HomeMy WebLinkAbout1997-008700 - add/remodel -- � - � r PERMIT
CI�'j( OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ;`-; � -
Crystal Bay, Minnesota 55323 Permit Number: _ _ '_:`��;:„,�, �"``
(612)473-7357 Date Issued: ,-:���.t>� -;;::_;,,�;�
SITE ADDRESS:
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REMARKS:
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CONTRACTOR: -- ;:�:::,::�. � �� .:::..:�i: _.. :_� � . '_; ;-: OWNER:
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APPLICANT'P ITEE SIGNATURE � ISSUED BY:SIGNATURE C�.
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�'otal Fee: $ / ��, '� %�, Date Received: - ,y� � % I
Entered By: ,�,��ti� Permit#: ,��7 0 ��
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER O CONTRACTORy
��
JOB SITE ADDRESS: ��.� .SpU�h ���� ►�.�� ZIP: S�3� �
��t'�'.� C?�'n`� u.jT2� 1�. D���✓ r��.' j—iC�--y 7 �,ll�►h�� i a;wu�►'����'�'
NAME OF OWNER: ���_SC�/v ,��S��+`� �1'Si.'-� PHONE: (home) �/7 ��—i/!�
(work)
MAILING ADDRESS: ;,-��K5 /�Or�.SY�►�L �djL CITY: �rp-N� ZIP: � �
CONTRACTOR: t�.7ttc (3�;I.t.�iti•.,cr Cc:�y� PHONE: �-17.a-,�v i-7
CONTACT PERSON: -(��.,.� ��..s�v w� MOBILE/PAGER:
MAILINGADDRESS: ����,�- yv�nc.,�-r3���t� CITY: (�1a��� ZIP: �'39/
STATE LICENSE: # ����
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION�#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration j� Land Alteration
PROPOSED WORK(describe in detai�: � ��,�� �rkl��.•}c�,b��.�-,�e��cCc�.� �l�w►��hc.
G�Lin��i'.-c�i.� _51�.. 6z�`ysJsi�i� 1�'LI�U� �vv�E��lt� �'s �� /�Pra.�a+�[ �x;�,.srirv, S•�v✓Lyt�h7
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding 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 work will be in accordance with the approved plan.
�
APPLICANT'S SIGNATURE: �� � ��+-�-� DATE: /��`��
NOTE! Parade of Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
6
__ � �
Sec.13.04 RIGHTS OF SLiB.TECTS OF DAT.a
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secaon.
,
Subd.2. Information require�to be given individual. An individual asked to supply private or confidential data concerning himself sball
be informed of: (a)the purpose and intended use of the requested data within the colleccing'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is leeally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidenoal data;and(d)the identiry of other persons or enaaes authorized by state or fede�al law[o receive the data. This requiremeat shall
not apply when an individual is asked to supply investigative data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the norice required under�his subdivision in the individual income tax or propem tax_refund
instrucdons instead of on[hose forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shalt be informed whether he is the subjec[
of stored data on individuals,and whether i[is classified as public, private or co�dential. Upon his further request, an individual who is the subject
of stored private or public data on individuals shall be shown[he dara without any charge to him and, if he desires, shall be informed of the conten[
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 secdon is pending or addirional data on the individual has been collected or created.
The responsible authoriry shall provide copies of che private or pubtic data upon request by the individual subject of[he data. The responsible auchoriry
may require the requesting person to pay [he actuai costs of making, cemfying, and compiling the copies.
The responsible authoriry shall 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 holidays,if immediate compliance is no[possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himse(f. To exercise this right,an individual shall no[ify in writing the responsible authoriry describing the nature of the disagreemenc.
The responsible authoriry shall within 30 days either: (a)correc[the data found to be inaccurate or incomplete and attempt to noafy past recipients of
inaccurate or incomplete data, including recipienes named by the individual; or(b)notify the individuai 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.
T'ne determinadon of[he responsible authoriry may be appealed pursuant to the provisions of the administrative 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 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 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.
-�"G'�1�1 �_ h�,�/L'S�.'�YI -
First tifiddle Lasc
.�S�o�K�'c`�- l71 l�=.� ✓�,VUe�
Address
�PP��VIGr���K/ !�✓�A/ ��--�J/ Y7S-��-���
Ci�, State Z�p Phone
I understand my rights as stated above.
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Signature
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONL�
ADDRESS OR LEGAL: �:��� f����� j?�� , ��,-�ts..-�,
PID• C� .a ��7 - �� .,? � ���a >
DESCRIPTION OF WORK: ��,�2.�-�'�� -- ��v,��a�'� �rJz�
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ZONING REVIEV�I BY: �� � �r�' ,�-�.,,�
� DATE APPROVED: I �'� ��
BUILDING REVIEW BY: =,S`�, ��� yti,���,��� DATE APPROVED: ( �-���( -�i`�
---------------------------------------------=--------------------------------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ►� No
PLAN REVIEW Yes ,/� No SEWER CONNECT'ION
STATE SURCHARGE Yes ✓ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
-------------------=----------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: f��- 1 C�
�Fire Department: ( ��r�c��-Wf�.:= Post Offce: (r�n�t, �-�����- School District: C`��p���i �
�Lot Area: Sq.ft. Acres Width Depth
� Survey Submitted: Yes No Date of Survey:
' Proposed Setbacks:
Front (Lake): Right Side:
� Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
� Lot Coverage:
� �
�� � Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
SOQ-lOOO'
; Hardcover Variance Required: Yes No Date of Council Approval:
�
REMARKS (in house):
10
~ # _
BUII.DING REVIEW CHECK LIST
usc: r2-� co�rs�rxuc�r�[ox �E: �N
Sq Foota�e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ �C`� ����`
Inspections Required: Work Requiring Separate Permits:
Site � 1� Plumbing Fire
Hardcover Removal �' Niechanical 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�
REl�1ARKS (TO BE NOTED ON PER.�'�IIT):
27
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTI E SCHEDULED �c� � =d0
PERMIT N0. 7��� COMPLETED � �l
ADDRESS �-�`� � fUw' �� �
OWNER CONTR. �H�
TELEPHONE NO. �Z� ��a�
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAVJGRAOING/FILLINd
�Q 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETIANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATEF HOOK-UP 17 SITE INSPECTION
_ �INAL 14 SEWER HOOK-UP 06 PROGFiESS
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
I
J 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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❑CORRE�T UNSAFE CONDITION W�THIN HOURS. - pH0T0 TAKEN
INSPECTOR WILL RETURN
O STOP ORDEF POSTED.CALL INSPECTOR =- CITATION ISSUEO
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins ction 24 hours in advance.473-7357
OwnedContract r ite:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
. DATE TIME i
<"--� �
CITY OF ORONO CALLED IN ��' � � /� ' �s �
INSPECTION NOTICE scHE�u�Eo �1f�.- `; � ` -' �
PERMIT N0. 1�`) COMPLETED /1
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ADDRESS � � � L�t��-. � /�. � J .
OWNER �C.•-��-�� % CONTR. .�. , '�_/��
TELEPHONE NO. `1�n�� ' �' ��C��
� DESCRIPTION �'�t%�,e:-�t"���
� 1 FOOTING . 11 MECHANICALRI 18EXCAV/GRADING/FIWNG
� 02 F MING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
F' 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
v 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING pERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
�� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cali for the next inspection 24 hours in advance.473-73rJ7
Owner/Co c ite:
Inspector. ' �
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN = ��- `� r � �
INSPECTION NOTICEy - , � SCHEDULED -' ��' "�= ! � � �'
PERMIT N0. �' � � '-' COMPLETEq �'1, �_
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ADDRESS .'3-�..�. > ;'��,._ , �,<-- <
OWNER L' �� ' � ���.�, CONTR. �� . .-� ,, (��-�`�
TELEPHONE NO. ���r��l " � `�� �:�j�-�
� DESCRIPTION
� Ot FO Nf�--� 11 MECHANICAL RI 18IXCAV/GRADINC�/FIWNd
-� 2 FRAMI_N(�___ 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
0 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq yyqLL gp. 12 WATER HOOK-UP 17 SITE INSPECTION
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Z OS FINAL 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEMQ-SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMO—FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBING HI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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0 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL REfURN r CITATION ISSUED
O STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS.
Call for the next in ction 24 hours in advance.473-7357
OwnerlContra or sit
Inspector. �
White Copyllnspector's Fite Ca�ary CopylSite NWice
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ATE TIME
CITY OF ORONO CALLED IN I y�
INSPECTION NOTICE SCHEDULED �" Z-� ���
PERMIT N0. ��C � COMPLETED � n
ADDRESS .3�5 1�h-�-c-<-�� /�c� ..�
OWNER ���-���'� CONTR. � �- f� �
TELEPHONE NO. �f �� �� 7
� DESCRIPTION /1�-�-��
W 1 FOOTINC3�s 11 MECHANICAL RI 18IXCAV/(3RADINC3/FIWNO
�
�Q 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNEFVFIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UO O6 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMQ—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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0 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS.
INSPECTOR WILL RETURN = PHOTO TAKEN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ' s ction 24 hours in advance.473-7357
OwnerlContracto sit :
Inspector.
White Copyllnspector's File Canary CopylSite Notice
ATE TIME
CITY OF ORONO CALLED IN I�'/�`'!
INSPECTION NOTICE SCHEDULED �8 57 �
PERMIT NO. � COMPLETED
ADDRESS �
OWN ERL��1�.� CONTR.
TELEPHONE NO. �(� � - '7��S
� DESCRIPTION
� 01 FOOTING 17 MECHANICALRI 18IXCAV/GRADINO/FIWNO
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
0�9 U N � 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq� yyqLL gp, 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UO p6 PROGRESS
� 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMO—FINAI 15 SEPTiC INSTALL 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBIND FINAL 36 FOUNDATION REMOVAL
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0 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOUFiS. r pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �-,CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnedContracto i :
Inspector.
White Copyllnspector's le Ca�ary CopylSite Notice