HomeMy WebLinkAbout2001-P03763 - minor alterations PERMIT
CITY OF ORONO
1750 Kelley Parkway - PO Box 66 Permit Number: po3�63
Crystal Bay, Minnesota 55323 Per'mit Type: �vlinorAtterations
(952) 249-4600 Date Issued: s�2�2ooi
SITE ADDRESS: 4305 Chippewa La
MAPLE PLAIN,MN 55359
P I D: 31-118-23-42-0011
DESCRIPTION:
Proposed Use: xesidentiai
Buildin Census Code 434
Permit Class: g
Permit Type: Minor Alterations Permit Sub-type(s): Building Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 44.85 Valuation: $ 1,200.00
State Surcharge Fee: $ 0.60
TOTAL FEE: $ 45.45
APPLICANT: .iim Cornick OWNER: 7 L CORNICK& D L CORNICK
MN 4305 CHIPPEWA LA
MAPLE PLAIN MI�155359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�E REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITI-I ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII,DING CODE REQUIREMENTS.
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APPLI A E IGNATURE ISSUEDBYSIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
Total Fee: $ Date Received: �� ' � '� �
� Entered By: Permit#:
CITY OF ORONO - BUILDING PERIVIIT 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: `7"J�� � (��'���C� ��Z ZIP: � .� �-5 J
NAME OF OWNER: \ �j`y� C U��/V�C� PHOivE: (home) C `� '{�?7(�
(work) Ct t�
�IAII.INGADDRESS: ��� - CITY: Z�: �S
CONTRACTOR: il/� 1� PHO�TE:
CON'TACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CI'I'Y� Z��
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO\�:
MAILING ADDRESS: CITY: Z�:
rJ�ME; REGIST'RATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration X Land Alteration
PROPOSED WORK(describe in detai�: /j���C/ /2U0 � '
OC�
STORIES: Z— SQ. FEET OF EACH FLOOR: ����
NO. OF BEDROOMS: � GARAGE STALLS: ATT.�_ DET.
d��
ESTIMATED CONSTRUCTION VALUATION (excluding land): � /,�QD
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 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.
�-
APPLICANT'S SIGNAT . DATE: ��Z —d �
NOTE! ParadeQf Homes even uire separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SL'BJECTS OF DaT,�
Subd. 1. Type of data. The rieh�s of individua!on whom the data is scor�or to be scored shall be as set for[h in this secdon.
Subd.3. Information reqirired to be given individual. An individual aske3 to supply private or confidendal data concecning himself shall
be informed of: (a)the purpose and in�ended use of the requesred dara wi�in the collecting'state agency,poliacal subdivision,or statewide rystem;
(b)whecher he may refuse or is legaily required co supply[he requesced daa:(c)any I�own consequence arising from his supplying or refusing to supply
priva�e or conndential data;and(d)the idenrity of o[her persons or enriaes aLchorized by state or federal law to receive the data. 'Ihis requiremenc s6a11
noc appty whzn an individual is asked to supply investieadve dan, pursu�^c co sectioa 13.82, subdivision 5, ro a law enforcemenc officer.
The commissioner of re�enue r�av place the norice reauired e d�r this subdivision in the individual income tax or propem tax refund
instructions insczad of on those forms.
Subd. 3. ?.ccess to data by indi�idual. Upon request to a rscoasible aec�oriry,an individual shall be informed whether he is the subject
of scored data on individuals, and whe[her it is classified as public,priva4 or confid�r.aal. Upon his further requesc, an individual who is the subject
of scor�d private or public data on individuals shall be shown[he dara wi:;.ouc any ciiarge to hun and,-if he desires, shall be informed of the concent
and meaning of[hat data. After an individual has been shown the priva��ac�and i�:ormed of ics meaning,che data need not be disclosed to him for
six mon�hs ehereafter unless a dispute or acrion pursuanc to this secrion is�ending or addidonal data on the individual has been collected or created.
The responsible auchoriry shall provide copies of the private or public data a�on reques:by the individual subject of the data. The responsible authoriry
may require[he requescing person to pay the actual cosu of makine,cer�:ing, and compiling the copies.
The responsible authoriry shal(comply immediately, if possib!e. wich any r_quest made punuant to this subdivision,or within five days of
the date of the reques�,exciuding Saturdays,Sundays and legal holidays,it immediate compliance is noc pos5ible. If he cannot comply with the request
wi�hin thac dme,he shall so inform che individual,and may have an addiaor.al five days within which to comply wirh the request,exciuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or pri��ate
data concerning himseif. To exercise this rieht,an individual shall norify iZ wridng 4::responsible authoriry describing�he na[ure of the disagreement.
The responsible au�horiry shall within 30 days either: (a)correct[he dae tcund to be inaccucate or incomplece and attempc to nodfy past recipienes of
inaccucate or incomplete data, including recipients named by che individL�I; or(b) r_orify the individual thac he believes the data to be correct. Data
in dispuce shall be disclosed only if the individual's stacement of disagre��enc is L.c:nded with the disclosed data.
The de�erminarion of the rtsponsible authoriry may be appea�:�pursuan:to the provisions of che administrarive procedure act reladng to
concested cases.
DAT� PRIV�CY AD�ZSORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your reauest
for a permit or license from the City of Orono or any of irs deparments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to de:ermine ��our qualification for the permit or license requested.
2. You may refuse to supply data, but refusal nay require that the Ciry deny the pemut or license.
3, The information may be shared with o[her loc�l, state or federal a�encies 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.
�. 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 perm.ic.
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First ,�+�, ; �fiddle Lasc
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Addres � �r �'V �� ��CJ �I � � �� l � ��"
Ciry � State Zip Phone
I under and my rights as stated above.
Sign
T TIME.
CITY OF ORONO CALLED IN �� � ��
INSPECTION NOTICE SCHEDULED _f � / �
PERMIT NO. �('�� "7�3 COMPLETED
ADDRESS 3C> j /�-<!��-��� l.
OWNER CONTR. ___��.�
TELEPHONE NO. U���� ��a" ��—07��
� DESCRIPTION ���''� � � ��
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FR,4MING 13 MECHANICAL FINAL 19 LAKESHOREIWETLANDS
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O 03 INSULATIGN 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPL4INT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOHTOMEETYOU:_YES_NO
� C I�AM NTS:
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W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W L�C RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITNIN HOURS. p pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site:
Inspector.�C1�� ����
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO CE r SCHEDULED ���
PERMIT NO. COMPLETED — "�� �' S - / `�
ADDRESS y�O� G� c%>�� �✓G'i LG-/� �
OWNER /C-�J/�/1 i K CONTR. h w- O u%G�r'
TELEPHONE NO. �� I�
� DESCRIPTION �'r �1 �'•c/I
� 01 FOOTING 11 MECHANICAL RI 18 EXCA�I/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
� 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �`�VORK SATISFACTORY:PROCEED �ROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-4600
OwnerlContractpr on site:
i
Inspector.T�/��'���C-�—%
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White Copyllnspector's File Canary Copy/Site Notice