HomeMy WebLinkAbout1992-004590 - garage to bedroom � , . �
PERMI'I���
CITY OF ORONO PERMIT TYPE:
. 1335 Brown Rd. South • P.O. Box 66 !� �`��
Permit Number. �j�; ���}
Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357 i s:�;I�F,i'�:�
SITE ADDRESS:
111 S E�fii:MW�( RG '��
C:H
F'. I . r�l. ; ff�—� t7—:�:�,—i�.—ix7t��
DESCRIPTION:
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REMARKS: :•":.`'�".;`
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FEE SUMMARY:
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CONTRACTOR: OWNER: — �F,F,� ����l.�. —
L��iT�L�iFF �;�Ep
� � �C E,fi�_�t�hl �n ��:
t��i t}'��� h'IN 55:;'�1
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;k THE �1CdUER'=;I�:�I��7 !�-i�',,;�E�Y �:�.���!J�'=��''_< �E���!I°_�'_;i i t�d Ti i M�F�::� TH� zEt�� I���'�I_ttr����t�T'=
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APPLICANT PERMITEE SIGNA ISSUED BY:SIGNATURE
.
� CITY OF ORONO - BUILDING PERMIT APPI,ICATION
��Total Fee: $ ,'�;,�.c z Date P.eceived:
Date P.pproved:
Entered By: ',��',
Permit�: �!'�i c..
AT.T• INFORMATION MIIST BE SIIBMIT'�ED IN F'DLI� BEFORE PLAN REVIEW WILL B$ STAR�ED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRBSS: � ` � �'�'" ��1 � C' ZIP:����-�� �
(work) ��r��' ��.�
NAMI? OF OWNER:�=�-t �[���;G�f �l._J�1.1(.�.�U1� PHONE: (home)�710'���f
I�SA.ILING ADDRESS: � l �S �1'^L�� �i�l � � � CITY:�� _ ZIP: � �
CONTRACTOR: ` (� PHON$:
?�3AILING ADDRESS: CITY: ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRBSS: CITY: ZIP:
NAME; RRGISTRATION �
TYPE aF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration_� Renovate Land Alteration
;
PROPOSF.D WORK (describe in detail) : ''� r"' �
� � � V � ��11 �` � —
�
STORIES: SQ. FEBT OF EACH FLOOR:
NO. OF BEDROOMS: C:ARAGE STAI.LS: ATT. DET.
- Lc.;��c�:r � � ��
-� m�-�r,c��
ESTIMATED CONSTRIICTION VALIIATION (eaclnding Iand) : $�,(�t'Y� c��- �;L�� .
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
�hat the work will be in accordance with the approved plan.
,,
APPLICANT`S SIGNATDRE: � . -' DATE: '��`:� " '�;�
l
.
. �,
,;:�;:
� ��, ��� �; ��
� � �� .��: 3u C I'�3�' Of ���i�T�
� �� �-� Post O�ce Box 66•Crystal Bay,Minnesota 5a323•Municipal Offices
« : �
'+ .��. s����, r'
� s -�"� A,` On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would 3ike 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 wi3. 1 be used to determine your
qualification for the permit or Iicense 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 iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Your full name is required to process this applicatian or
permit.
�J��l��V�� �/�� �l�f��"�(.���
First Middle Last
1' f t� �I���t.��f� 1� �'��•
dress
� , !�.v ���`�
City State Zip
��� - ��:��� I
Phone
I understand my rights as stated above.
_ � � � ,
Signature
�
BUILDING&ZONING-473-7357 • AD!11L'�IISTRATION&FIVANCE -473-7358 • P[JBLIC WORKS-473-7359
ASSESSIN G
-- �
�.04 RIGHTS OF SIIBJEC'I5 OF DATA
Subdivision L Type of data- The rights of individuals 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 indivi�u�1- An.individuel esked to
� � supply private or confidential data concernin�gm�sitYun the collecti g state agency,
purpose and intended use of the requested
(b) whether he ma� refuse or is legally
political subdivision, or statewide system; �own consequence arising from his
required to supply the requested date; (�) anY
supplying or refLLsing to supply privete or confidentisl data; and (d) the identity of
other persons or entities authorized by staauBolr ise�ke �o s pplye�est gat ve da a
requirement shall not apply when an indivi
pursuant to section 13.82, subdivision �; to a law enforcement officer.
The commissioner of revenue ma ropertv tax re�und instr�uctions insteadho5
subdivision in the individuel income tax •r �
on those orms. . - -- -
Subd. 3. Access to �ata by individu8l- t7Pon request to a responsible �
authority, an individual shall be informed whether h�VBLeeor c�nfidential.e Upon his
individuals, and whether it is classified as public, p ublic data on
further request, an individuel who is the subject of Se to himrlande if he desires, shall
individuels shall be shown the data withou�fan�y ��a. After an individual hes been
�e informed of the content end meaning t� �ta need not be �isclosed to
shown the private data and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
� pending or additional data on the indivif�h h�gte or p blic datarupon request by
� responsible authority shall provide copies o P
the individual subject of the �ta. Th of making,1�Qrt fYingya�d � mp�ing the
requesting person to pay the actual costs
copies. ssible with any request
The responsible authority shall comply immediatelyoff Ph date of the request,
made pursuant to this subdivisi�d le with lid ys,��immediate compliance is nat
excluding Saturdays, Sundays �
possible. If he cannot comply with the request withi�i�nt�ch toh omplynw�tr► the
individual, and maY ha�e an 8dd�tional five days
request, excluding Saturdays, SundaYS and Iegal holidays.
. Subd. 4. Procedut'e ahen dats is Aot a�a ivate datla lconcerning h�m e�• To
contest the accuracy or completeness of pubLc o ln �� the responsible authority
exercise this right, ar► indivi�uel shall notify
describing the nature of the disagree a LQ eT,��C�,�e orencomplet and att mpt to
days either: (s) correct the data foun
notify psst recipients of inaccurate orV a�p�t he tbelie esthe datalt� be correct
the individusl; or (b) notify the in�
Data in dispute shall be disclosed only if the individual's statement of disagreement is
• included with the disclosed data. ealed ursusnt to the
' The determination of the responsible authority may be aPP p
provisions of the administrative procedure act relating to contested cases.
�- � CHECR OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /I lS 6�OwN !�-c�A /� Sc� PID:
DBSQ2ZPTION OF WORR: (�,�C►MOt/��Cr - �S-N'T���c��(L �c�Rlc pf\jv.��
-------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: S-Z6�9 Z
BIIILDING REVIEW BY: DAT$ APPROVED: g"Z6 "��2
-----------
g�g q•p gg �RGgp: Misc. Fees Ca�culated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes-� No SEWER CONNECTION
STATE SURCHARGE Yes �No WATER CONNECTION
INVESTIGATION FEE Yes No_� PARR FEE
SAC Yes No_� SITE INSPECTION
Number of SAC IInits OTHER (specify)
--------------------------------------------------------
ZONING CHEGR LIST Zoning District:
Fire partment: Post Office: School Distr' t:
Lot Area Width: Depth:
Survey Subm' tted: Yes No Date of Survey:
Proposed Setb cks:
Front (La ) : Right Side:
Rear (Street : Left Side:
Adjacent Struct res: etland:
Building Height: Def. gt. Peak Hgt.
Avg. Setback: Lot Coverage:
Existin Proposed
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Varianc Required: Yes N Date of Council Approval:
Grading: Staff pproval Date: By Council Approval Date:
Septic: Staf Approval Date: B
Zoning Fi :# Resolution �: Reso].ution Date:
REMARK (in house) : .
BDILDZNG REVIEW CHECR LIST � �
IIBC: $� (Z-3 CONSTRIICTION TYPE: �— .
Sq Footage $ Per Sq Ftg
Basement � x =
lst Floor x =
2nd Floor x =
Garage X =
/� x �/� . 2 = �; �c�J
TOTAL
Estimated Construction Valne: $ �00(� �U
Inspections Required: Work Requiring Separate Permits:
Site � Plumbing Grading/FilJ.ing
Footing Mechanica]. Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
�WaIJ. Board (Masonry) Lawn Irrigation
�Fina 1 (Mf g.) Other
Other Well (State Permit)
�Electrical (State Permit)
------------------------------------------------------------------------
REMARRS (IN HOIISE) :
--------------------------------------------------------------------------
REVIEW BY OT�FtS: DATE:
Access: Existing New
Access Approval: Date BY� �
--------------------------------------------------------------------
REIKARRS (TO BE NOTED ON PERMIT) :
IC�TIQN OF PRE��SES REQUIRED - �:� .
����T�� �RO .
� ��;
, p Dis la ed �
Ap;�r�N�ed Addr�ss.,s Shall 8e p Y ,
Plaint� Visible And Legib{e From The
Street Fronting The Property
P�tt��DE SNtUI�E DE'TEC'T�ORS
F�?R ENTTRE BLFILDING
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✓
DATE TIME
CITY OF ORONO CALLED IN 9,z
INSPECTION NQTICE SCHEDULED lC/9/� i:/�
PERMIT N0. �—� ��� COMPLETED l��`i- 7 L `� % Sv
ADDRESS
;'•
OWNER � CONTR.
TELEPHONE NO. 7 0 '�.3 ��
� DESCRIPTION 1�����-�v���
�
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRC� 11 MECHANICAL FINAL 18 EXCAV/GRADINGIFILLING
QINSULATION J 24125 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
Z 04 � 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
J 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
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W� �i'�WORKSATISFACTORY:PROCEED f:° PROJECTCOMPLETE
W �C CORRECT WORK&PROCEED i ISSUE CERTIFICATE OF OCCUPANCY
O �CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. f' PHOTO TAKEN
INSPECTOR WILL RETURN
C STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Cail for the next inspection 24 hours in advance.473-7357 �
OwnerlContractor on sit�: _
Inspector. '
, .,
White Copyllnspector's File Canary CopylSite Natice
✓�
DAZE TIME
CITY OF ORONO CALLED IN � `'1'/ Cr/J ^ _ -=������
INSPECTION NOTICE scHE�u�Eo .�����l�%� /��` u�-�/<c�
PERMIT NO. ��---?�� �- cornP�ErEo K ��
..
ADDRESS l� /'��� ��2.�"`.. -�- �t�-
OWNER J�y� �-r CONTR.�'��-�%z���%'
TELEPHONE NO.� �� � �' �� �'=� � _
� DESCRIPTION
lL 01 FOOTtNG 11 MECHANICALRI 16WELLTESTPUMP
� FRAMIN � 11MECHANICALFINAL 18EXCAV/GRADINGIFILLING
031NSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
� 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Z
Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
Q
W 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
=�UMBING FINAL 23 SEPTIC FINAL
J
�`O��ONTRACTOR TO MEET YOU:�' YES_NO
� COMMENTS:
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d 'C_1 WORK SATISFACTORY:PROCEED i] PROJECT COMPLETE
W
� CORRECT WORK&PROCEED �:% ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. �= pHOTO TAKEN
INSPECTOR WILL RETURN
1= CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContract on ite:
Inspector. ��
White Copyllnspector's ile Canary CopylSite Notice