HomeMy WebLinkAbout1998-010599 - land alteration � , PERMIT
, CITY OF ORONO PERMIT TYPE: -�
2750 Kelley Parkway- P.O. Box 66 i�:�;`�;' '.'°-j�'F:,�`'-.`
Crystal Bay, Minnesota 55323
Permit Number: �_��;_;.��=���
(612) 473-7357 Date issued: f�;;;:;; � ,=Y;_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: .- ;�;���� �,_.:�;;�t. - _� j . �ii .OWNER:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATUR� -G�
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Total Fee: $ Date Received: '�- � j- `���
1 Entered By: � � Permit#: /O 7'g s
CITY OF ORONO - BUILDING PERMIT APPLICATION �
A.11 information must be submitted in full before plan review will be started.
. (please print all information) .
THE�APPLICAIti'T IS: (circle one)� O�YNER OR CONTR.ACTOR� �� � . . - � _
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JOB SITE ADDRESS: � �-}�C L.1 �v t,� '� �c,,,c.�. ZIP: =. 3 :�(�;��
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� NAME OF OWNER: t�,��� C• -.r t� a. �.. � PHOYE: (home) ,_�� i - � e� , �: �
(work)
b�ILING ADDRFSS: � � . CTTY: ZIP:
CON'TRA.CTOR: C .. ,�t 2��fi ��Lf��,s��:_�-,.i-r�—PHO�tE• �{�I �.-� �i S,
CONTACT PERSON: � '�,rY� ��-r�� ,���1, � �MOBILE/PAGER: ��=;o - �}3 7�
MAII�ING A.DDRE.SS: ���:� � ��,�.�.;�� ��<,.Y�� CIZ'Y: ��:�,� . �.��� � ZI�': ��-����,.
STATE LICENSE: # S�1 i �1 .
AF.CHIT'ECT/EI�'GINEER: `.�" PH0�1E: �
NIAILIl�IG ADDRESS: / �.. � CITY: � � ZIP: � �
NA�ZE; REGISTRATION#
TYPE OF tiVORb'.: New Addition Accessory Structure
Move � � Remodel/Alteration Land Alteration�_
PROPOSED WORK(describe in detai�: `��i,-��:,�..� ( �� ���:,.��cl:�-� ,-�: �_�-� � ,�,�, -
.k \� \/ �
-l � �L.i�\ \ —.�: �.��.4.s�_.� ,
STORIES: SQ.FEET OF EACH�'LOOR: � � -
NO. OF BEDROONIS: GARAGE STALLS: ATT. DET.
. � _,
EST �MA.TED CONSTRUCTION VALUATION (excluding land): $ I S c�c� , �`
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 Ciry and with
the State Buildin� 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.
APPLICA.NT'S SIGNATURE: � t�-�z. )� . �-�r���� DATE: � -- ��; -`i 4
i
NO?'E! Parade Qf Home� events require separate permit approval by Police De,�artment and
� City Counci160 days prior to the event. Non permitted events will not be allowed.
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Sea13.0:RIGHTS OF SUBJECTS OF D?,TA .
Subd. i. Type o[data. The righcs of individual on whom[he data is score3 or to be swrd shall be as set forth ia this secaon. -
Subd.2. InFormatioa reqtrirrd to be givea indiPidual. .i.n iadividual asYed to suppiy privare or confidenaal daa eoncerning himseif shaIl
be informed of: (a)the purpose and inr_nded use of the rsquesc�dara wichin ehe collecan3 Stace agency,poliacal subdivision,or sratewide rysum;
(b)whe�her he may r_fuse or is legally rtquired to suppiy the requesud data;(c)any lrnowa coasequence arising from his supplying or refusing to supply
privam or eonndenaaI dam;ar.d(d)che ideedry of o[her persoas or enades auchocized by snce or federal taw to receive[he dam. This requiremeat s6a11
not app(y when an individual is asked to supply invesrieadve data,pursuaac to secdon 13.82,subdivision 5.to a law enforcement ofiicer. •
'Ihe comr.issioner of re�•enue nav olace the noace r_auired under this subdivision in the individuai incone nz or orooem tax refund
inscrucdons insuad of on�hose forms.
Subd.3. Accas to data by iadi.idual. Upon request to a responsible auchoriry,an individual shall be informed whether he is ehe subject `
of smrd dat�on iadividuais,and whether it is classifi:d as pubiie,private or conFdenaal. Upan his furcher request,an individual who is the subjec[
af s�ored priva�e or public dae on individuals shal!be shown che dam wichout any charge to tiim and;if he desires,shall be informed of the concenc
and meaniag of chac dara. Aher an individual has been shown the privace daca and informed of ics meaning,the dara need not be disdosed to him for
six mon�hs ehereaccer unless a d'upute or acaon pucsuan�co chis secdon is pending or addiaonal dara oa the individual has been collecmd or creaced.
The r.sponsibte auehoriry shall provide copies of the privace or pub[ic da�a upon requesc by che iadividu�l subjecc of the dara. The responsible au�horiry
may require che requesdng person to pay the actual cosu of making,cerdfying,and comp�ing the copies.
The responsible aurhoriry shall eonply immediacety,if possible,wich any tequest made pursuant to[his subdivision,or wichin five days of
the da�e of che requesc,exciuding Sacurdays,Sundays and tegal holidays,if immediace compliance is not possible. If he cannot eomply with the request
wichin[hat time,he shall so inform ehe individuai,and cnay have an addiaonal five days wicfiin which ro comply wirh the request,eccluding Saturdays,
Sundays and legal hotidays.
Subd.4. Procedure xhen data is not accurate or eomplete. M individual may contest the accurdcy or completeness of public orpri�ate
dara concerning tiu:�self. To exercise chis ri¢hc,an individuai shall noufy in wriung che responsible au�horiry describing the nature of the disagreemenc
The responsible authoriry shall wichin 30 days eicher: (a)correct the dara found ro be inaccurace or incomptete and attempc to nodfy past recipiencs of
inaccurate or incomplete daca, inciuding re:ipieats named by che individual; or(b)notify the individual thac he believes the da�a to be coacc[. Data
in dispute shall be disclosed only if the individual's sracemenc of disagreement is included wich[h:d'udoscd dan.
The dececminadon of the responsible auihoriry may be appea(ed pursuan[to the provisions of rhe adminis�aave procedure act relaang to
contested eases.
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 Ciry of Orono or any of its departments may require you to furnish certain private or
confideatial information. "
You ue notified thar.•
1. The information you fumish 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 shazed wich ocher local, state or federal a�encies to the excent necessary to process
' the permit or license.
4. If your requested permit or license requires Council actlbn to approve, some information maq b�come
public.
5. You have cenain 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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Address � � .
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Ciry Sam Zip Phone .�! �� , `f/%�'
I understand my_ri� ts az stated above. ,
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Signacure .
CHECK OFF LIST FOR ISSUANCE OF PERi1�ZITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: !�t S c� CI�+C-R R-y ��,q�• �
PID:
DESCRIPTTON OF`�'VORK: _[�rNti,,,jG w A-u.S
---------------------------
-------------------------
ZO�TIiYG REVIEti�BY: DATE APPR4VED: � - !o -4�,
BUIZDING REVIE�'� BY: - �N/A- DATE APPROVED: . .
FEES TO BE CHA�tGED: .����� �s. Ne�CaZcula ed�y:y��J
PERMIT Yes e/ j�o •
PLAN REV�W Yes No SEWER CONNECTTON
STATE SUR`H1�G c yes No '4�ATER CO�INECTION
INVESTIGAZ'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
--------------G--------------------------
ZONING CHECK LIST zoni.ng District: /flU Cf�/�N'b �
Fire Deparcment: Post Office: School District:
Lot Area: Sq.ft. Acres tiVidth Depch
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): . Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Bullding Height: Def. Hgt• Peak Hot.
0
Lot Coverage•
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: gy; • �
Zoning File: # Resolution: # Resolution Date: -
Shoreland Dis�ict: �
Avg. Setback: Bluff Setback: I.ot Coverage:
' Existing Proposed �
Hardcover: 0-75'
75-250' . . �
250-500' . .
500-1000'
. Hardcover Vaziance Required: Yes No Date of Council Approval:
. �
REI�ZA.RKS (in house):
� - .. . �
. .�, _26 .
BUII,DING REVIEW CFiECK LIST ' .
�C' CONSTRUCTTON TYPE: '
� Sq Footaae $ Per Sq Ft�
Basement X
lst Floor - � z � � _ .
���� 2nd Floor . .. . . . : x _ :
Garaje X .
x
TOTAL
Estimated Construction Value: $ �
-- Inspections Required: � Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footin; Septic Sewer Connection "
Framin� Fireplace Lawn Irrigation
Insulation (Masonry) Ocher
Wall Board (11�If�.) Well (State Permit)
—�O her Gradin�lFilIin� Electrical (State Permit)
-------------------
REitiZARKS (IN HOUSE): . .- "�"�`-------
------------------------DATE
-----------------
REVIE'�V BY OTHERS: -------------------
Access: Eustin� Ne�v �
• Access Approval: Date •
By:
REMA.RKS (TO BE NOTED ON PER1tiIIT): �`-`�___ _____�____ __�� _
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; � SITE PLAN � GR.ADlNG PLAN '
[�APPROVED
I ❑ APPR�V�D W1TH REVlSIO�i�1S
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DATE TIME
CITY OF ORONO CALLED IN ���
INSPECTION NOTICE ��1 SCHEDULED ��
PERMIT NO. �� � COMPLETED it _G��
ADDRESS /r'y�� r�;�2"���"--�• c
OWNER�� CONTR.; <<.�
TELEPHONENO. '� �-Z' ����
� DESCRIPTION 1� " -�'��" -�� �.-i.i.�-�-�
�
l� 01 FOOTING 11 MECHA L RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 NL��D 12 WATER HOOK-UP 17 SITE INSPECTION
FINAL 14 SEWER HOOK-UP O6 PROGRESS
� MO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. G PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins tion 24 hours in advance.473-73�J7
OwnedContra t�-site:
inspector. � �`�`
White Copyllnspector's File Canary CopylSite Notice