
Peak H t. ~�
Building Height: Def . Hgt. �•I� g
Avg. Setback: /✓�/Y�` Lot Coverage: ��i4-
Existing Proposed
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Varianc Req ' red: YeS NO
Date of Council Approval.:__
Grading: Staff Ap roval ate:
�"`�_ y; Council. Approval Date:
Septic: Staff App oval D te: By'
Zoning File:# es lu ion �� Resolution Date:
REMARRS (in hous ) :
.�.. _, .
BIIILDING REVIEW CHECR LIST
�, . _
IIgC. �� �--� CONSTRIICTION TYPE: .�.y-
Sq Footage $ Per Sq Ftg
Basement X = .
lst Floor X —
2nd Floor X =
Garage X —
x =
TOTAL
.
$stimated Construction Value: $ /S��
Inspections Required: Work Reqniring Separate Permits:
Site � PZumbing Grading/Fi�J.ing
�Footing MechanicaJ. Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wal.l Board (Masonry) Lawn Irrigation
�Final (Mfg.) Other
Other Wel Z (State Permit)
Electrical (State Permit)
----------------------------------------------------------
REMARRS (IN HOIISE) :
�r
-------------------------------------------------------
REVIEW BY OTHL�F2S: DAT'E:
Access : Existing New
Access Approval: Date BY=
-------------------------------------------------
REIrSARRS (TO BE NOTED ON PF.RMIT) :
� �•
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�.,.,r;�.�:� a�x{ ',�
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��'��_ � +��,:� C I'TI' Of UR�leTO
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;_�- � Post Office Box 66•Crystal Bay,Minnesota 5a323•Municipal Offices
'a"_�;"f .'. 9 �.
. � _ � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
I.icense f rom 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 Iicense 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 Iocal, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii action
to approve, some inf ormation may become public.
5, You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6, Yaur full name is reguired to process this applica�ian or
permit.
j)'Jlc� �� � ��� �-���- �l� /�R� ��I.
First
Middle Last
3`� +� � ���l S� r �)`� ►��-��_
Address
a'k� 1�I�L� ��L l�11L` /Y1 � 5 � 3 S �
City State Z1p
,� 7� - ! ��S
Phone
I understand my rights as stated above.
_ ���'��. ; ��. '� , �� ��-�i�
; .� ��.� ,�'�
� � � f�.�_
Signature
BUILDING&ZONING—473-7357 • ADMllYISTRATTOV&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING
— - - �� .
i
�_04 RIGHTS OF SIIBJECTS OF DATA �
Subdivision L Z`YP'�
of data. The rights of individuels on whom the data is r
stored or to be stored shall be as set forth in this section.
Subd. 2. Information required
to be given in�vi�uaL An.individuel Esked to
� " supgly private or confidenti8l data concernin�8m�sit�h�in the collecting state agencY,
purpose and intended use of the requested
(b) whether he may refuse or from his
political subdivision, or statewide system; �oWn consequence arising
required to supply the requested date; (�) �Y
� su lying or refusing to supoly private or confidederal law to receiae the data.1tThis.
PP state or f
other persons or entities authorized by �vesti ative datg�
requirement shall not apply when an individual is asked to supply g
pursuant to section 13.82, subdivision �, to a law enforcement office:.
The commissioner of revenue mev p1er2V tgX rei�und instr�ucteonsunsteadhoi
subdivision in the individual income tax or rr��
on those i orms. . - -— - " .
Subd. 3. Access to �ata by in�vi�i- UPon request to a responsible
uthorit an individusl shall be informed whether h��ate or confident al.e UPon h�s
a Y� ubl�c
individuals, and whether it is classified as p r P ublic data on
e to him and, if he desires, shall
further request, an individuel who is the subject of stored private or
individuels shall be shown the data withou�fan�y ��g. �ter an individual h� been
�e informed of the content and tT►ea.rung the dats need not be �sclosed Lo
shown the private data and informed of its mLan�ac�on p��ugnt to this section is
him for six months thereafter unless a d�SP
� ending or additional data on the individuh h�ate or p blic dataruponarequest by
' P require the
responsible authority shall provide eflpies o t p
the individuel subject oftrie actual�co tis of mPaking,l�ert�fYingye�'d �ompiling the
requesting person to pay -
copies. ssible with any request
The responsible authority shall comply immediatelYof th date of the request,
made pursuant to this subdivision, or within five ��immediate compliance is not
excluding Saturdays, Sundays and lege.l holideys,
ossible. If he cannot comply with the request withi wiihin which toh omply w�h the
P hsve sn additionsl £ve days
individual, and maY �d Ie al holidays•
request, excluding Saturdays, SundaYS g
diu�e when data is not ac�ate or complete. An individuel may
Subd 4. Proce himself. To
contest the accuracy or completeness of public or private data concerning
in writing the responsible authority
exercise Lhis right, ar► individual eQ�n�°tTh resp��ible autharity shall within 30
describing the nature of the disagr lete and attempt to
days either: (a) correct i�c��a�e ord�comple e daLaeincludingPecipients named by
notify past recipients of
the individual; or {b) notify the indi��� i��dua�1,�SLatemen Of disagreement is
Data in dispute shall be disclosed only
• included with the �isclosed data• egled ursuant to the
' The determination trat ve pro�dui'e a t relat ng to contested cases•
provisions of the admin�s .
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, \I�`1 '�P
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED ��"S 3 �O�e�`�
PERMIT NO. COMPLETED � �� v 7�
ADDRESS 3��v �45�0�=
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
� 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
�
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SETITURN ON 17 ITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
� 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
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