HomeMy WebLinkAbout1999-011520 - replace wind/patio PERMIT ,
r �� �ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Cr stal Ba , Minnesota 55323 Permit Number: 4'�`�.i ��.-��`:��v'�
y y Date Issued: - �-��`-
(612)473-7357 ;_;r,,-_ ; j_�:
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT-PERMITE I ATURE ISSUEDBY:SIGNATURE �i,
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r Total Fee: $ .a,S Date Received:
Entered �3y: Permit#: //_5�,6
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) % OWNER R CONTRACTOR
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JOB SITE ADDRESS: �C��5 C`Cl J�� 1 � ��`=� ZIP• -4' � ����''
NAME OF OWNER: ��-a- L�:�v�� � �� �?�s,�t L. PHONE: (home) y'{' l c��'�'�-
� y� y� � (work) `f�`� �.��%��'f
MAILING ADDRESS:7C��S ��%tDC,c� t'� �.cy CITY:d,/ ��.���. ZIP: �x,S',3�! ►
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 Accessory Structure
Move Remodel/Alteration ,/ Land Alteration
PROPOSED WORK(describe in detai�: '��p I G�� a(� W�h�.c��5 < �r I �t �f'��'�
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--�i1� �",�t �f�._ c�eC.C_'.�'- �.c� � �f , �c-,-�
STORIES: �� SQ. FEET OF EACH FLOOR: �'`� '�
NO. OF BEDROOMS: `f GARAGE STALLS: ATT. DET.�
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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.
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APPLICANT'S SIGNATURE: � DATE: � j� 7 �
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.
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Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA
Subd. 1. Type of data. The righu 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 confidendal data conceming himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any]mown consequence arising from his supplying or
refusing to supply private or confidential data;and(d)the idendty of other persons or enades authorized by state or federal law to receive the data.
This requirement shall 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 nlace the notice reauired under this subdivision in the individual income tax or orooertv tax refund
instruccions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his furrher 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 that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this section 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.
The responsible 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 Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with
the request within that rime,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 nodfy in wridng the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)conect the dara found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)notify the individual that he believes the dara
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The deternunation of the responsible authority may be appealed pursuant to 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 �ity 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.
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I understand my rights as stated above. �
GCiCi'��
SignaNre
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DATE TIME
CITY OF ORONO ' CALLED IN /
INSPECTION NOTICE SCHEDULED � 3 '_� �
PERMIT NO. ��Jr a a COMPL ED
ADDRESS
OWNER CONTR.
TELEPHONE NO. '�� �`' �a�ZCo O ���. ��� ����1
� DESCRIPTION ,(,(ll��,sl��
lL 01 FOOTWG 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 2 FRAMI 13 MECHANICA�FINAL 19 LAKESHORE/WETLANDS
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O NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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d �NORK SATISFACTORY:PROCEED C PROJECT COMPLETE
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� `�CORRECT WORK 8 PROCEED C! ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �-, PHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR C! CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor on site:
Inspector.�,/�"/�-�/� ���-�
White Copyllnspector's File Canary CopylSite Notice
DATE TIM�
CITY OF ORONO CALLED IN ` �� �
INSPECTION NOTICE SCHEDULED l b �
PERMIT NO. CI!:S-a�0 COMPLETED �a ��
ADDRESS � �'� C��l SCc� -��o�r� F �C� ,
OWNER � CONTR. �i�'+����'� �
TELEPHONENO. � ���`���'���
� DESCRIPTION
LL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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3 INSO ULATIO � 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 4 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-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 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS: h�� t�i1i �f3e � 1'1 �� w�^
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d �IORK SATISFACTORY:PROCEED �: PROJECT COMPLETE
� ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORREC7 WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. r- pHOTOTAKEN
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.473-7357
OwnerlContractor on site:
Inspector.��l E,� ��t ..;,T�
White Copyllnspector's File Canary Copy/Site Notice