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CITY OF ORONO PERMIT TYPE:
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1335 Brown Rd. South • P.O. Box 66 Permit Number: i it s���_�:�.�.
Crystal Bay, Minnesota 55323 Date Issued: - � ��- -�
(612) 473-7357 t;�f'�``�f`'�i";
SITE ADDRESS:
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CONTRACTOR: -- hF���Iicai-�t. -- OWNER:
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APPLI NT PERMITEE SIGNATURE_ I;t �i '� � �
. It CITY OF ORONO - BQILDING PSRMIT APPLIGATION
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Tota1 Fee: $ �� Date Received:
Date Approved:
Entered By:
Permit#:
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PZ�AN REVIEYi�I WII,L B$ STARTED
(See Check-off List Enclosed )
--------------------------------------------------------------------------------
THE APPLIGANT IS: (circle one) OWNER or CONTR.ACTOR
�� � �
JOB SITE ADDRESS: ��__ � .�;� l '%i.:�5��ff_i -����1� f��� ZIP:
(work)
NA1�iE OF OWNER: �,L.;-{ �� //a �r=� PHONE: (home)
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MAILING ADDRESS: �>�-.�. ; � .-�.�5��% 7�% i����/��TY: C'��C�%i.=.i� ZIP:
� , -> - _
CONTRACTOR: �,i%' E�%i�f_'_- � %_��;+ '�� PHONE: _/�,� -, ' - �
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MAILING ADDRESS :�f-�"i�' ���-��. - ;�r,��,�� �-�'� CITY:�/�f�_'�{ ZIP: ,lx���i��"
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSED WORR (describe in detail) :� i��w� ����; � �r %�.�� %
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEUROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (egcluding 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 conformance with the
ordinances and codes of the City 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 �ccordanc� with the approved plan.
,
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.APPLICANT'S SIGNATORE: !�G`rf ,�`�C, DAR'E: ( � ' l '
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� - � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike 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
qual.ification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other Iocal, state or
federal agencies to the extent necessary to process the permit or
licensee
4. If your requested permit or Iicense requires Council action
to approve, some information may become publ.ic.
5. You have certain rights under M.S. 13.04 to review privat�
data on yourself. -
6o Your full name is required to process this application or
permit.
,� , ,�`;
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� Middle Last
First �
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`;Z �_ � �,�, i;��,�� ��:���r.'1 �.' I�"
Address
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City State Zip
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< < `>
Phone
I ur�derstand ,r,�y rights as stated above.
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ignature
BUILDING&ZONING—473-7357 • ADMINISTRAT[ON&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESS[NG
�.a4 �G� Og �gJECTS OF DATA
Subdivision 1. Type of data- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Information r�d
to be given u►�v�du81' An.individual asked to
� su 1 rivate or confidentiel data concernindg �amWit�h�in the collecti g state agency,
PP Y P
purpose and intended use of the requested from his
olitical subdivision, or statewide system; (b) whether he may refuse or is legally
p 1 the requested date; (�) anY �OWn consequence arising
required to supp y riygte or confidential data; and (d) the identity of
supplying or refusing to supply p
other ersons or entities authorized by state or�e�kedlto supplyin est gat ve data,
p 1 when an individual
requirement shall not app y
pursuant to section 13.82, subdivision 5, to a law enforcement of icer. d under this
The commissioneru�income tax or Drolert tax re�und instructions instead o
subdivision in the iniivi�
on those orms. . --- -
Subd. 3. Access to data by
����, Upon request to a responsible
authority, an individual shall be informed whetbh�ec hPf vateeor confident al.e Upon his
individuals, and whether it is classified es p � ublic data on
��.ge ta him and, if he desires, shall
further request, an individusl who is the subject of stored private or
individuals shall be shown the data withou�fan�y t �ta. After an individual h8s been
�e informed of the content $nd meaning the data need not be �isclosed to
shown the private data and informed of its meening+ u�uant to this section is
him for six months thereafter unless a dispute or action p
rivate or public data upon request by
ending or additional data on the individ�e hes been collected or created. e
• p r o v i d e c o p i e s o f P r e q u i r e t h e
responsible aut hori ty s h a ll p The responsible aut hori t y m a y �in the
the individual subject of the �ta• certif n and comp g
requesting person to pay the actusl costs of malcing, Yi g'
copies. if ssible, with any request
The responsible authority shall comply immediatesYof th date of the request,
made pursuant to this subdivision, or within five �f immediate compliance is not
excluding Saturdays, Sundays and legal holideys,
ossible. If he cannot comply with the request within that time, he shall so inforth the
P have an additional five daYS Within which to comply
individuel, and may and le al holidays•
request, exeluding Saturdays, SundaYS g
te or complete. An individuel may
Subd. 4. Proced�u'e �►hen data is not a�a ivate data concerning himself. To
contest the accuracy or completeness of public or p
ht, an individuel sha.11 notify in writing the responsible authority
exercise this rig nsible authocity shall within 3 0
describing the nature of the disagreement. The respo
da either: (a) correct the data found to be iete dataeincludingreec pients namedt by
�
notify past recipients of inaccurate or incompl
the individuel, or (b) notify the individual t�'v dual's statementof disagreement i
Data in dispute shall be disclosed only if the ln �u�t to the
• included with the disclosed data. be gQpeaied p
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED -� -�� ��!'-' `"- •` �c=�
PERMIT NO. COMPLETED s'3I- �r0 /O.00
ADDRESS_--- --�__i�''� � ��'��' �
�r.t i.-- 1_�.'�----�i C`-✓•'"+ac.�
OWNER CONTR.
TELEPHONE NO.
�- FOOTING � PLUMBING RI C FIRE PREV.
��RAMING ` PLUMBING FINAL C FIRE SUPRESSION SYS.
� �':- INSULATION ❑ MECHANICALRI Ci EXCAV/GRADING/FILLING
� 1 WqLL BD. �_, MECHANICAL FINAL C LAKESHORE/WETLANDS
� C FINAL �� ���(/C/ C FIREPLACE/WOOD BURNER �TREE REMOVAL
Q [; DEMO—SITE �'�r r C WATERHOOK-UP ❑ KENNELLICENSE
� f DEMO—FINAL C METER SETITURN ON C SITE INSPECTION
� - SEWER HOOK-UP ❑ PROGRESS
_ �7 SEPTIC MAINT. C COMPLAINT
J C SEPTIC INSTALL. � FOLLOWUP
� C SEPTIC FINAL
O ❑ SITE WELL
�
� C WELLTESTPUMP
� COMMENTS:
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W ORK SATISFACTORY:PROCEED C PHOTO TAKEN
�
C' CORRECT WORK&PROCEED �_ CITATION ISSUED
Q f CORRECT WORK,CALL FOR REINSPECTION C ISSUE CERTIFICATE OF OCCUPANCY
V BEFORE COVERING TEMPORARY
C CORRECT UNSAFE CONDITION WITHIN HOURS. pERMANENT
INSPECTOR WILL RETURN
G STOP ORDER POSTED.CALL INSPECTOR
[ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContr or on '
Inspector.
White Copyllnspector's File Canary Copy/Site Notice