HomeMy WebLinkAbout1992-004665 - tear-off - PERMIT
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t ��TY OF ORONO PERMIT TYPE: �;�9j�������
1335 Brown Rd. South • P.O. Box 66 Permit Number: t�t i�.r,F,._
Crystal Bay, Minnesota 55323 Date Issued: {f'=�������`�� �
(612) 473-7357
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CONTRACTOR: O�(�([�EE� — ��'�'�����'t� —
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APPLICANUPEFMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORC.70 - BUILDIiIG FER�T A.PPI,ICATION
Total Fee: $ � ' \�' � ` Date Received:
Date A�pro�ed :
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vntered Bv: �
Permit r: ��� �' �
ALL INFORMATION MIIST BE SUBMITTED IN FIILL BEFOR.E PLAN REVIEW WI?�L B$ STARTED
(See Check-aff List Encl.osed)
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THE A.PPLICANT IS s (circle one) �,�1NEI�.%or CONT�ACTOR
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JOB SITE ADDRBSS: ��S`J �NS�'� ���. ��i� . ZIP: S � > ~� I
(work)
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N�ME OF OWNER: �-��`� ,`"�� PHONE: (home) �/7�"v ���
MATZING ADDRESS: CITY: ZIP:
CONTRI�CTCR: pH��'
MATI�ING ADDRESS: CSTY: ZIP:
STATE LICENSE: �
ARCHITECT/ENGINEER: PH��'
MAIZING ADDRESS: CITY: ZIP:
NAME: REGISTRATION z
TYPE OF WORR: New Addition Accessory St�yucture blove
Demo Remodel/Alteration Renovate � Land Alteration
PBOPOSED WORR (describe in detail) : �� �°�'�
STORIES: SQ. FEST OF EACH FLO�Rr
NO_ OF BEDROOMS: Gs'�RAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding Iand) : $ �"v0°•�`�
I hereby apply for a buiiding 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 Buil.ding Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work wi1 1 be in accordance with the approved plan. �
,���APPZICANT'S SIGNATIIRE: �=� DATE: C�'�7' f�--
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�`'� �� Post Office Box 66•Crystal Bay, Minnesota 5a323•Municipal Offices
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= s - a g On the North Shore of Lake Minnetonka
DATA PRNACY 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
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
aualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may reauire that
the City deny the permit or license.
3. The information may be snared with other Iocal , s�a�e or
f ederal agencies to the extent necessary to process the permit or
Iicense.
a. If your requested per^�it or Iicense ?'?C.Sll1?'AS Councii ac�io%
to approve, some information may become pub3ic.
5. You have certain rights under M.S. 13.04 to rev�ew grivate
data on yourself.
6 . Your full name is required to process this appl.ication or
permit.
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First Middle Las`
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Address
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City State Zip
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Phone
I understand my rights as stated above.
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Signature �
k31,`ILDIVG& ZONI�G-473-7357 • AD,tiiINISTRA?ION&FIVA?10E - 473-73�3 • PUQLIC WORKS - 473-7359
ASSESS(N G
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DAT � TIME
CITY OF ORONO CALLED IN ��' / �"� '�»
INSPECTION NOTIC / � SCHEDULED - � — �
PERMIT NO. 1" �'�`' `� COMPLETED �''`���"n1 '
ADDRESS ��� '-c ��" 7� �` ���`
OWNER "- � ������ CONTR.
TELEPH�NE NO. ��- � `� ��
� DESCRIPTION - � '
� 01� 11 MECH ICAL RI 16 WELLTEST PUMP
Q 2 FRAMIN � 11 MECHANICAL FINAL 18 EXCAV/GRADiNG/FILLING
y LATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
� 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
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
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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d �WORKSATISFACTORY:PROCEED '� PROJECTCOMPLETE
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� �1 CORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
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O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ` pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION tSSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContr or o ite:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
✓
CITY OF ORONO CALLED IN �(�f�(�, G�� TIME
INSPECTION NOTICE � SCHEDULED ) 9� - ���
PERMIT NO. � COMPLETED � w
ADDRESS � � t�'�
OWNER CONTR..e�/Jo,O�
TELEPHONE N0. ''��I� ' G} ���� _
� DESCRIPTION r����� �1��
ly� 01 FOOTING 11 CHANICAL RI 16 WELLTEST PUMP
� 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
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031NSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
� 12 WATER HOOK-UP 34 TREE REMOVAL
Z
Q 05 FINAL 13 METER SETlTURN ON 17 SITE INSPECTION
� EMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
W 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 10 PLUMBING FINAL 23 SEPTIC FINAL
J
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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d ORKSATISFACTORY:PROCEED PROJECTCOMPLETE
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� l� CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
W
OO Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. — pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �' CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n xt inspection 24 hours in advance.473-7357
OwnerlCo a or n site:
Inspector.
White Copyllnspector's le Canary CopylSite Notice