HomeMy WebLinkAbout1998-010235 (building-deck add.) PERMIT
CITY OF ORONO PERMIT TYPE:
2750 K�Iley Parkway - P.O. Box 66 ���1 3 LC}I;'!�_
,Crystal Bay, Minnesota 55323 Permit Number: ;:;f s_;�i:`;�
(612) 473-7357 Date Issued: :^���f_i:M;f'Y,'_'
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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PPLICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ � `f. }—� Date Received:
, Entered By: � Permit#: J i; �,�, j
CIT OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR
JOB SITE ADDRESS: ��ie2„3 7 �t3S e o �t�'� � ��Z'��IP: ,��31�
NAME OF OWNER: ��'�-'�/ /l��5/EPC�K PHONE: (home) �`f/�r�S
(work)
MAILING ADDRESS: 3�,;� L��-sc�d @��rG�c ciT�: �Uj�jz�-f� z�: ��.��
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition *o �ea,� Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�: A.�%l,��u-{, ?o De�l� �`f� �f � r�
S'TORIES: 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: S S� �
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Couneil 60 days prior to the event. Non permitted events will not be allowed.
5
Sec.13.04 RIGHTS OF SUBJECTS OF DATA ,
Subd. 1. Type of data. The rights of individual 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 individual. An individual asked to supply private or confidential data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.
This requirement shal( not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or oropertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the
subject of stored data on individuals, and whether it is dassiY7ed as public,private or conf'iden[ial. Upon his fitrther request, an individual who
is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed
of the content and meaning of[hat data. After an individual has been shown the private data and informed of its meaning,[he data need not be
disctosed to him for six months thereafrer unless a dispute or action pursuant to this secrion is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
1fie responsible a.uthori.ry shall comply immediately,if pocsible,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 request within that time, he shall so inform the individual, and may have an additional five days within which to comply with 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
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt ro notify
past recipients 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 included with the disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant ro 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.
��/�� f�cP!,S ��.5/��C ��(
First Middle Last
3a��7 �"�-�.�o L�•,� l.�
Address
�N��Z���-- �<-��-�- �s3�/ Y��-�r�S
City State Zip Phone
I understand my rights as stated above.
Signa e
6
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MAP, �2 '98 U9; 13 AM SOHPISOPI BROS ST PAUL +g12 64� 5884 Page 1
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!, CITY OF ORONO �
�ii BUILDING P RM PtAlal REVIEIIV
�i I (NSPECTOR _
� DATc S`1� •�I� PER!v11T NO._
�� C7 APP�;OVtD AS SU:3;.��?TED
��' �B'APr^ROI�cQ VJITN COAR�CTIONS AS NOTED
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_ These comments aro for your informdtion.All work shali be dons
� �� in fu�l comp!iar;;,o x±h ar applicabl� building and zo�ing code.
, , Requireme�ts induding iEt,ms not specificaliy noied in ih;s reviow.
KEEP THI�PLAN SET ON St7E A�ALL 71M� — J'� - •'
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APR 3� '98 �7: 28 AM JOHt��50N BP.OS ST PAUL *612 649 5894 Pa9e �
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� CHECK OFF LIST FOR ISSUANCE OF PERNIITS
' � FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 Z 3'Z C��c.� G���C
PID• �� � /�7 - a 3 � 3 �.�v/3
DESCRIPTION OF WORK: �L� y�,pp�1,n,�1
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ZONING REVIEW BY: DATE APPROVED: S- � 3- 5�
BUILDING REVIEW BY: DATE APPROVED: s- i3-S�b
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes +� No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes ✓ No WATER CONNEC'ITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (spec:fy)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
� (
Lot Area: Sq.ft. Acres Width Depth
� Survey Submitted: Yes n� No Date of Survey: �1� �z ll
L�
Proposed Setbacks:
Ft,�nt (Lake): �3� } Right Side: (C�2.�
,� ' + � r
&� (Street): � �z Left Side: �� -
Adjacent Structures: ���t,(ft�� Wetland: N k�
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
P, Grading: Staff Approval Date: By: Council Approval Date:
��
Septic: Staff Approval Date: By:
Zoning File: # ` Resolution: # — Resolution Date: -"-
Shoreland District: .�,c'S
Avg. Setback:�— Bluff Setback: N �/� I.otCoverage: �.f�
Existing Proposed
Hardcover: 0-75'
75-250' 2y �� Z�`�'lv
250-500'
500-1000'
Hardcover Variance Required: Yes No 5� Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
UBC: j Z - 3 CONSTRUCTION TYPE: y�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
:>_,
Estimated Construction Value: $ �l��>
Inspections Required: �`'ork F�equiring�eparaie 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)
,�Final Grading/Filling Electrical (State Permit)
Other
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xEMaRxs(nv xousE>:
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMII�:
8
DATE TIME
CITY OF ORONO CALLED IN �� O. �7
INSPECTION NOTICE ,� SCHEDULED 7-I� `� c���
PERMIT N0. �e '��5 COMPLETED
ADDRESS 3� � 7 Cl��-� ���
OWNER �,C�--2.U"l�k-�iC/ CONTR.
TELEPHONE NO. Gi � % � ,�� 7
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� DESCRIPTION �..1�-�'�/
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� �RAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i 09 PLUMBING RI 23 SEPT�C FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVA�
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑ CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �- pHOTO TAKEN
INSPECTOR WILL RETURN � CITATION ISSUED
0 STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnedContractor o�e:
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Inspector. �
White Copyllnspector's File Canary Copy/Site Notice
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CERTIFICATE 4F SURVEY FOR�,,
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C` GARY NASIEDLAK �.���Q Cx���'
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= � IN L�T 18, SPRING PARK
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� � HENNEPIN COUNTY, MINNESOTA
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Lecta]. l�escrint:.i_on of. narcel_ sizr.��eved
Lot 18 , Spring Park, also all that part of vacated Lake Shore nvenue and oF
the tract of land lying between said vacated avenue and I,ake Minnetonka
which lies between the easterly extensions of the northerly and south�rly
lines of said Lot 18 .
Lof .�rro = /6�E23 f1'p.Ff,
o: Iron marker
Bearings shown are based on an assumed datum. � ' � � �
This survey shows the location of all existing buildings on thP
above described property, It does not purport to show any other
improvements or encroachments .
(951.o) : Exiffin) E/�vo�:i,�
12.o : Pro/of�.! E/�dq fiin ,
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3)B.t�E/�r f,�r = 9J�.o .
, I hereby certify that this survey was prepared by mc or under my direct super- �nTr g- q-q3
� � ` � � � vision, and that I am a duly registered Civil Engineer and Land Sur��eyor undcr 'r� �6- _
�� the laws �f the State of Minnesc�ta. scni.i: � �� _ �(O�
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' �., 'y�f*�:�°�{� "���,,,�';����j�,�;�,,,r� a���.' Mark S. C�ralbcr�; Minncsota Lic�nsc Numbcr 12755 361
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