HomeMy WebLinkAbout1996-007803 P�RMIT
- Gr�Y OF ORONO PERMIT TYPE: . ._.
�750 Kelley Parkway- P.O. Box 66 L�;�,-=4Y%=.���:;
Crystal Bay, Minnesota 55323 Permit Number: i_+i i i�T��_���_
(612) 473-7357 Date Issued: �.7.-;��;�;;:���.,
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: ` �!r'F'� ��'=!�-�fi� ' OWNER:
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APPLICANT/PE MITEE SIGNATURE ISSUED BV:SIGNATURE
. .
. Total Fee: � �`�� � �J �� DateReceived: J ' I �� - 1 �--
DateApproved: � �a �� �- 9�
Entered By: ��'� _ Permit#: '7���3
CITY OF ORONO - BUII.DING PERNIIT APPLICATION
ALL INFORMATION vfUST BE SUBMITTED IN FULL BEFORE PLAl�1 REVIEW WILL
BE STARTED
-- ----------------------------------
------------------------------------�.,----------------------
TIiE APPLIC:�rT IS: (circle one) OWNER OR�CONTRACTOR :�
�� � >, ,1;,. �� �-J z�: , ,��>�s-�
JOB SITE �DDRESS: �� y �� <i � � �, � ` — " �
i
N�tiIE OF OWNER: j" �-���y h '~��1/ �- PHOIV'E: (home) 1��7�- �'/-�a
(work)
I�IAII.IiV'GADDRESS: � �_� �_CITY: ;,.�,.,, �/Q„ ZIP: �;-t; s�s_
�,?,;,5- a t�S, �-�'�-�_ �. �
CONTRACTOR: �� ��i r s c � <y s�•�< i�c'r- PHONE: % 7� -.�1 //��
�IOBILE PHONE/PAGER:
MAII,INGADDRESS: �� a X l0 3 3 CITY: �> r l� ,.,z, ZIP: _�;��'_3..� 3-
STATE LICENSE: #_ o a o �.���_
ARC�ECT/ENGI�Ii EER: << c� ;t�_ _ PHO�IE:
VIAILIPtG ADDRESS: CITY� Z�'
��v�: REGIST'RATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Larid Alteration
, . �.+ ��l/� r ,_���
PROPOSED WORK(describe indetail): �--,�,��l; l� �= I2 - ������� �� �- �� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STAI.LS: ATT. DET.
� �
ESTLI�IATED CO�ISTRUCTION V�iI.UATION(eYcludingland): � �� �'� � � �-� �
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 Buildin� 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.
APPLIC?�'�1T'S SIG�tAT'URE: �� r'����-, �i. �,�f_f�.�: DATE: �--� 7- ` ��f_
1VOTE! 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.
. � ..
Sec.13.04 RIGH'TS OF SUBJEC'TS 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 secaon.
Subd.2. Iaformation reqirired to be gioen individual. An individual asked w suppiy private or confidendal data conceming himself sha11
be informcd of: (a)the purpose and inunded use of the requested data within the collecUng'state agency,polidcal subdivision,or stacewide system:
(b)whether he may refuse or is legally required to supply[he requested data;(c)any kno'x'n consequence arising from his supplying or refusing to supply
priva�e or confidendal daca:and(d)the idenriry of ocher persons or endries authorized by state or fedecal law to receive the data. This requirement shall
no[apply when an individual is asked to supply invesagaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav lace the nodce re uired under this subdivision in the individual income rax or ro ertv taz refund
instrucdons instead of on those forms.
Subd. 3. Access to data by indi�'idual• Upon request to a responsible authoriry,an individual shall be informed whe�her he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidenual. Upon his fur[her request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the contenc
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 to him for
six months thereafter unless a dispute or action pursuant to [his secdon is pending or addidonal data on the individual has been collected 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 authoriry
may require[he requesting person to pay the actual costs of making,cerafying,and compiling the copies.
The responsible au[hori[y shall comply immediacely, if possible, wich any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with[he reques[
within[hat dme,he shall so iniorm the individual,and may have an addidonal five days within which to comply with[he 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 private
data concerning himself. To ezercise chis right,an individuai shall notify in wnting�he responsible authoriry dzscribing the nature of the disagreement.
The responsibie authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, inciuding recipien[s 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�°be a ageal denursuantlto the p ovsi nls of the adminisuadve procedure act relaang to
The determinadon of the responsibte authoriry may PP P
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 priva[e or
confidential information.
You are notified that:
1, The information you fumish will be used to deternune your qualification for the permit or license 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 local, 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.
j, You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or pemut.
Ficst
Vtiddle Last
Address
State Zip Phone
City
I understand my righu as stated above.
Signacure
� CHECK OFF LIST FOR ISSUAI�iCE OF PERMITS
FOR OFFICE USE ON �
ADDRESS OR LEGAI.: `"`
PID: �7(�;. - � - . 1:�
DESCRIP'I'ION OF WORK: Q�4s�MtT!'% ��iv��F�
Z0�1ING REVIEW BY: N I DATE APPROVID:
BUII.DING REVIEW BY: DATE APPROV�: 3 � �• 4�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
pL� ���,y Yes ✓ No SEWER CONNECTION
STATE SURCHARGE Yes �/ No WATER CONNECI�ON
INVESTIGATION FEE Yes No c� PARK FEE
SAC Yes No v SITE INSPEC'I'ION
Number of SAC Units OTHER (specify)
_�___�__---
-- - --------------------- v
ZONING CHECK LIST Zoninb District: Shorelan istrict :
Fire Departme t:
Post Offi : School Dist�t:
Lot Area: Sq. . Acres idtb epth
Survey Sub tt • Yes o Date of Survey:
,
Proposed Set acks� �� _ _ _
Fro t (I.aK�e): igh[ Side:
1
Re (Street�: ft Side: _ �
r
� '
Adj ent St ctures: Wetl d: % �`
;/ l
Building He ght: Def. Hgt. Pe Hgt. �
�� Lo �Covera e: t
Av�. Setba : �Bluff S�tback: � g �
\ Exist' g P�oposed , ___, _
....�-_.._---
Hardcover: 0-75'
75-250'
250-500'
500-1000' I �
Hardcover ariance Required: Yes No �_ Date f Council Approval:
Grading: S aff Approval Date: By: Council Approval Date:
Sepuc: S Approval Date: By'
Zoning File: # Re ol ion: # Resolution Date:
REMARKS (in house):
, ,
BUII.DING REVIEW CFIECK LIST
��: �Z• 3 co�rs�rxuc�o�v �E: U^�
� Sq Foota�e S Per Sq Ftg
Basement z —
lst Floor X —
2nd Floor R —
Garage X —
R —
TOTAL
ov
Estimated Construction Value: $ yZi��
Inspections Required: Work Requiring Separate Permits:
Site _� Plumbing Fire
Hardcover Removal �Iechanical Water Connection
Footing Septic Sewer Connection
J� Framing Fireplace Lawn Irrigation
_� Insulation (Masonry) Other
a Wall Board (Mfg.) Well (State Permit)
� Final Grading/Filling p� Electrical (State Permit)
Other
gEMARKS (IN HOUSE):
----------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date BY�
-----------------
REI�iARKS(TO BE NOTED ON PERNIIT):
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DATE , TIME
CITY OF ORONO CALLED IN � /-3I%'�
INSPECTION NOTIC� SCHEDULED _L�1� /� :C�c�`
PERMIT NO. ���� --�COMPLETED � _�
ADDRESS `���'�,� ! �, J L -E = -- •
OWNER " -� CONTR. ���_e`�=
TELEPHONE NO. �7�Z �:�;rJ / �o
� DESCRIPTION ��•�.��'�i� .,�_ f
� 01 FOOTIN(3 11 MECHANICAL RI 18IXCAV/GRADINt3/FIWNO
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE FiEMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q �---e-�sl
� �FI_NqL� 14 SEWER HOOK-UO O6 PFlOGRESS
J 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FlNAL 35 HARD COVER REMOVAL
� 10 PLUMBING FIMAL,_�� 36 FOUNDATION REMOVAL
Z OWNE�/CONTRACTOR_Tb MEET YOU:�S_NO
� COMMENTS:
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WORK SATISFACTORY:PROCEED PROJECT COMPLETE
WL CORRECT WORK&PROCEED �SSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. r pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR ^' CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next in pection 24 hours in advance.473-7357
OwnerlContracto it :
Inspector. —
White Copyllnspector's File Canary CopylSite Notice
v
DATE TIQAE
CITY OF ORONO CALLED IN �= � �' ���J�
INSPECTION NOTICE SCHEDULED ��i�,�� ���3 �' �
PERMIT NO. �� -����J coMP�ErEo �_ �l�
ADDRESS ���5� -�--.�< �.��--- /L
OWNEI�� /�u�.-� CONTR.�-'�� '�-�-�43 c'�f�
TELEPHONE NO. l�� " �� ��k�
� DESCRIPTION
� 01 F � 11 MECHANICAL RI 18IXCAV/GRADINCi/FIWNQ
02 FRAMIN 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z OS FINAL 14 SEWER HOOK-UO 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPIAINT
J
W 07 DEMO—FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBINO RI 23 SEPTIC FINAL 35 HARD COVEH REMOVAL
� 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� CORRECT WORK 8 PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECT R
❑CfTATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARR GE ACCESS.
Call for t nex ' s cti n 24 hours in advance.473-7357
OwnedContract site:
Inspector. ''
White Copyllnspector's File Canary CopylSite Notice
����
DATE TIME
CITY OF ORONO CALIED IN J� �.�
INSPECTION NOTICE SCHEDULED "-`�f�� 3�'�
PERMIT NO. v`3 COMPLETED ___ab,�__ �
ADDRESS � '�`�� � �C�-.
OWNER (.�/'� CONTR. ��cOC'�
TELEPHONENO. �170�� c�7 /�v
� DESCRIPTION
� 01 FOOTINO 11 MECHANICAL RI 18IXCAV/dRADINO/FIWNCi
�Q 02 FRAMINCi 13 MECHANICAL FINAL 19 LAI�SHORElWETLANDS
Q SULATION 24/25 WOOD BURNER/FlREPLACE 34 TREE REMOVAL
Z pq , 12 WATER H�OK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UO 06 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEM�FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBIN(3 FINAL 36 FOUNDATION HEMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
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OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. L PHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for t ext m pec ion 4 hours in advance.473-7357
OwnerlContractor n �
Inspector. ^
White Copylinspector's File Ca ary CopylSite Notice