HomeMy WebLinkAbout1994-006448 - finish family room PERMIT
, �ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 . '._<< '___.??:::s=:
Crystal Bay, Minnesota 55323 Permit Number: -.
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(612)473-7357 Date Issued: - _ - - _
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE , �'.�
.- _ ^ - CITY OF ORONO — BIIII.DING PERMIT APPLICATION
Total Fee: $ �3 ��. � � Date Received: �j'`j,Z�9�
Date Approved: 9 - �� - y�
Entered By: ' '�� �
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Permit�: � �( � � '
A7•T• INFORMATION MIIST BE SIIBMITT� IN FIILL BEFORE PLAN REVIEW WILL Bg STAR�ED
(See Check-off List Enclosed)
-----------------------------------------------------------
T� APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDR$SS: '/O�GJ G�-�'�'0 1'�' Q� ZIP:
(work)
NAME OF OWNER:
R,�(�1ti2_� �STE NS PHONE: (home)
HAILING ADDRESS: CITY: ZIP:
. �
CONTRACTOR: K S� �`�'� 'O�.A`l t t�f�1 GS . �� PHOIJ$: `�`"��J (�E-I �
MAIZING �nDx�ss: l�� �7`�`�',�'� c�a , Cz�:-P��+u �-rt{ zzP: �� ��4'l
STATS LICENSE: � OC�� �LO
ARCHITECT/ENGINEER: ���— PHONE:
MAIZING ADDRSSS: CITY: ZIP:
N�: RBGISTRATION u
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSF.D WORK (describe in detail) : •t'l►'�l�j-�-1 �M� Q-�0� � N i� '��
�Cu�vL l.Q�d��e- G�a�
STORI$S: ( SQ. FEBT OF EACH FZOOR: �D�-� s,
NO. OF BEDROOMS: GARAGB STAI�LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ �� �� v
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the wor3c 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. •
APPI,ICANT'S SIGNATOR.E: �LK�I.�D-P`I�C DA DATE: � � �
� � �.
� � ;.
aj � � CITY of OROND
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` Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
• M1� �
� . a ,:�,; 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 like to inform you that your request for a permit or
license f rom 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 Iicense 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
federal. 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 under M.S. 13.04 to review pri�a�e
data on yourself.
E. Yaur full name is required to process this applicatian or
permit.
�� � �c��-
First Middle Last
►��O ��� � ��
Address
� �� n� � s���
City� State Zip
�� � 1 `-�I� --
Phone
I understand my rights as stated above.
��� �ao� .
_
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING '
�.� �G� OF �gJEC1'S OF DATA
'vision L Type of ��- The rights °ti�viduaLs on whom the data is
Subdi
stored or to be stored sha]1 be as set f orth in thLs sec An.individuel esked to
S�d, 2. Information re9ui�d
to be given in�ivi�ual.
� ivate or confidentiel data concerning him`s hin the collecti g state agencY,
supply pr uested data
purpose and intended use of the req tem; (b) whether he may refuse or is legallY
political subdivision, or statewide sys �own consequence arising from his
1 the requested dat8; (c) any
required to supp y rivate or confidential data; and (d) the identity of
supplying or refusing to supply p St$te or federal law to receive the data. This.
other persons or entities authorized by 1 investigative data,
requirement shall not apply when an individual is asked to supp y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The
commissioner of revenue ma lace tgX re°un� i�tructionsu nsteadhos
subdivision in the individual income tax or ro ertV
on those orms. � -— -
Subd. 3.
Access to �a� bY ����' UPon request to e responsible
8n individuel shall be informed whet�ec h r�gteeor confident al.e Upon his
authority, ublic data on
individuaLs, and v�►hether it is classified as Pu � P
e to him and, if he desires, shall
further request, an indi��u� �L8 without any chargtored private �vidual h8s been
individuels shall be shown the of that data• After an ln
�e informed of the content and mea�ng the data need not be �isclosed to
shown the private date and informed of its u�e�acti�n pursuant to this section is
him for six months thereafter unless a �SP n request by
e
� endin or additional data on the in���th h�ateQor public datarupoeate ' the
• P g• rovide copies of P uire
responsible authority shall p oiysible authority may req�in the
the individual subject oftrie actual.cos h of making, certifying, and comp g
requesting person to pay - Te uest
copies. if ssible, with anY 9
The responsible authority shall comply immediately, P�
or within five days of the date of the request,
made pursuant to this subdivision, if immediate compliance is not
excluding Saturdays, SundaYs and legal holidays,
If he cannot comply with the request within that time, he shall siinforth the
possible. �Ve � additional five da}'S Within which to comp y
individuel, and may �d legal holidays•
request, excluding Saturdeys, SundaYS lete. An individual may
Subd. 4. Proced�e when data is not ac�urate or comP �mself. To
or completeness of public or private �tthe�responslble authority
contest the accuracy in writing within 30
exercise this right, an individual shall notify �ible authority shall
describing the nature of the disagreement. The resPo lete and attempt to
reci ients named by
days either: (a) correct thgcda�ate ordincomplete dataeinalud�ngp ta to be correct.
notify past recipients of in eement �.s
the individuel; or (b) notif the individual that he believes the
Data in dispute shall be disclosed only if the individuel's statement of disagr
• included with the disclosed data. be aQpealed pursuant to the
' The determination of the responsible authority tp contested cases-
provisions of the administrative procedure act relating
CHECK OFF LIST FOR ISSIIANCE OF PERMITS
' ' � FOR OFFICE USE ONLY
' �
ADDRESS OR LEGAL: 3 O�{ 5� �sc'`� �r PID:
JESCRIPTION OF WORR: L�='�`"' - " ' ����5��
ZONING REVIEW BY: d ------- ----------DATE APPROVED: �''I- �C�'CI �P
BIIILDING REVIEW BY: DATE APPROVED: �t'- ��'1 ''S�
-------------------- ---
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes�c/ No
PLAN REVIEW Yes � I�Io SEWER CONNECTION
STATE SURCHARGE Yes-T� No WATER CONNECTION
INVESTIGATION FEE Yes �No _ _ PARK FEE
SAC Yes No�- SITE INSPECTION
Number of SAC Units OTHER (specify)
--------------------------------------------------------�- --------------------
ZONING CHECR I,IST Zoning Di�trict:
Fire Departmen • Post Office: School. D strict:
Lot Area: Width: Depth:
Survey Submitte : Yes No Date of Su vey:
Proposed Setba ks:
Front (La e) : Right Sid :
Rear (Str et) : Left Side.
Adjacent Struct res: Wetland:
Buil.ding Heig t: De . Hgt. � Peak Hgt.
;
Avg. Setback:� '� Lot�� Coverage: ,
� E�isting �roposed
1
Hardcover: 0-j 5 ' ` �
I ',� ' r_._.._._.--------------- ,
75-2�0 ' �
, i
250-5p0 ' �: � �
�
i '�
500-1Ob0 '
Hardcover Var�ance Requi�ed: Yes N� Date of Council Approval:
� � '
Grading: Staf A proval D�te: � By: Council Approval Date:
,
Septic: Staff p rovaJ. Dat�: I. BY=
,
Zoning File:# Re 1ution #: ' Reso�ution Date:
�
REMARKS (in house) : �
wv�l� �9��� r�' o ��c ��
BIIILDING REVIEW CHECR LIST _Y _ .
�C: �„• 3 CONSTRIICTION TYPE: '`�� '
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor � X
2nd FJ.00r X
Garage X _
x
TOTAL
Ssti_mated Construction Value: $ / 3,0�v
Inspections Rem,;red: Work�Requiring Separate Permits:
Site � �� umbing Grading/Filling
Footing echanical. Fire
S���aming Septic Water Connection
-- "I}�sulation Fireplace Sewer Connection
t�f�V 11. Board (Masonry) Lawn Irrigation
�'ina 1 (Mf g.) Other
Other Wel 1 (State Permit)
E�ectrical (State Permit)
-------------------------------------
R_F.MARRS (IN HOIISE) :
----------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
By:
Access Approval: Date _____________
--------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
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LAYID ON CONCRE"I�
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DATE ,TIMk
CITY OF ORONO �jS� c,a��Eo iN -=- --��`� � �5 ���
INSPECTION NOTICE��� scHEou�E� �' �� - � -�,/<�' �—
PERMIT NO. COMPLETED � "`
ADDRESS . ��L��� .�� � "� �-C`-�� � � _ �� � ,
OWNER ��!r `�� �� `: CONTR. �� �
TELEPHONE N0. ✓ `� � " /� �rI
� DESCRIPTION �C.�-�x:'�t�-�� �� ��(Or•�lG h�� �.`;1.�
� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIWNG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHOREJWETLANDS
Q-�63 INSUL�A�TION� 24/25 WOOD BURNER/FIREPLACE 34 THEE REMOVAL
Q04 VPALCBD. 12 WATER HOOK-UP 17 SITE INSPECTION
= O5 FINAL 14 SEWER HOOK-UO O6 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBINCa FINAL 36 FOUNDATION REMOVAL
� OWNEH/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d C'WORK SATISFACTORY PROCEED PROJECT COMPLETE
W
� CORRECT WORK&PROCEED �- ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContra r o site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice