HomeMy WebLinkAbout1996-008249 - add/remodel �► ,' PERMIT
�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 E;i_;?'i ::;�ui:
Permit Number:
Crystal Bay, Minnesota 55323 +'�?'��s�'�
(612) 473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ �;;.,F,� ; �:.,,-�t. _. �_;� ��{_: OWNER:
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A PLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE „�c.�j���
'� �, S� DateReceived: � =�- ��"=
Total Fee: $ f,� 4�
Date Approved:
Entered B�,�: Permit#: ��? � �
CITY OF ORONO - BUILDING PERNIIT APPLICATION
ALL Ti�1FORI�IATION i�NST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL
BESTARTED �
----------------------------------------------------------------------�------------------�--------------------
THE APPLIC�'�1T IS: (circle one) � OWNER OR(CONTRACTOR
, . , i, _ � r ' .
JOB SITE ADDRESS: _.;.., . ZIP:
.
1� '� _
`�F::_. � t
NAME OF OW�IER: �1G-,� ,� ' �-- ' r l� ' PHONE: (home) , •
,` (work)
MAILING ADDRESS: . � i CITY: ZIP: � � ,
� , l ��;;: , ,
CONTRACTOR: PHONE: f - ,;
NIOBII.E PHOivE/PAGER: - - '
MAILINGADDRESS: ' CITY:~~-- - ZIP: •
STATE LICENSE: # ',r,-�� <'''
ARCHTTECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: Z�:
N��,�; REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration �./ I..and Alteration
PROPOSED WORK(describe indetail): - • `�"� '
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
aj� ,
ESTLl�1ATED CONSTRUCTION VALUATION(escluding 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 wor ' 1 be in accordance with the approved plan.
APPLICA��TT'S SIGNATURE: :_ ,� ..r,,�.,%'� DAT'E: � _. r ,_ ,_ .
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.
9
.- '�r►;. C��� G--i N �-�S
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O O
� C ITY of OR�NO
,�, `� J �. J� �tunic�pal ot�ices
:i
�v Post Oftice Box 66
�'.� `':` G�' crysca►say,�c;anesota ss323-o066
��kES�I�4�
DATA PRIVACY ADVISORY
In accordance �;�ith �1.5. 13.04, Subd. 2, "Rights of subjects or data", �;�e would like to
inform you that your request for a permit or license from the City ot Orono or any of its
departments may require ��ou to furnish certain pri��ate or confidential information.
You are notified that:
l. The informacion ��ou furnish will be used to determine ��our qualification for the
permit or license requested.
?. You may refuse to supply data, but refusal ma�� require that the City deny the
pernit ar license.
3. The information may be shared ��ith other local, state or federal aaencies to the
exter�t necessar}• to pr�cess :ri� perrnit or license.
4. If ��our requested permit or license requires Council action to appro��e, some
intormation may become public.
�, You have cer�ain ri�hts under M.S. 13.04 (see follo�vinR paQe) to review private
data on vourself.
6. Your full name is required to process this applica�ion or permit.
PLEASE PRIl�TT
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' ::�� %� �' �
First Middle Last
/C; ,
/�/ ���`� 4� ,� � ���"�
Address i
� � _ . . ,._..; r-� � �4�, ",
/ ,, ' � .��;�, C. � ,, ��
C.��n1','�; .�c �r>..- ��;
Ciry � State Zio Phone
I understand my riQhts as stated above.
,
/ �� �
SiQn�ture �
'�--�� ' TELEPHONE-473-7357 • E�,X--t73-0�10
10
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Sec.13.0� RIGHTS OF SUBJECTS OF DATA
Subdivision 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. Information required to be given individual. An individual 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, political subdivision, or
statewide system; (b) whether he may refuse or is legally required to supply the requested data;
(c) any known consequence arising from his supplying or refusing to supply private or
confidential data; and (d) the identity of other persons or entities authorized by state or federal
law to receive the data. This requirement shall not apply when an individual is asked to supply
investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue may_place the notice required under this subdivision in the
individual income tax or�ro_perty_tax refund instructions instead of on those 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 the subject of stored private or public data on individuals shall be shown the data without any
charge to him and, if he desires, shall be informed of the 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 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 authority may require the requesting person to
pay the actual costs of making, certifying, and compiling the copies.
The responsible authority shall comply unmediately, 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 holidays, 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 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 private data concerning himself. To exercise
this right, an individual shall notify in writing the responsible authority describing the nature of
the disagreement. The responsible authority shall within 30 days either: (a) correct the data
found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or
incomplete data, including recipients 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
statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions
of the administrative procedure act relating to contested cases.
11
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ( b Zv NUfZT�-t- f3(l�w�V f2.oA�U
PID:
DESCRIPTION OF WORK: � ec�5
---------------------------------------- -----------------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: � �2- '�
BUILDING REVIEW BY: DATE APPROVED: �-�Z -�i�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes �/ No SEWER CONNECTION
STATE SUR`HARG� Yes � No WATERCONNECTION
INVESTIGAT'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: G�-��
Fire Department: (,t��r tt.v Post Office: (t9,• _(�4?C.t,.s School District: ��(�e/J O
_�
Lot Area: Sq.ft. �-(2�y°l O Acres • ��� Width ((��f.�� Depth Z S"G• Z 2
Survey Submitted: Yes �� No Date of Survey: "�j- 31- `t't.
Proposed Setbacks: s�•Y a�
Front (L�lec): N�(f� Right Side:
Rear (St�eat): 1�{0� Left Side: �7 2 � �--
Adjacent Structures: l�-'TTY�Ut-E�.`�'� Wetland: /�/A-
Building Height: Def. Hgt. N �� Peak Hgt.
Lot Coverage: C9. SL
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: BY�
Zoning File: # Resolution: # Resolution Date:
Pj • Shoreland Dist:ict: _
N• Avg. Setback: Bluff Setback: LotCoverage:
Existing Proposed
Hardcover: 0-75
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
�—
REMARKS (in house):
26
BUILDING REVIEW CHECK LIST
UBC: R - ,3 CONSTRUCTION TYPE: Y1J
Sq Footage $ Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 2,y ov�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
pC Footing Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
s—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 PERMIT j:
27
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DATE TIME
CITY OF ORONO CALLED IN ��-«'/�"`°
INSPECTION NOTIC� � SCHEDULED `'% '� %'c, j/ _3%'
PERMIT N0. -� `�� co�LETED �_ �_
,�� , �
ADDRESS�� L -�/��'� �i'` Y , '_ s r �cG •
OWNER ,�"`,�- ._ � /Lc�%�-�. `�
' CONTR." -�-._� �
� �,i
TELEPHONENO. �_�.�; `� ' l�'� ��
� DESCRIPTION ��c � .�`
� 01 FOOTING 11 MECHANICALRI 18IXCAV/GRADINd/FIWNd
�Q 02 FRAMING 13 MECHANICAL FINAL 19 LAl�SHORE/WETLANDS
p 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q _
��5 FINAL 14 SEWER HOOK-UO 06 PROGRESS
J 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBIN r/ 36 FOUNDATION REMOVAL
Z OWNER/ RACTO�)O MEET YOU:v YES_NO
� COMM .
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d WORK SATiSFACTORY:PROCEED
W � PROJECTCOMPLETE
� L'CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
Q C7 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL REfURN `
❑STOP ORDER POSTED.CALL INSPECTOR '--� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance.473-7357
OwnerlContra t n e:
Inspector.
White Copyllnspector's Fi e Canary CopylSite Notice
li
DATE TIME
CITY OF ORONO CALLEO IN � /3/G6
INSPECTION N TICE SCHEDULED �/i.5/y� � .3�'
PERMIT N0. ��f'�� COMPLETED L( L{
ADDRESS � n � � �
OWNER ��rJt'r� CONTR. ��
TELEPHONE NO. '�i�7C� "�`fU 3
� DESCRIPTION ��i
� p�� 11 MECHANICAL RI 18IXCAV/GRADINO/FIWNG
�Q 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� pq WqLL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UO O6 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING Fil 23 SEPTIC FlNAL 35 HARD COVER REMOVAL
� 10 PLUMBINQ FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU: YES_NO
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d �WORK SATISFACTORY:PROCEED � PROJECT COMPLETE
WL CORRECT WORK 8 PROCEED �; ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WOAK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR
�.=� CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContract�oF� '�e:
Inspector. - 1�
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