HomeMy WebLinkAbout1997-008836 - window replacement * PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ,,;,�;Y!:�L...!�:=;..�wi�,
Crystal Bay, Minnesota 55323 Permit Number: ,:,^,:., .,-
,��: „_.,:;�..:
(612) 473-7357 Date Issued: _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: �-- r��,=�� T�:,:�.�-,_. --
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APPLICANT%P RMITEE SIGNATURE ISSUED BY:SIGNATURE ��'
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Total Fee: $ ;C�.,(,S' Date Received:
•►�- � �Entered By: ��;, Permit#: `'�3 G.'
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWN RpR CONTRACTOR
JOB SITE ADDRESS: �7�S 11�K,E �"Ql�i� �� ZIP: �5����
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NAME OF OWNER ���(/�/1 ��r G'��1 PHONE: (home) �- ��
/ j��� (work) �'"�l� - 3 S-U�
MAII.ING ADDRESS: .z.7�5 �C� �l�/�� CITY:� 'L ` ZIP: . <�.-'
CONTRACTOR: PHONE:
CONTACT PERSON: MOBII.E/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
�JAME; REGISTRATION#
TYPE OF WORK: New Addition f Accessory Structure
Move Remodel/Alteration i/ Land Alteration
PROPOSED WORK(describe in detai�: vfj�c.� �i,� i�cµ-�� c'1 t �c�.��:5 �� _
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �C�Z D ��
I hereby apply for a building pernut 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 ac�ordance with�e approved plan.
;` , � � ,
,
ArrLICANT'S SIGNATURE: � � � �L�� DATE: �-—r`� �y 7
1
NOTE! Parade of Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom che data is scored or to be scored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. �.n individual asked to supply private or confidenaal data concerning hunself shall
be informed of: (a) the purpose and intEnded use of Ihe 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 identiry of other persons or enrides au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieadve dara, 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 individuai income tax or proPertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by indi�idual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and wherher it is classified as pubiic, private or confidencial. Upon his further request,an individual who is the subject
of stored private or public da[a on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown the private data and informed of iu meaning,che data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending or additional data on the 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 auchority
may require the requesring person to pay the actual cos[s of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, wi[h 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[he individual,and may have an addicional five days within which to comply wi[h 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 pubiic or private
data conceming himself. To exercise rhis rieht,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement.
The responsible au[horiry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt ro norify 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 de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relaang 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 deternune 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 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.
(. Your full name is required to process this application or permit.
�/ � ' f �
First vliddle Last
-�.7 �S- �o� �?���.
—� /
Address �� � /.�� j �j=;�C! ! " ( ��`t
N
City State Zip Phone
I
I understand my!�ights as stated . ve.
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Signature
CHECK OFF LIST FOR ISSUANCE OF PERI�IITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2 � �15 CV�S C,o V',o,.�,-� (�,o.r,
PID:
DESCRIPTION OF WORK: ��...>�� ,�o� �2r_;�c� c�
_----_-------------------------------------------------------------------------------------------------------------
ZO�TG REVIEW BY: �t%�� DATE APPROVED:
BUILDING REVIE`V BY: . .f�-ti�ATE APPROVED: 3 !�3- S�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes c.� No
PLAN REVIEW Yes No � SEWER CONNECTION
STATE SUR�HARGE Yes c��No WATER CONNECITON
INVESTIGAT'ION-FEE Yes No �' PARK FEE
SAC Yes No �- SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZO��TG �HECK LIST zoning District:
Fire Department: Post O�ce: School District:
Lot Area: Sq.ft. Acres Widch Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
��/ Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland Dist:ict:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-7�'
75-250'
� 250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
� 26
BUII.DING REVIEW CHECK LIST
UBC: �' 3 CONSTRUCTTON T'YPE: VN
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gara�e x =
R =
TOTAL
Estimated Construction Value: $ S,C�00�
Inspections Required: `Vork Requiring Separate 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 Perm.it)
_p� Final Grading/Filling � Electrical (State Permit)
Other
RENIARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERNIITj:
27
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SPI�CIAL NOTE
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°�ATE .'3� �7
CITY OF ORONO CALLED IN J ':�.L:�'f_7 a
INSPECTION NOTICE SCHEDULED "��-�7 7 �-' � 4'�
PERMIT NO. ���� COMPLETED �
ADDRESS ��7 � c
OWNER CONTR.
TELEPHONE NO. ��� - 0 � �/
� DESCRIPTION ,
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLINd
FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 031NSUlATION 24/25 WOOD BURNER/FIHEPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z OS F�NA� 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HAFD COVER REMOVAL
v 10 PLUMBING FINAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d � /ORK SATISFACTORY:PROCEED PROJECT COMPLETE
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� C CORRECT WORK&PROCEED : ISSUE CERTIFICATE OF OCCUPANCY
W
� C; CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PEFMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. -, pH0T0 TAKEN
INSPECTOR WiLL RETURN
�CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CAL�TO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance.473-7357
OwnerlCont on 'te•
Inspector.
White Copyllnspector's 'le Canary Copy/Site Notice