HomeMy WebLinkAbout1999-011535 - building PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kellea Parkway- P.O. Box 66 ;=;;..:_t[_�E T���t;
Crystal Bay, Minnesota 55323 Permit Number:
Date issued: `��� �'`''��`�
(612) 473-7357 i:}��;'�t��:',:�'�
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: -� . , ���� : �::t�-,� -
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Total Fee: $ ��'�1. $� Date Received: �p- �-���
' Entered By: _�� _ Permit#: /�/�3�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNE�3. R CONTRACTOR
�___.�-�
JOB SITE ADDRESS: .✓��� �J� c� �S ��r�ri� ZIP:
NAME OF OWNER: �t c h�t-� �� I ci?YJ Q�i 5 PHONE: (home) �S 3%�7�[,o
(work) �3 2 -3%��o
MAILLIIG ADDRESS: �`-l�'�I (�/�� � =�SJ CITY: 13ioo��n�,��,,, ZIP:�S�.3 7
�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILI�i 1G ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WOItK: New _� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: ��� � � Z S�Q Y��'ic S �tvC
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � npp�Qo
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 pernut and work is not to start without a
permit; and that the work will be in accordance with't� approved plan.
„
APPLICANT'S SIGNATURE: i "tI-(� " '�✓ DAT'E: �;� '�l�
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
5
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights 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 confidential data concerning hunself
shall be informed of: (a)ihe purpose and intended use of the requested data within the collecdng state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidential data;and(d)the idenury of other persons or entities 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
enforceme�t officer.
The commissioner of revenue mav olace the notice rectuired under this subdivision in the individuai income tax or oro�ertv tax 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 whether it is classified as public,private or conf'idential. Upon his further 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 thereafter unless a dispute or action pursuant to this secdon is pending or additional data on the individua]has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority 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 time, he shall so inform the individual,and may have an additional five days within which to comply with the request,
excluding Saturdays,Sundays and lega(holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private dara concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)noafy the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 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 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.
First Middle Last
Address
C��y State Zip Phone
I understand my rights as stated above.
� `�iv� f, "
� .l [.(`/�✓� ` i �./'l1_1 —
Signature
6
�
, CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2'�Q �l b ��,
PID:
DESCRIPTION OF WORK: SN-c�`�'�
---------------------------------------------- ----------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: 6 • I S -g y
BUILDING REVIEW BY: DATE APPROVED: 6 v s -S 5
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERI�IIT Yes �/ No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes �� No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONIl�'G CHECK LIST Zoning District: R-S
Fire Department: L.,� L�-,�,�; Post Office: �xs�w School District:
.��__�
Lot Area: Sq.ft. ,�i,� Cl�a Acres — Width — Depth -
Survey Submitted: Yes_� No Date of Survey: p�, -�,(Jt
Proposed Setbacks: �
Front (Lake): I �5 � Right Side: 3 S -�
Rear (Street): 5"a` i= Left Side: 6° ` �
Adjacent Structures: N/!'� Wetland: —
Building Height: Def. Hgt. ���L-- Peal: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 Setback: I.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
M .
BUILDING REVIEW CHECK LIST
UBC: �) - ( CONSTRUCTION TYPE: V�"�
Sq Footage $Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 4� ��t��,
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
�g Septic Sewer Connection
Framing Fireplace . Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
� Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
------------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------------------------------------------------
REMARKS (TO BE NOTED ON PERMI�:
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DATE TIME
CITY OF ORONO CALLED W �
INSPECTION NOTICE SCHEDULED � � � �
PERMIT N0. � C PLETED � 4 � � ���
,
ADDRESS �� ���
:��� ��
OWNERIv��, ��+�v'� ' �'�r.�t��c.c CONTR.
TELEPHONE NO. CY'�� - ��-�G�
� DESCRIPTION _,,���ac��� ��
l� 01 FOOTING 11 M HANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 L 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
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 1 BING FINAL 36 FOUNDATION/REMOVAL
OWNERI�CONTRACTOR TO MEET YOU: ES_NO
� OMMENTS:
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d �WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
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� ❑ CORRECT WORK 8 PROCEED ❑ 13SUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. G PHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR I�CITATION ISSUED
❑ INSPECTIONREQUIRED.CAILTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contractor on site:
Inspector. �`� G�-d`�- �C� ►/1 /
White Copyllnspector's File Canary CopylSite Notice