HomeMy WebLinkAbout1992-004491 (building: bed/bath remodel) PERMIT �
� GITY OF ORONO PERMIT TYPE:
13�5 Brown Rd. South • P.O. Box 66 E��1 i�'[}����
Permit Number: t it i4�.'�1
Crystal Bay, Minnesota 55323 Date Issued: i�7!"�;�f'at
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
E:EC�F;f_il iI�'I J E:ATH REM+;EDEL
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CONTRACTOR: — A����l i���-�t� — OWNER:
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PPiJCANT PLrRMI E SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BIIILDING PER'�iIT APPLIC.ATION
Tc�al r e�: S��G+ �.�� � Date Received: �//� �� �--�
Date P.�vroved :
�ntered By: � ��i� �
Permit Q: � ���
�I� INFORMATSON MIIST BE SIIBMITT� SN FiTLL BEFORE PL�N REVIEW �� B$ STARTED
(See Check-off_List EncZosed)
------------------------------------- ---- ---���------------------------
� APpI,ICANT IS: (circle one) OWNER o CONTRACTO
� ��j�, �.w( ��,�., ��� zzP: `3 5�� ��
JOB SIT'E ADDRSSS: �.%
(work)
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x� oF owx�z- c��c�� ' U� 1 P$orrE: (h cme) / ) `'( —
2�.ASLING ADDRESS: �'�'� � �� V 1.�� CITY: ��t i ` a'' ^ ZIP: S 5 �"1�
� � i PHONS s �� -�� iU �
CONTR�ICTOR: � ,.,
/ � ZIP: � �`` L.�
N.AILING ADDR.ESS:��/�� -� r.� CITY: � �
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STATS I�ICENSE: Q
?1FtCH?TF:�.'�'/ENGI?�TEER: PHONE:
I�,AILING ADDRSSS: CITY: ZIP:
NAME: RBGISTRATION �
TYPE OF WORK: New Addition Accessary Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
Y�� �
PROPOSED WORR (describ in detail) : � ' � � �`�
r� �
���. � � ��
STORS$S: SQ. F'EBT OF EACH FLOOR:
NO. OF B$DROOMS: GARAGS STAI.ZS: ATT. DET.
ESTIHATED CONSTRIICTION VALIIATION (eacl.ndi.ng Ia.nd) : $ 1-`� n t) i7 �� `'
�
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
o�3inances and codes of the City and with the State Building Code; that T
ur.derstand this is not a permit and work is not to start without a permit; and
t�at the work will be in accordance �th the approved plan. •
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APPLICANT'S SIGNATIIRE:
r � DATE: � � , �
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^. � �-- b �� C ITY of ORON(�
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Post O�ce Box 66•Crystal Bay, Minnesota 5a323•Municipal Offices
�
� _ � � Orc 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 Iike to inform yau 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 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 license requires Council actio*�
to approve, some information may become publ.ic.
5. You have certain rights under M.S. 13.04 to review pri�a�e
data on yourself.
6. Your full name is required to process this applicaticn or
permit. �' ._
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i st Middle � ast
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Address �
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City State Zip
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Phone
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I understand my r�,ghts as stated above.
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Signature �
BUILDING&ZO`lING—473-7357
• AD!�tINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESSIN G
'
�.p.4 RIGHTS OF SIIB�7ECTS OF DATA � .
Subdivision L Z`ppe of ��- The rights of individu8ls 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 i����" An.individual esked to
� ' u 1 rivate or confidential data concerning �mwitlhin the collecting state agen ye
s PP Y P
purpose and intended use of the req tem;d (b) whether he ma� refuse or is legally
political subdivision, or statewide sys �oWn consequence arising from his
required to supply the requested date; (c) any
su lying or refusing to supply private or confidentiel data; and (d) the identity of
PP state or federal law to receive the data. This_
other persons or entities authorized by P �vesti ative data,
requirement shall not apply when an individual is esked to su ply g
pursuant to section 13.82, subdivision �, to a law enforcement officer.
The commissioner of revenue mav plettv tax rei�und instQucteonsunstead�oi
subdivision in the individual income tax or pr��
on those orms. . - --- - � _
Subd. 3. Acc�ss to �ata by indivi�aL IIpon request to a resoonsible
uthorit an individual shall be informed whether h�vateeor confident al.e UPon his
a Y� ubl�c, p
individuels, and whether rt is classified as p ublic data on
further request, an individuel who is the subject of se to�mrl�v�aae if he desires, shall
individuals shall be shown the data withou�fan�y ��g. �ter an individual h�s been
�e informed of the content and meaning the data need not be �isclosed to
shown the private data and informed of its meaning, ursuant to this section is
him for six months thereafter unless a c�ispute or action p
� ending or additional data on the individu e h� 8te or p blic dataruponarequest by
' p reauire the
responsible authority shall provide coples o t P o�ible aut�rgy maY �in the
the individual subject oftrie acaual.costs of making, certif n , and comp g
requesting person to pay -
copies. y ssible, with any reQuest
The responsible authority shall comply immediatel , if Pa
made pursuant to this subdivision, or wit olida e,�f Simmediatea compliance ei�su not
excluding Saturdays, SundaYS and lega.l h YS
P
ossible. If he cannot comply with the request �t�within wtuch toh omplynw�h the
individu8l, and m S turds_vs, Sundays and legal holidays-
request, excluding
te or complete. An individusl mgY
Subd 4. Proced�u'e xhen daffi � ublic o private data concerning himself• To
contest the accuracy or comQleteness of p � y�i� the responsible authoritp
exercise Lhis right, an individu8l shall notify �ible euthoritq shall within 30
describing the nature of the disagreemenL The respo
days either. (a) correct the data found to be ete dataeincluding pee�Pi�� namedt by
notify past recipients of inaccurats or incomp
t�ie individual; or (b) notify the individual that he believes the data to be�cmQn�c�
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the �sclosed data. � appe�led pursuant to the
' The determination of the responsible authority �o��ntested cases.
provisions of the administrative procedure act relating
�
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E.,��
- •� • ' CHECK OFF LIST FOR ISSIIAN� OF PER�'iITS
. FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3Z�I5 C;RZI`«�A��; I��D�y��) PID:
DESCRIPTION OF WORR: �. V�T" f-� �'-�_ �^•, ,>�� �_�- -------------------------------
-----------/---------------
ZONING REVIEW BY= I� ( / ) DATE APPROVEDz
DATE APPROVED: �- �� "�/�
BIIII.DZNG REVIEFI BY: �"�''�: �-�-ti���- - ------------------------------------
FEES TO BE CHARGF�= -r Misc. Fees Cal.culated By:
PERMIT Yes ✓ No �
PI,AN REVIEW Yes—� No SEWER CONNECTION
STATE SURCHAKGE Yes�� No - WATER CONNECTION
INVESTIGATION FEE Yes No �%: PARR FEE
SAC � Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
--------------------
ZONING CHECR LIST Zoning Dis rict:
Fire Department:
Post Offi e: School D �strict:
Lot Area: Width: Depth:
� �,
Survey Submitted: Ye�� No Da e of Suxvey: ��
�
Prcposed Se�backs: I ght Side-
Front (Lake) # ' �
J ',
' �eft Side:
Rear (Stree ) :
�
i
Adjacent St uctur�s: Wetland:
' Peak Hgt.
Buil.ding Heightc Def . ',Hgt.
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-'75 '
75-250 ` �
250-500 `
500-1000 '
Hardcover Variance Require�: Yes No
Date of Council Approval:
� gy; Council Approval. Date: _
Grading: Staff Approval D�te:
Septic: S;taf f Approval. D�ite: . B�'�
Zoning F�.le•# _ -�, ResoZution �: ResoI.ution Date:
,
RF�M(ARK$ (1.II house) : % .-
sQILDING REVIEW CHECK ZIST . ,
�C. �y � -3 CONSTRIICTION TYPE: -�1��1_ �
Sq Footage $ Per Sq Ftg
Basement X -
lst Fl.00r X
2nd Floor X -
Garage X
x =
TOTAL
Estimated Construction Value: $ Z�,J`'G —
Inspections Rem,;red: Work Requiring Separate Permits:
Site � X Plumbing Grading/Filling
Footing �Mechanical Fire
_�Framing Septic Water Connection
_�Insulation Fireplace Sewer Connection
�Wall Board (Masonry) Lawn Irrigation
• Fina 1. (Mf g.) Other
Otner Wel.l (State Permit)
�Electrical (State Permit)
----------------------------------------
RRMARKS (IN HOIISE) :
------------------------------------------
REVIEW BY OT�S: DATE:
Access: Existing New
Access Approval: Date By=
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REMARRS (TO BE NO�ED ON PERMIT) :
�