HomeMy WebLinkAbout1994-005909 (building- add./remod.) _
PEI�IliIIT
GIT�'�OF ORONO PERMIT TYPE:
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2750 Kelley Parkway P.O. Box 815 PermitNumber: ;`;;`;:_,�.:�,,�:�
Orono, Minnesota 55356-0815 Date Issued: - - � - - V- .
(612) 473-7357 - ''�='=�'�=-`:"
SITE ADDRESS:
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APPLICANT%PERMI SIGNATURE SUEDBY:SIGNATURE
' ' ' CHECR OFF LIST FOR ISSIIANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3�c'� C(�S� �� PID:
DESCRIPTION OF WORR: l�.C=w�n+D E�-
---------------------------------------------------
ZONING RLVIEW BY: N �I'� DATE APPROVED:
BIIILDING REVIEW BY: DAT$ APPROVED: 2-�-rj y
----------------------
FEES TO BE CHARGF.D: Misc. Fees Calculated By:
PERMIT Yes f No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes� No WATER CONNECTION
INVESTIGATION FEE Yes No �" PARK FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
--------------------------------------------
ZONING CHECR LIST Zoning District:
Fire Depar ent- P st Office: Schoo District:
Lot Area: Wid h: Depth:
Survey Sub it ed: Yes No Date of Survey: '
Proposed S tba ks: �
Front (Lak ) : Righ Side:
�
Rear Stree ) : Left Side: � �
` �t
Adjac nt Str ctures: Wetland:
.`
Building H ight: ef. Hgt. Peak Hgt.
!
Avg. Setba k: I Lot Coverage:
;
xisting � Proposed (
� ��
�
Hardcover: ' 0-75 '
7�-250 ' � '
25Q-500 ' ` �
�
500-+1000 ' t
�
Hardcover �Fariance Required. Yes� No Date of Council Appro al:
Grading: S�aff Approval Date By: Council Approval. ate:
Septic: St�ff Approval Date: BY=,' I
Zoning Fi��: # Resolution #: Resolution Date: �
REMARKS (in house) :
BQII,DING REVIEW CHECK LIST ' ' "
pgC: �� � CONSTRIICTION TYPE: �
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL
��
Ssti_mated Construction Value: $ l l (�C� `—
Inspections Required: Work Requiring Separate Permi.ts:
Site � �Plumbing Grading/Fill�ing
Footing Mechanical. Fire
�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
�Wall. Board (Masonry) Lawn Irrigation
�Final (Mfg.) Other
Other Wel 1 (State Permit)
D� Electrical (State Permit)
-------------------------------------------------------
�2F.MARR$ (IN HOIISE) :
---------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
------------------------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
-.
� � � .
' CITY OF ORONO — BIIILDING PERMIT APPLICATION
Total Fee• $ Date Received: /�.5���
Date Approved:
Entered By: � Permit�:
ALL INFORMATION MIIST B$ SDBMITTSD IN FI]LL BEFORE PI,AN REVIEW WILI� B$ STARTED
(See Check-off List Enclosed)
TSE APPLICANT IS: (circle one) OWNER or � ONTRACTOR
JOB SITE ADDRSSS: '��R� C'x< <� t�11?r�_ ZIP= S���I
(work)
NAML OF OWNER: ��3�z4• }�;�6 S l.t�f�- PHONE: (home) 4�(-7�!L�
MAILING ADDRESS: "31U'? ���-C E1�vr CITY:���r,A ZIP: SS�`ij
CONTRACTOR: T�F �r.::����:; �r�?�w�T�r.�ia 1� f.; PHONS: �i�a.- 5)�S
MAII,ING ADDRSSS: ll U� CT�y (�'�:t i "} CITY: 4�'!,�p�;.,;e,1 ZIP: .5�36��'
STATS LICENSE: � `j(���-
ARCHITECT/ENGINEER: T'Nt, GA�L'�N`"'"d�:� ��>+�t�•:,,A�'tt•.>c� iN i PHONE:
MATLING ADDR.$SS: CITY: ZIP:
N�: R.BGISZ�TION �
TYPE OF WOR.R: New Addition Accessory Structure Move
Deino Remodel/Alteration Renovate�1�, Land Alteration
PROPOSED WORK (describe in detail) : '��.� �Y�P�� �� l2��c� rx�s�t'��,n �i���=�'
�P M�s."� 1f�oo�..
�TORISS: SQ. FEBT OF EACH FZOOR:
i0. OF B$DROOMS: GARAGE STAI.LS: ATT. DET.
:STIMATED CONSTRIICTION VALIIATION (eacluding land) : $_►�Tt�G
hereby apply for a building permit and I acknowledge that the information
.bove is complete and accurate; that the work wi7.1 be in conformance with the
-=dinances and codes of the City and with the State Building Code; that I
;aderstand this is not a permit and work is not to start without a permit; and
:�at the work wil 1 be in accordance with the approved p lan.
�PPLICANT'S SIGNA2'URE: /��Q�,,.., �,J�;��R,���a, DATE: I' .d-� '��r�
. • � .
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4 CITY of ORONO
�
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
•
� - � � 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 Iike to inform you that your request for a permit or
Iicense 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 Iicense.
3. The information may be shared with other Iocal , state or
federa.I 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 ander M.S. 13.04 to review priva��
data on yourself.
6. Your ful.l name is required to process this applicatian or
permit.
��-��J '�J�1°2w� �Ar� �R�
First Middle Last
a��, �cti �� t�
Address
��,;,.,.�� �Y�v� >;��'`I° --
City State Zip
��i��,- -����1'
Phone
I understand my rights as stated above.
�� �
����.. �.,t;'4'0�2.�j,.����
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATIOIY&F[NANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESS[NG
, � � �
�,04 RIGHTS OF SIIBJECTS OF DATA
Subdivision L Type of data- The rights of individugls on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Information required t° be g�r� ����L An.individual asked to
� supply private or confidentisl data concera a tgmWi hin the collecti g state agency,
purpose and intended use of the request
olitical subdivision, or statewide system; (b) whether he may refuse or is legally
p the requested dat8; (c) any known consequence arising from his
required to supply
supplying or refusing to suQply private or confidentiel data; and (d) the identity o
other persons or entities authorized by state or federal law to receive the data. This.
1 when an individual is asked to supply investigative data,
requirement shall not app y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mg rolert tgX re�und instructionsunsteadhos
subdivision in the individual income tax •r �
on those orms. . - — _
Subd. 3.
Access tc �ata by in�ivi�ual• UPon request to e responsible
authority, an individual shall be informed whether h r vateeor confidential.e Upon his
individuels, an d w he t her i t i s c l a s s i f i ed as public, p u b l i c d a t a o n
further request, an individusl who is the subject of se tr�ed�mri�v�aae if he desires, she]1
individuels shall be shown the data witho o f an�y ��a. Af ter an individual has been
�e i n f o r m e d o f t h e content and meaning t h e d a t a n e e d not be �sclosed 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 individ�h h� gte or public datarupong equest by
responsible authority shall provide copies of P require the
the individual subject oft�e actual.costs of mak ng,l cert fyingyand compiling the
requesting person to pay .
copies. immediately, if possible, with any request
The responsible authority shall comQly
made pursuant to this subdivision, or Wlt olida e �f Simmediateatcompliance eisu not
excluding Saturdays, Sundays and legal h YS�
possible. If he cannot comply with the requese w�ithin�i��ntW�ch toh omplynw�h the
individual, and may have s.r► additional fi YS
request, excluding Saturdays, SundaYs and legal holideys.
Subd. 4. Procedtu'e when data is not accurate or complete. An individuel may
contest the accuracy or comQleteness of pub�f �inr WTit ng tthe�responslb e au hor ty
exercise this right, an individusl shall no y
describing the nature of the disagreement. The responsible autholete and at pt to
days either: (a) correct the data found to be inaccurate or incomQ
notify past recipients of inaccurate or incomp�t he believesdthe datalto be correct
the individuel; or (b) notify the individual t eement is
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the �isclosed data. ealed pursuant to the
' The determination of the responsible authority may be app
provisions of the administrative procedure act relating to contested cases.
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�`�� �KD � ��pp��tro � 06I��� . �.��sS C��(nl��� ���l� 1 05TCo ntyNRoad 9 SHEET NO. DATE��N I 1 ,-1'
µ��� ('p� � � ��� MOUND, MINNESOTA 55364 CALCULATED BY
�"r �� (612) 472-5715 CHECKED BY DATE
SCALE
CITY OF ORONO CALLED IN
°�� -�,y �- �'�E ,:
IiVSPECTION NOTICE� scHE�u�E� ' '�-�' �� ' Q�
PERMIT NO. � �� COMPLETED l� L
ADDRESS /� �U� r �' , �-.c'��—�
OWNER CONTR. � �LI�
TELEPHONE NO. � �"� � S 7 /. �� /
/ f711..s1'��2Ps� Ot:_
� DESCRIPTION ��ZLc111�7_�_Yic� � ���-�I.�j� / G1
lL 01 FOOTING 11 MECHANICALRI 16WELLTESTPUMP
� 02 FRAMING 11 MECHANICAL FINAL 18 EXCAWGRADING/FILLING
�
03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
� 04 WA L BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Z
Q FINAL 13 METER SET(fURN ON 17 SITE INSPECTION
� M SITE 14 SEWER HOOK-UP O6 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
Q
W 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 10 PLUMBING FINAL 23 SEPTIC FINAL
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Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� `�,WORK SATISFACTORY:PROCEED i_ PROJECT COMPLETE
W , C'';CORRECT WORK&PROCEED L. ISSUE CERTIFICATE OF OCCUPANCY
O CI CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. , pHOTOTAKEN
INSPECTOR WILL RETURN i- CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
L:: INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
1
OwnerlContr�etqor o s�te:
r � , � .
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DA E, TIME
CI fY OF ORONO CALLED IN 7 "T
INSPECTION NOTICE ;C�U� SCHEDULED -� �� �" �>•� =��
PERMIT NO. COMPLETED
ADDRESS -�% ��=�� -• �, c
OWNER i ; � ,�.-/, , CONTR. �,z�� ,_�; •_:
/
TELEPHONE NO. �7-�- � 7� �
� DESCRIPTION �%��_��z,��z��-�=�
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADING/FILLWG
� AkS N 24125 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
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DATE TIME
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White Copyllnspecto's File Canary CopylSite Notice