HomeMy WebLinkAbout1998-010887 - fill & retaining wall � PERMIT
� CITY OF ORONO PERMIT TYPE: i s�,��., — ��-r:«—;
2750 Kelley Parkway- P.O. Box 66 = - '- -.�;-� ''"`�-
Crystal Bay, Minnesota 55323 Permit Number: i_�;�i.s�W�=;�,�`
(612) 473-7357 Date Issued: _ti:=�_:;��;:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: �' *����°� ?i==�j�{� �
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APPLI TiPERMITEE SIGNATURE ISSUED BY:SIGNATURE �
Total Fee: $ Date Received:
Entered By: ,�.�. Permit#: 1��� ,;�'� `�
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 OR CONTRACTOR
JOB SITE ADDRESS: � (�-� ������ �� ����"j�� T�1�� ZIP: ��Cj JC1 �
NAME OF OWNER: - � !��,' ���'��� PHONE: (home) � � � ��U.�-�'
(work) `J�{ I `� 'i "f
MAILING ADDRESS: ��1.�� CI1'Y: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAII.ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHOiVE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK descnbe in detai�: }'�A�j �I (� ����.ti V��l(�JI�� l,E.;�"(-L �"
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�� �i. lE'� �:� �ilN�
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 co rmance with e ordinances and codes of the City and with
the State Building Code; that I und stand this is ot a permit and work is not to start without a
permit; and that the work will be ' ac�¢rdance itli Zhe approved plan.
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APPLICANT'S SIGNATURE: '�,��l� (,�F� � DATE: �' C C�<
NOTE! Parade of Homes events require� parate permit approval by Police Department and
Ciry Counci160 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGFTTS OF SLJBJECTS OF DATA
Subd. 1. Type of data. "Ihe righcs of individual on whom the data is stored or co be stored shall be as set forth in ttus secrion.
Subd.2. Information reqirired to be given individual. An individual asked ro supply private or confidendal dara concerning himself shall
be informed of: (a)the purpose and intcnded use of the requesied dara wichin the collecang Ytate agency,poliacal subdivision,or sracewide sysum;
(b)whecher he may rcfuse oY is legaily required to supply the requesced data;(c)any fmown consequeace arisiag from his supplying or refusing to supply
privace or confidendal data;and(d)the idendry of other persoas or enades au[horized by state or federal law to receive the data. This requiremcnt s6a11
not app(y when an individual is asked to supply invesrigaave data,pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the norice reouired under this subdivision in the individual income tax or propem taz refund
instructions 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 whe�her it is classiFied as public,private or confidendal. Upon his fur[her request, an individual who is the subjecc
of stored private or public data on individuals shall be shown[he data wichout any charge to him and, if he desires, shall be informed of the content
and meaning of that data. Aher an individual has been shown[he private data and informed of iu meaning,the data need not be disclosed to him for
six months chereafter unless a dispute or action pursuanc to this secaon is pznding or addidonal data on the individual has been collected or creaced.
The responsible authoriry shall provide copies of the private or public data upon request by the individuat subject of the data. The responsible authoriry
may require[he requesdng person to pay the actual cosu of makinz,cerafying,and compiling the copies.
The responsible auchoriry shall comply immediacely,if possible, wi[h any request made punuant to this subdivision, or within five days of
the date of[he request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within chat dme,he shall so inform the individual,and may have an addidonal five days wichin 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 himseif. To exercise this righc,an individual shail noafy in wridng che responsible au[horiry describing the nacure of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempc to nodfy past recipienrs of
inaccunte or incomple[e data, including recipiencs named by the individual; or(b)nodfy the individual that he believes the data to be correcc. Data
in dispute shall be disclosed only if the individual's statemen�of disagreemenc is included with[he disclosed data.
The de[erminadon of the responsible aurhoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing 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 pernut or license from the City of Orono or any of its departments may require you to fumish 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 Ciry deny the permit or license.
3. The information may be shared with ocher 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.
j. 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 chis application or permit.
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First �tiddle Last
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Address � '
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Ciry , Stare Zip Phone
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I understand riQ s as stated �bo e.,
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Signacure
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: � I 5 C�-�C v`1 < (�G�S L
PID:
DESCRIP'TION OF WORK: r' i C_c_._ -�- ��r,�,�,�,5
------------------------------------ ---- ---------------------------�----------------------------------
ZOr�1G REVIEW BY: DATE APPROVED: (C��I `1 - `t'�
BUILDING REVIEW BY: DATE APPROVED:
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FEES TO BE CHARGED: (olC�-f)r� Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CH�CK LIST Zoning District: (�
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Sid :
Rear (Street): Left Side
Adjacent Structures: etland:
Building Heigh[: Def. Hgt. eak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Set ck: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes N Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
�C� — ' CONSTRUCTION TYPE:
Sq Footage $ Per Sq Ftg
Basement x —
lst Floor x =
2nd Floor z =
Garage x =
R =
TOTAL
Estimated Construction Value: $ Cjc f�-!���j�, (�.Qn,v��T
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
pLFinal Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
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DP,TE f TIME
CITY OF ORONO CALLED IN ���-=�d-`' �
INSPECTION NOT�I � SCHEDULED �i '� % � �
PERMIT NO. %(,L ' COMP�Eo Ll. t�
ADDRESS��/`�_ ��_4"'c c' c �-t.,�_��� �� %
OWNER .�T= CONTR.
TELEPHONE NO. � � ��.� " �- �3�
� DESCRIPTION � � �, �j'�`C=
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GFiADING/FIWNG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAi�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 2t COMPLAINT
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W 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-i1P
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v � ING FINAL 2$CEDAR SHII�GLES 36 FOUNDATION REMOVAL
WN ONTRACTOR TO MEET YOU: i �ES_NO
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d �ORK SATISFACTORY:PROCEED " PROJECT COMPLETE
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� '. CORRECT WORK&PFiOCEED : ISSUE CERTIFICATE OF OCCUPANCY
W
O C,CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cali for ihe next inspection 24 hours in advance.473-73�J7
Owner/Contractor on s' -
Inspector.
White Copyllnspector's File Canary CopylSite Notice