HomeMy WebLinkAbout1996-008358 - add/remodel �
'� , -� PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��<<�1�#����?��
Crystal Bay, Minnesota 55323 Permit Number: �;�_;;_,:�;c;_
(612)473-7357 Date Issued: �;,�;;:}�.E=�y'j��;�,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE .��
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Total Fee: $ /�-1� C � Date Received:
Entered By: �l Permit#: 3���:�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
�>� �
JOB SITE ADDRESS: �y� � � ��C ZIP: `S
NAME OF OWNER: � C � PHONE: (home) �������'--
(work) ��/�f
MAILING ADDRESS: '�� �pc{ �i F��,� CITY: �2Q',.[�1� ZIP: ��
-T------ `�
CONTRACTOR: /�le�'�� �. ��� PHONE: �j� .� �
CONTACT PERSON: �{ � `� MOBILE/PAGER: ����7.���'
MAILING ADDRESSo`Zs� i�!`/r�' CITY:/�'�'./�- �i�a'�IP: �� �
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY:
1VAIVIE: REGISTRATIO
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
�
P POSED WORK(describe in detai�: ���.���l.e�C fr' �'��li-��Ss�t �
✓ • J
%v , —`�- /I� ' � �';fe,
;��� ��r�- � �`'�� ���� -�- '�
STORIES: SQ. FEE OF EACH FLOOR: �S2e�i
/ NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
✓ ��- t.�d�. �:��,� .�-e—�s�%�v �y�*-�-a�'� ! �
ESTIMATED CONSTRUCTION VAL�ATION (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 acco e with the appr ved plan.
APPLICANT'S SIGNATURE ` .�;�=�t, DATE: �
NOTE! Parade of Homes events require separate per►nit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
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Sec.13.04 RIGH'TS OF SLIBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon.
Subd.2. Information required to be given individual. An individuai asked to supply private or confidendal data concerning himself shall
be informed of: (a) the purpose and intended use of the requested data within the collecdng'state agency, polidcal subdivision,or starewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply
private or confidenaal data;and(d)che idenciry of other penons or endries au[horized by state or federal law to receive[he data. This requirement shall
not apply when an individual is asked to supply invesrigaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place [he noric� required under this subdivision in the individual income tax or proaertv tax refund
instrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject
of stored data on individuals, and whether it is classified as public, privace or confidenaal. Upon his furcher request,an individual who is the subjecc
of stored private or pubtic data on individuals shall be shown the data wi[hout 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[o him for
six months thereafter uriless a dispute or action pursuant to this secdon is pending or additional data on the individual has been collected or created.
The responsible authoriry shall provide copies of the Qrivate or pubfic data upon requesc by the individual subject of the data. The responsible au[horiry
may require the requesting penon to pay the actual cosu of making, cerrifying, 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 not possible. If he cannot comply with the reques�
within that time,he shall so inform the individua(,and may have an addidonal five days within which to comply wirh 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 priva[e
data conceming himseif. To exercise this right,an individual shall notify in writing the responsible authoriry describing the narure of[he disagreement.
The responsible authoriry shall within 30 days either. (a)correcc[he data found to be inaccurate or incomplete and attempt to nodfy past recipienrs 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 inc(uded wi[h the disclosed data.
Tne detzrmination of the responsible authoriry may be appea(ed pursuant to the provisions of the administracive 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 pernut 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.
$. You have certain righ[s under M.S. 13.04 (available upon request) to review private data on yourself.
(, Y full name is required to process this application or permit.
C� ��� t
First � /Middle Last
/�^B�U �
Address,^���'/'�� �l/ �«/�� �.GiJ.� �`�� v�✓`'' vU
Ciry State Zip Phone
I understand my rig ta d above.
'
Signature
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: y Zf.; s ;;._ -c-�., C�,��r;�.;,.�; r„�,.•�
PID:
DESCRIPTION OF WORK: �rv�,n,,�,� �1.�,��,�..r.�
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ZONING REVIEVV BY: N 1►A DATE APPROVED:
BUILDING REVIEW BY: ,._ ,�,, ' �,,�,,.� DATE APPROVED: `� - `�� `i la
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes r✓' No
PLAN REVIEW Yes No ✓ SEWER CONNECTION
STATE SURCHARGE Yes �� No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District:
,..
0
Fire Dep ent: Post Off ce: Sct�ool istrict:
Lot Area: S ft. Acres Width / Depth
r
Survey Su mitt d: Yes No Date of$�urvey:
Proposed etback : /
ont (L e): Right S de:
ear (Street : Left Si e:
djacent Stru tures: Wetland:
Building eight: Def. t. Peak Hgt.
Lot Cove age:
Grading: Staff Approval D e: By: Council Approval ate:
Septic: taff Approval Date: By: �
Zoning F le: # Res lution: # Resolution Date:
Shorelan District:
vg. Setback: Bluff etback:
Existi g Proposed ��
ardcover: 0-75'
75-250'
250-500'
SOO-lOOO' ';
t
ardcover Variance Required: Yes No�_ Date of Council Approval: `�
REM KS(in house):
10
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BUII..DI�i iG REVIEW CHECK LIST
usc: 2- 3 co�rs�xuc�o�v �E: ��'�
Sq Footage � Per Sq Ftg
Basemen[ x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ "Zy 65��`
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
�` Framing Fireplace Lawn Irrigation
�_ Insulation (Masonry) Other
_� Wall Board (Mfg.) Well (State Permit)
.LFinal Grading/Filling �Electrical (State Permit)
Other
RENIARKS (Pi 1 HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REI�IARKS(TO BE NOTED ON PERIVIIT):
27
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DATE TIME
CITY OF ORONO CALLED IN C /�� �_` �
INSPECTION NOT E SCHEDULED � /7 i'� %:c'c'
PERMIT NO. �'�-`� y COMPLETED l� ICI
T
ADDRESS '� �� �� �
OWNER �rf��t<.4-.�,�..� CONTR.�,�'�.�—
G'�
TELEPHONE NO. 5��; -`-'� C-'0
� DESCRIPTION
W 01 FOOTING � 11 MECHANICAL RI � .,s 18IXCAV/GRADING/FIWNO
�Q 02 RAMING �. 13 MECHANICAL FlNAL '��' 19 LAI�SHORE/WETLANDS
Q 0.3 INSULATION 24/25 WOOD BURNE IREPLACE ' 34 TR�EAEMQI[�L!
� 04 WALL BD. 12 WATER HOOK-UP �7 SITE INSPECT�— "
Q
= O5 FINAL 14 SEWER HOOK-UO 06 PHOGRESS
~ 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
J 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: _--_ `—( i � /;� �`"� 4 � , c-"' /i=
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d WORK SATISFACTORY:PROCEED
W C PROJECT COMPLETE
WL CORRECT WOFiK R PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. ` pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
G CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance.473-73�J7
OwnerlContractor n s' :
Inspector.
White Copylinspector's File Canary Copy/Site Notice