HomeMy WebLinkAbout1998-010188 - pool PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �;;1 s I�i j����
Crystal Bay, Minnesota 55323 Permit Number: ;,��:;;y:;�;
(612) 473-7357 Date Issued: �_;� ;-•-: ,,_,_,
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: — �;����i i�r:it. — OWNER:
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
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Total Fee: $ ,�� �`� � Date Received:
Entered By: Permit#: j �); ��
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ����UGf l� Q%ll'�L,�/�t/ �,(J. ZIP: ,SS�Jr �
NAME OF OWNER: LS�1 S ft: /� Lf/�-�SC-'t(/ PHO�TE: (home) � �.� �' GI/I.3
(work)
MAII.ING ADDRESS: `3 Z..S S�ll�l 3l��r'�l ��� L�'"/� Lf�lct�t'�IP: SS.�
CONTRACTOR: ��-C-� �,SNik C:c`-ef��c=.�/� PHONE: ��,1-//5--�
C0�ITACT PERSON: /?c SS MOBII..E/PAGER: ��-,- - �3� �
MAILINGA.DDRESS: 1 L°�''�ifi i..r,�')'Zi�d�ITY: If��IE, ZIP: SS� � �S�
STATE LICENSE: #
ARCHIT'ECT/ENGINEER: PHONE:
MAII,ING ADDRESS: CITY: Z�:
NAME; REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: S r:✓�!1'�.�"J�� p�
STORIES: SQ. �EET OF EACH FLOOR:
NO. OF BEDROONIS: GARAGE STALLS: ATT. DET.
ESTII�i IATED CONSTRUCTION VALUATION (excluding land): $ i�C��� G�
I hereby apply for a building permit and I aclrnowledge 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 pemut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNAT`iJRE: ;�-� — DATE: ✓r �
NOTE! Parade of Flomes 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 RIGHTS OF SL'BJECTS OF D:�T?.
Subd. 1. Type of data. The riehcs of individual on whom[he data is stored or to be stored shall be as sec forth in this secdoa.
Subd.2. Information reqtirired to be given individual. An individual asked to supply privace or confidendal dara conceming himself shall
be informed of: (a)the purpose and inrended use of the requested dara within the collecang'stat�ageocy, polirical subdivision,or scatewide rystem;
(b)whecher he may refuse or is legally required�o supply[he requested data;(c)any 1a�town coasequence arising from his supplying or refusing to suppty
• private or conFdenoal data;and(d)�he idenacy of other persoas or enodes auchorized by state or federal law to receive the da�a. This tequiremeot shall
no[apply whzn an individual is asked co suoply invesdeadve dam, pursuant co secdon 13.82, subdivision 5, to a law enforcemenc o�cer. -
Tha commissior r of revenue mav olace the norice r�ouired under this subdivision in the individuai income tax or prooem tax refund
inscrucrions insczad of on thase forms.
Subd. 3. Access to data by individual. Upon request to a responsibie authoriry,an individual shall be informed whecher he is the subject
of stored data on individuals,and whecher it is classified as public, private or conftdenrial. Upon his furcher request, an individual who is the subjecc
of scored privace or public data on individuals shall be shown the dara wi�houc any charge to him and,-if he desires, shall be informed of the contenc
and meaning of chat data. After an individual has been shown the privace data and informed of ics meaning,tbe data need not be disclosed to him for
six monchs chereafcer unless a dispute or acaon pursuanc to chis secdon is ptnding or addirional data on the individual has been collecced or created.
The�esponsible auchoriry shall provide copies of the priva[e or public data upon requesc by�he individual subjecc of che data. The responsible authoriry
may require the requesting person to pay che accuai cos�s of making, certifying,and compiling the copies.
The responsible authoriry shall conply immediately, if possible, wich any request made pursuant to this subdivision,or wi�hin five days of
the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within[hac tirne,he shall so inform�he individual,and may have an addirional five days within which to comply wich the request,exctuding 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 chis rieht,an individual shall noafy in wricing che responsible authoriry describing the nacure of the disagreement.
The responsible auchoriry shall within 30 days either. (a)correcc che da�a found to be inaccurate or incomplece and attempc to nodfy past recipiencs of
inaccurate or incomptete data, including recipiencs named by the individual; or(b)nocify the individual[hat he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's sta�ement of disagreement is included with the disclosed data.
The deczrminarion of the responsibte authoriry may be appealed pursuant[o the provisions of the adminisezarive procedure act relaring to
conresced 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 pernut or license from the City of Orono or any of its departments may require you to furnish certain p:ivate or
confidential information.
You are notified that: �
1. The information you furnish wili be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, bu� 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 permit or license.
4. If your requested permit or license requires Council ac[ion to approve, some information may become
public.
5. You have certain riQhts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process chis application or permit.
�C�S ,� ��,L-Zlc.,�''l/
First �Siddle Lasc
,G�� iv�Y���-- ,F3 L v�
Address �,/, ss-3GS ���'l�s�
!f7"1LOt- `� _
Ciry Srate Zip Phone
I understand my rights as stated above.
___—�__
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Signacure
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFTCE USE ONLY
ADDRESS OR LEGAL: _�Z,S �Sd v T}�} �3/L�wrJ �.�-�
PID: J.7 - �
DESCRIP'TION OF`VORK: ��
-- -- �=-------------------------------------�-----------------
ZOivING REV�W BY: DATE APPROVED• 5-7- f�
BUII�DING REVIEW BY: �,� (�_ DATEAPPROVED: s'- �- y�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes _� No S�.tiVER COivNECITON
STATE SUR`HARGE Yes v No ��ATERCONNECTION
INVESTIGAI'ION FEE Yes No PARK FEE
SAC Y:.s No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZOiVING CHECK LIST zoni.ng Discricc: L2-��
Fire Department: Post Office: Co-.,• (�h C¢.. School District: o�•-�
Lot Area: Sq.ft. 3cr�,i57� Acres 6• g Width �/5"7� Depth (06 7
Survey Submitted: Yes D� No Date of Survey: (o - S—� $
Proposed Setbacks:
Front (Lake): _ �ZS'''.- Right Side: /S�
Rear (Street): 3 6 0� } Left Side: 'Z�
Adjacent Structures: fSD � Wetland: N(/�-
Building Height: Def. Hgt. /U//�— Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
� Zoning File; # Resolution: # Resolution Date:
V � .
Shoreland Dis�ict:
Avg. Setback: Bluff Setback: Lot Covera�e:
• Eziscing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARbS (in house):
• 26
BUII.,DING REV�W CHECK LIST '
��� N�4Y CONSTRUCTION TYPE: N�i�-
' Sq Footage � Per Sq Ftg
Basement x _
lst Floor x _
2nd Floor z =
Garage z _
z —
TOTAL
Estimated Construction Value: $ /(�,Uv� ��
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal —�Mechanical Water Connection
_�Footing Septic Sewer Connection
Franung Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�" F�� Grading/Filling a( Electrical (State Permit)
Other
-------------------------------------------------__—______---_
REibIARKS (IN HOUSE):
-----------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access ApFroval: Date By; •
--------------------w��_------�� �_
REiVIARKS(TO BE NOTED ON PERNIII�: '
27
DATE TIME
CITY OF ORONO CALLED W �' � �� �9
INSPECTION NOTICE �7 SCHEDULED --?�i�/�'� �-d �
PERMIT N0. / � O COMPLETED � _�
ADDRESS � �
OWNER CONTR. �
TELEPHONE NO. ��� �'/f-�3
� D RIPTION �,��
�
� FOOTW � 1� MECHANICALRI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL F�NAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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Wd I�VORKSATISFACTORY:PROCFED [' PROJECTCOMPLETE
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CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
O ,--1 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. ; pHOTOTAKEN
INSPECTOR WILL RETURN
�1 STOPORDERPOSTED.CALLINSPECTOR �- CITATION ISSUED
Cl INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for th ext in pection 24 hours in advance.473-7357
OwnerlContr t n sit :
Inspector. !
White Copylinspector's File Canary Copy/Site Notice
Certificate of Survey
for Gentry Construction
in the NW Ya of Section 3-117-23
Hennepin County, Minnesota
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I hereby certify that this is a true and correc�t representation of a surve�i oT i:l�e buun��:;� i �s o; tl�e
Nortn 450 feet of the South 900 feet of the East: 700 feet of ihe Northl��est c!u�;r�:`�r ot �;ec;tio� :3; Townshi�
117 North, Range 23 West of the 5th Prineipal Meridian, the location of an existing„I�uu_;e thereon
and the pr�posed location of a proposed addition. It does not purport to sl�oi! any oth��r i�n4�rovernents or encroachmen�:� .
Scale : 1'' = 100' COFFIN & GROfJ�3ERG, :��;;.
Ddte : 6-9-8�3,rP� 7-6-P8 i!��.��.:�i•�--�--�
o : I ron marker N'r r . ron ery 1 c. �o-i%7;:�
En�ineers, Land Surveyor�s aiici Pianne�,s
Lon� Lak�, P�innesota
CITY ��' OR�N�
� S1TE PLAN Gi?�1GiNG PLAN
Q APPROV�D �oo t
❑ Af�PRGVEJ VViT� R�VI�I�NS
❑ DtSAF'�f� `'��
BY
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