HomeMy WebLinkAbout1998-010226 - new residence PERMIT
CITY �F ORONO PERMIT TYPE:
27„50 Kelley Parkway- P.O. Box 66 �,�;j�,i i�t:i��
Crystal Bay, Minnesota 55323 Permit Number: _a i i;�.���:i'=�
(612) 473-7357 Date Issued: �?��:-:i,�;�:�:_
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: — ��v:��I ��.���;{. — _:� . L I t: . OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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, Total Fee: $ � � �' ` Date Received: -.5��, /� �'
Entered By: '�� Permit#: i'� � <�k=
CITY OF ORONO - BUILDING PERMIT 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 O CONTRACTOR
JOB SITE ADDRESS: 3S G�ys�c- �R-k- ZIP:
NAME OF OWNER: 5-�-,��,`, � ��•�`, �Cu�+`.�.a2 PHONE: (home) qa� - o�A7
(work) 3 3 0- o<18 3
MAILING ADDRESS: ,�'t<t q `�a.a�a s 9�2 CITY: �.�� ZIP: �A�
CONTRACTOR: �,N�,��5 cZ.,�c,N� ��� PHONE: �i 3'�- So Sv
CONTACT PERSON: �H�,2L.�� cAo.nc�5 MOBILE/PAGER:
MAILING ADDRESS: 1l.�9•�+S .y�2.o..�woo�o GZ' CITY: �� ��,t�2a.`ZIP: 55 3Rlo
STATE LICENSE: # '���
ARCHITECT/ENGINEER: s�n�._ �S ��aovc PHONE:
MAILING ADDRESS: 5 w��z., CITY: ZIP:
NAME: S n���`. REGISTRATION#
TYPE OF WORK: New r/ Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: c�s-r�,,,�z-�o� oc= 5��G.�... ������•-*
�-Lo�ti�,
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: 1.� GARAGE STALLS: ATT. � DET.
-�- � F�'�v�;. l��...�rL, �-�.�.s.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 4@O, ooc7 •� �
�vv'f.s.� �� S�T�C
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 ermit and work is not to start without a
permit; and that the work will be ' accor ' th appr d plan.
G.F1 A �u < <
APPLICAI�iT'S SIGNATURE: b-t� c� �.q�,�DATE: 5 - C,9 • 9�
NOTE! Parade o Homes events require separate permit approval by Police Deparlment and
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 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 himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'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 identiry 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, [o a law enforcement officer.
The commissioner of revenue may place the no[ice required under this subdivision in the individual income tax or property 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 confidential. 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 section is pending or additional data 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 person to pay the actual costs of making, certifying, and compiling the copies.
The responsible authority shall comply immediately, if possible, with any request made pursuant[o 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 comp(y wi[h 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 private
data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry 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)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disaoreement is included with the disclosed da[a.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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.
G 4�Ac�2.�—�S Q.�G�•kAJ1.+� �b0/n.3 S
First Middle Last
\A�14 S �—�C2.o��•�oc7'� G-T
Address
��-� `�.�...�q„��. �nJ ss3aC� �3'� � SoSv
Ci�y State Zip Phone
I erst d as sta ed abov .
Signature
' CHECK OFF LIST FOR ISSUANCE OF PERNIITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �5 C2v sr��. G�Z�'�K
PID:
DESCRIPTION OF WORK: �E� �5
------------------------------------------------------------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: S - �3'4f�
BUILDING REVIEW BY: DATE APPROVED: 5•�3• S`�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �' No .
PLAN REVIEW Yes ✓' No SEWER CONNECTION
STATE SUR`�ARGL Yes �' No WATERCONNECTION
INVESTIUAZ'ION FEE 1'es No PARK FEE
SAC Ycs No SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: L/2•�/j
Fire Department: (,,c�N �Gv Post Office: (,�,r�c,(�t�tc,� School District: b cZurvp
Lot Area: Sq.ft. ��,��5���� Acres Z.-o�( �- Width 2�(`7•g Z Depth 3�S•?7 pve,
Survey Submitted: Yes �( No Date of Survey: S •Y•`lg
Proposed Setbacks:
Front (Lake): _ 5�' � Right Side: 35 �
Rear (Street): 2.35� � Left Side: 1 1� � = 5
Adjacent Structures: �/ //�.. Wetland: /V 1�4
Building Height: Def. Hgt. �o' Peak Hgt. ZS'
Lot Coverage: N ��'
Grading: Staff Approval Date: 5- � 3 - y�E By: p�a .. Council Approval Date: N/�4
Septic: Staff Approval Date: , �i/ '-�� By: �,�/
Zoning File: # — Resolution: # — Resolution Date: '"'
Shoreland Dist_�ict: �
Avg. Setback: – Bluff Setback: – L.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):
• 26
BUILDING,REVIEW CHECK LIST
UBC: R '.3 CONSTRUCTION TYPE: V�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
o�
Estimated Construction Value: $ y(�(},000 '—
Inspections Required: Work Requiring Separate Permits:
Site .� Plumbing Fire
Hardcover Removal _� Mechanical Water Connection
_� Footing �Septic Sewer Connection
_� Framing .� Fireplace oL Lawn Irrigation
_� Insulation (Masonry) Other
�_ Wall Board oL(Mfg.) �Well (State Permit)
oL Final Grading/Filling o�Electrical (State Permit)
Other
-------------------------------------------------------------------------------------------------------------------------------------------
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------------------------------------------------
REMARKS(TO BE NOTED ON PERMIT):
27
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ATE TIME
CITY OF ORONO CALLED IN `1 � � ���
INSPECTION NOTICE SCHEDULED '•
PERMIT NO. (c�Z2� COMPLETED � l�
ADDRESS �� �"�U��C',�� C:�st.�_ '��
OWNER C_h(;r.,1�S2�� ��.1�'�1Cnn�C1. CO��
TELEPHONE N0. S(o C� — '�`� '.��� -�YIYI rt t�,T_
� DESCRIPTION��S�,�C'�1 �
l� 01 FOOTING 11 MECHANICAL RI � 18 EXCAV/GRADING/FILLWG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q
03 fNSULATI 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Q
T 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� ❑WORKSATISFACTORY:PROCEED �, PROJECTCOMPLETE
�ORRECT WORK&PROCEED i.:. ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance.473-73rJ7
OwnerlContracto n site•
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� DATE _ TIME
CITY OF ORONO CALLED IN � ��� ,'S O 4�
INSPECTION NOTICE SCHEDULED ��-a 7-�� �� D /�'/
PERMIT NO. ����'� COMPLETED
�
ADDRESS
OWNER CONTR.
TELEPHONE NO. yv��— S U�� c�L
� DE TION
1 FOOTWG 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� MING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 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
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
I_1 CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR ' CITATION ISSUED
C: INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next insp ction 24 hours in advance.473-7357
OwnerlContractor�e:
Inspector. - '
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN � x/�f�"�
INSPECTION NOTICE k SCHEDULED --� �" �
PERMIT NO. � COMPLETED ���5- �• ��
ADDRESS �-5 � � �
OWNER CONTR.
TELEPHONE NO. �� 7 " 5 D -�d „E!2 �35 " 77��
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� DESCRIPTION�2D�a!''' �.� �
l� 01 F G 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 TION 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ;- pHOTO TAKEN
INSPECTOR WILL RETURN
i CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-73�J7
OwnerlContract si :
inspector.
White Copyllnspector's File Canary CopylSite Notice
Established in 1962 49398
LOT SURVEYS GOMPANY [NC. F.B.No. NO����-�.as�
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LAND SURVEYORS SCALE: 1 " = 40�
REGISTERED UNDER THE LAWS OF STATE OF MINNESOTA o Denotes iron Monument
7801 73rd Avenue North 812-580-3093 C� Denotes Wood Hub Set
Fax No. 580-9522 for excovation only
Minneapolis, Minnesota 65428 x000.0 Denotes Existing Elevation
�J u�u P��Q r� (a.e r t i f i r tt�r ODo.O Denotes Proposed Elevation
-- Denotes Surface Drainoge
CHARLES RICHARD, INC. NOTE: Proposed grades ore subject
to results of soil tests.
Property 1 ocated i n Secti on Proposed building informotion
must be checked with approved
33, Tow�Shi p 118, Range 23, building plon ond development or
Hennepi n County, Mi nnesota grading plan before excovation
and construction.
9��•� Proposed Top of Block
7��D,2- Propoaed G�age Floor
� �58,�proposed Lowest Floor
Type of Building
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io � � APPROVE�J WITH REVISlOi�S (�� -
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Lot 1, Block 1, CRYSTA� CREEK - , � �
7he only eosements shown are From plots of record or information �,� ��rZ �,/�.r/Cl f /
provided by client. r/ �' t ('(',C`�
We hereby certify that this is a true and correct representalion of
a survey of the boundories of the above described land and the
location of all buildings and visible encroochments, if any, from or on �� �� �
said lond. Signed "
Surve,yed by �S tn�s 4th d�y or MaY ts 9II. ,��,��� �,� � �g,�� Gregory R., as h Mn. reg. No. 24992