HomeMy WebLinkAbout1997-009382 - gar addn 2nd dormer �► � PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _ _'+`��-�
Crystai Bay, Minnesota 55323 Permit Number: - W - -.,., i
(612) 473-7357 Date Issued: _ r�,- ,
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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APPLI NT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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� Total Fee: $� 7 � �'`� Date Received:
Entered By: �' Pernut#: �},Y-Z
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
.� l se rint all information)
----��='�=-s-��---�--���.��`-1�-���-- ---------------------------------------------------------
THE APPLICANT IS: (circle one) ^ R CONTRACTOR
JOB SITE ADDRESS:�.,� �O �Q.S C� � �� �7 � ZIP: �.,�',, �� )
NAME OF OWNER:��,�� i� F�����-��`����:�� PHONE: (home)��C� c�/ G v
(work) `�/ �� —f�«�
MAILING ADDRESS:`���' CI�.���- j� 1 .�'�.CITYc�k-�1-�� ZIP: S S ��(
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # ,
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
l�JAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detai�: `�'t-��� 1��1`'�k��. C�--�
����-�-►��1 ►� �'-�. r=�
STORIES: 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 wi t�pproved plan.
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APPLICANT'S SIGNATURE�' �-� - �.%��----- -DATE: �'�'"�'����
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
• �, � �
Sec.13.04 RIGH'I'S OF SIIB.TECTS OF D�TA
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 secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and intended use of the requested dara within the collecting'state a�ency, political subdivision,or statewide system;
(b)whether he may refuse ot is legaliy required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or co�denrial data;and(d)the idenriry of other persons or entiues authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his fur[her request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to hun and,"if he desires, shall be informed of the conten[
and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for
six mon[hs thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on[he individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesring person to pay the actual costs of making, cenifying,and compiling the copies.
The responsib(e authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Sa�urdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform[he individual,and may have an addiuonal 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 pri�•ate
data conceming himself. To exercise this rieht,an individual shall noafy in writing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to 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 disa�reement is included with[he disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administra[ive procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�ts 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 pemut 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 pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
$, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
� ��� I S H- � ��,��11��-.�
First Middle Last
2r7 I� C�.SC-� 1�� �-� -
Address
��l�c� Fl)1-1 5 S��) �71 —0 7�'
City State Z�p Phone
I understand m rig�as stated ,ove.
/ � / i�
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Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRF.SS OR LEGAL: Z-71� C r45 C,o (�orrv-r (Zo,�,�
PID:
DESCRIP'I'ION OF WORK: G�tt1��c O N - 2�� sto
ZOi�TIl�tG REVIEW BY: DATE APPROVED: 9�� -5 7
BUII.,DING RE'VIEW BY: DATE APPROVED: q •� • S�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes �" No
PLAN REVIEW Yes � No SEWER CONNECITON
STATE SUR`HARGE Yes �/ No WATERCONNECTTON
INVESTIGATION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONIlVG CHECK LIST Zon.ing District: C,+C-/L
Fire Deparcment: ywo�tip Post Office: �uq,�,4�r. School District: c,�-P�Tt�t1c�
Lot Area: Sq.ft. 1��,C�3Z .2� Acres • 31 tiVidth I Oo Depth /6 U .3 Z �i.�f
Survey Submitted: Yes,� No Date of Survey: g-l3�8 S
Proposed Setbacks:
�ront (�.a�e'j: �f•� Right Side: 1 c�1� �
Rear (S��r•eet): l 37 � Left Side: �O� '—'
Adjacent Structures: Z�� '� Wetland: �! (,�}
Building HeiUht: Def. Hgt. D,(c. Peak Hgt. p�JC.
Lot Coverage: (�,(.�
Grading: Staff Approval Date: N I� By: — Council Approval Date: —
Septic: Staff Approval Date: lv l/} By: —
Zoning File: # 2 Z 5'-f Resolution: # � `� �.� Resolution Date: 1 ' Z-�'S� �
Shoreland DisL-ict: y�'S _
Avg. Setback: ��/� Bluff Setback: /U [A- Lot Coverage: �
• Existing Proposed
Hazdcover: 0-75'
75-250' . .
250-500' ' wv �f+9M�
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REI�ZA,RKS (in house):
26
BUII.,DING REV�W CHECK LIST �
�rsc: �- � covs�xUc�ox�E: �� -
� Sq Footage $ Per Sq Ftg
Basement z _
lst Floor x _ . .
2nd Floor x _
Garage x =
x =
TOTAL
�1,omo'°"
Estimated Construction Value: $�'
Inspections Required: � Work Requiring Separate Permits: �
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
_�Fram.ing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well (State Permit)
�F�� Gradin;/Filling _�Electrical (State Permit)
Other
REI�ZAR�S (IN HOUSE): ------`_�'�'_�___�______ ---- _�__
REVIEW BY OTHERS: --------- DATE: ~--------------- ----- -------
Access: Existing New
Access Approval: Date gy.
REMARKS(TO BE NOTED ON PERA�II'I�: M���_��-~ "�-"�-'-_
� 27 _ _ � -' �t:
�,e'n C_.t . . . .
• �r��.''' �<�J'� �`-�L'��Y Certificate of Survey for
.c ,y:� r� - .
-�^n"'•��'', - =:� `' Tom Martin
r y.
,k�,�F, � ' � �, of Lots 12 and 13 , Block 3, CASCO HEIGHTS
a�:..;-� . - r ,;
6 q��•-`�• � �`�-` -x Hennepin County , Minnesota
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X v�_;.�� `� ��v GR�uiNG PLAN ; �s6� ' �� o°� \
�-A�'�'�=�u'w��,�.;-GAfL4t� ReaF do�� � �SS 89�� �
❑ A�3�'�r.�V��,� V`r;�� ���ISIDNS � `�°Sco"'�e�
❑ ��A�PRii� ��'� ��96s , :='
BY '�" '
DATE ___�i -� -4� _ ti
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I t�ereby certify that this is a true and ' correct \
. undaries of /
1 P n r e s e n t a t i o n o f a s u r v e y o f t h e b o \
L o t� 12 and 13 , Block 3, CASCO HEIGHTS, an.d of C<
the Iocation of a11 buildings, if any, thereon . /
It �?oes not purport to show any other improvements
or encroacnments . •
COFFIN & GRONBERG, INC.
i�'��zc�- ^E�—��� — �i�$;'•"?+ �;--�.,- -. `
�tlark S. Gronberg Reg. No . 12755 2 ��' , • -
�,�:. . ..
Gordon R. Coffin Reg. No . 6064 ,��-� � � -
Engineers and Land Surveyors '' � _ _
Long Lake, Minnesota ,. �
Phone 473-4141 �
Scale : 1 inch = 30 feet � �~
Date . August 13 , 1985
o , iron rnarker
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DATE TIME
CITY OF ORONO cn��Eo iN •���✓����
INSPECTION NO I , scHEou�Eo �f,� >� �
PERMIT N0. ��"L"" COMPLETED ��
ADDRESS � / ; � � � �
OWNER �� � -��' CONTR._,�-�"�'
TELEPHONE NO. '� 7� — ��C'C'
� DESCRIPTION 1����__��-,
� 01 FOOJJAIG,�� 11 MECHANICAL RI 18 EXCAV/GRADING/FILLIN(i
�Q�,�2 F�1 (d6� ' 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
p 031NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEMO—FINAL 15 SEPTiC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION FiEMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d �ORK SATISFACTORY:PROCEED PROJECT COMP�ETE
� L CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
� L CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. -, pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR '-^CITATION ISSUEO
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance.473-73�J7
OwnerlContra si e:
Inspector.
White Copyllnspector's Fi Canary CopylSite Notice