HomeMy WebLinkAbout1998-010688 - building PERMIT
� CITY OF ORONO PERMIT TYPE: - - -=;-.
2750 Kelley P`arkway- P.O. Box 66 =�_ -�='__��`_
Permit Number: i;�,�;;;_:-::=
Crystal Bay, Minnesota 55323 _ _ ; ._ _
(612) 473-7357 Date Issued: t;�:;•��r:_;i�_;
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: — �c,�=1 i�a}�t. — '_�_" . L_i�. .OWNER:
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- � APPLICANT PER EE SIGt AT� L_ --— � ISSUED BY:SIGNATU
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Total Fee: $ t r:=� .:��' Date Received:
�ntered By: ;�j, Permit#: �1��.� �S�''�
CITY OF ORONO - BUII�DING PERMIT APPLICATION
All information must be submitted in full before plan re�-iew will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
� ,.•� � .: ...,h. �
JOB SITE ADDRESS: aio!- � � ZIP:
NAME OF OWNER: Q,� PHO�TE: (home)
� (work
MAII�ING ADDRESS: /�� CITY: ZIP:
. COivTRACTOR: ��G%�� PHO\TE: �"������
CONTACT PERSON: ' MOBILE/PAG R:
MAILING ADDRESS: . CTTY�' ZIP•
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO�'E:
MAILING ADDRESS: CITY: ZIP:
NA.��: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move � Remodel/Alteration Land Alteration
PROPOSED WORK(describe i etai�: I��� �
STORIES: � ,r�Q. FEET OF EACH FLOOR:
I�TO. OF BEDROOMS: l GARAGE STALLS: ATT. T. .
ESTIMAT'ED CONSTRUCTION VALUATION (excluding lanc�: $ �`!� i��
�� �,��► v�
I hereby apply for a building permit and I ac�owledge 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 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.
,
A.PPLICANT'S SIGNA +. -�,/�, DATE: �����
__-,�
NOTE! Parade of Homes events require separate permit approval by Police DepartmenP an�
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
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Sec.13.04 RIGHTS OF SUB.TECTS 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 privau or confidential data concerning himself shall
be informed of: (a) the purpose and intended use of the requested data within the collecang�tate agency, polidcal subdivision,or statewide system;
(b)whe[her he may refuse or is legally requued to supply the requested data;(c)any]mown consequence arising from his supplying or tefusing to supply
private or confidendal data;and(d)the idendty of other persoas or endaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply mves6gadve data,pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
1"he commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv taz refund
instrucrions 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 co�denrial. 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 hun and, if he desires, shall be informed of the content
and meaning of that dan. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
siz months thereafter unless a dispute or action pursuant to this secdon is pending or addiaonal dara on the individual 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 authoriry
may require the requesting penon to pay the actual costs of making,cerafying,and compiling the copies.
'I�e responsible authority shall comply immediately,if possible, with any request made pursuant to this subdivision,or wi[hin five days of
the date of the request,ezcluding Saturdays,Sundays and legal holidays,if unmediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,ezcluding Sarurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeness of public or private
data concerning himself. To exercise this right,an individual shall noafy in wriang the respoasible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and attempt to nodfy pas[recipienu of
inaccurate or incomplete data, including recipienu named by the individual; or(b)nodfy the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disa;reement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the admuustrative 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 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 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.
5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to rocess this application or ermit.
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Ficst Middle st
Address
Ciry State Zip Phone
I under t y right as tated ba .
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Signacure
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� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESSORLEGAL: 3ii: �i� _z��iL�
PID:
DESCRIP"TIOl�T OF WORK: CJ I��"a�N
---------------------------------------- - -----------------------------------------
ZONING REV�W BY: � � ..`
DATE A.PPROVED: � -2.,u —�i 4,
BUILDING REV�W BY: — �,�,,�- DATE APPROVED: a'� � -�; <;�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes J' No
PLAN REVIEW Yes i/ No SEWER CONNECTION
STATE SUR�HARGL Yes �/ No WATERCONNECTION
INVESTIGAZ'ION FEE I'es No PARK FEE
SAC Ycs No SITEINSPECTION
Number of SAC Units OTHER (specify)
Z0�1Ii�TG CHECK LIST Zonin� District: (�5
Fire Department: ���-i,:i Post Office: �z;,,�r-Q School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setba�ks:
F.Fent (Lal:e): _ f��� Right Side: 2�.1
R�ear (Street): �tY�' Left Side: sy �
Adjacent Structures: _3� Wetland: /v�� "
Building Height: Def. Hg[. CU� k— Peak Hgt. —
I,ot Coverage: (�� �
Grading: Sta2f Approval Date: rt� r f� By: Council Approval Date:
Septic: Staff Approval Date: By:
Zonin� File: n 2.3�„� Resolution: # �fi 1 J�f Resolution Date: '1-�3 ti ir�
Shoreland Dist=ict: _�'e'S
Avg. Setback: �_ �L Bluff Setback: N(/� L,ot Covera�e: v -lC
� Existing Proposed
Hardcover: 0-75'
75-250' �. �
250-500'
500-1000'
Hardcover Variance Required: Yes No ,� Date of Council Approval:
REMARKS (in house):
• 26
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BUII,DING REVIEW CHECK LIST
UBC: + ' �' CONSTRUCTION TYPE: '�iN
' Sq Footage $ Per Sq Ft;
Basement x =
lst Floor z =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ 3l)�U�:%c�,v"
Inspections Required: `Vork Requiring Separate Permits:
� Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
y� Footing � Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�.Final Grading/Filling � Electrical (State Permit)
Other
REMARKS (Pi 1 HOUSE):
-----------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
.,��-----------------------------------------------------------------------------------------------------------------
REMARKS(TO BE NOTED O\T PERMIT): �
27
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���',; , � 7�:ese cc:nme-;ts 2ra fpr your infer;�s!ion.�Ji wo:k shaii 6e done
;n i��ll cor�plisnce with aif app!icabie buil�ifng and zoning code.
,;��� Requiremen:s ircludirg ii�ms r,ot speciiically,noted in this review.
.'a���" KEEP T'riiS PLAN SE7 ON SITE AT A�.:.TlMES
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DATE TIME
CITY OF ORONO � � CALLED IN � q�4 J a+,,
INSPECTION NOTICE � SCHEDULED 9 Vl hm
PERMIT NO. o''�p��+'�' • COMPLETED � �
ADDRESS 3�� ��Ll �IaT� •
OWNER �� II �IPG�� CONTR. S�'� F�'��
TELEPHONE NO. cl �y - 1454 ,Wk.
� DESCRIPTION
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAM�NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 3 INSULATION 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
� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORKSATISFACTORY:PROCEED _; PROJECTCOMPLETE
W C CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� I7 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ,r pHOTO TAKEN
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.473-73�J7
Owner/Contract�
Inspector. �
White Copyllnspector's File Canary CopylSite Notice