HomeMy WebLinkAbout1999-011251 - finish basement PERMIT
CITY OF ORONO PERMIT TYPE:
! 2750 Kelley Parkway- P.O. Box 66 - _ ±�.�.�'�`w;:
Crystal Bay, Minnesota 55323 Permit Number: - i
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(612)473-7357 Date Issued: - -�- � -::w ,
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SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: - r;�=L:l < <�:._:}. - _ . . !�.�: .OWNER:
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APPLICANT'PE ITEE SIGNATURE ISSUED BY:SIGNATURE �
Total Fee: $ ���� � "=� T Date Received:
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Entered By: �( Pernait#: j/��j j
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CITY OF ORONO - BUII�DING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICAI�'T IS: (circle one) OWNER OR (�ONTRACTO�,i'
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JOB SITE ADDRESS: i ��� �� � � l. I�� �. Z�: � 5��,
�=�t7� _'i �� l� Z ����-���j ��'E:��
� I �Q/!�!c PHONE: ome �` ` .� ����
NAl�iE OF OWNER: � I`�(,�� d � � � )
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NIAILING ADDRESS: /�t� �� �--Ei�� �fi CITY: ;"1,`_;� �,-,'� ZIP: �� '�
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CONTRACTOR: ��l Gir� � '�"lC� PHONE: ���,� � � l
CONTACT PERSOti': 's!�..- '� MOBILE/PAGER: �.�L - �? ;`/ Z _
MAILING ADDRESS: � � % '�� �+-� CITY: i;l%�i''u�, ZIP: �5 'i (
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STATE LICENSE: #� (9(i�,��� �
ARCHIT'ECT/ENGIl�TEER: PH0�1E:
MAILING ADDRESS: CITY: ZIP:
N�,�; REGISTRATION#
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(��'�'�,r�?f �[ 1 i/1� 1�-,
TYPE OF WORK: New _�`�_ Addition Accessory Structure
Move Remodel/Alteration Land Alteration
I � ,/�_ , { �'
PROPOSED WORK (describe in detain: VV U�� � ����I�E -K� �'��(i�'� I e `��i��
,
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STORIES: � , SQ. FEET OF EACH FLOOR: -��� � '�� S�l
NO. OF BEDROO�ZS: �-j' GARAGE STALL S: A T T. �_ DET.
�1 � �
ESTIvi IATED CONSTRUCTION VALUATION (excluding land): $ ���; �C i^_______
I hereby apply for a buildinJ 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
pernut; and that the work will be in acc,ordance with the approved plan.
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APPLICANT'S SIGNATURE: �''��'/��� DATF.: ^ ``7v�
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NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLJETECTS OF D?�Ta
Subd. 1. Type of data. The righcs of individual on whom[he data is stored or ro be storcd shall be as set forth in[his secaon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confideariai daca conceming himself shall
be informcd of: (a) che purpose and inr�nded use of che requesxed dara wichin the collecang'stace ageocy,polidcal subdivision,or sratewide rystem;
(b)whe�:er he may refuse or is legally required co suppiy ehe requesced data;(c)any Imown coasequeace arising from tiis supplying or refusing to supply
privace or confidenaal data;and(d)the idenary of o�her persoas or endaes au�horized by sc�te or federal law to receive[he data. This requiremenc shall
not apply when an individuai is asked to supply inveso¢arive dam,pursuaa�to secdon 13.82, subdivision 5, co a law enforcemeat ofFicer.
"Iha comrrussioner of revenu- nav ola�� che nodc- rauirod under this subdivision in [he individual income_rax or orooem taz refund
instructions ins�:ad of on chose forms.
Subd. 3. ?.ccess to data by individual. Upon request to a cesponsible aurhoriry,an individual shall be informed whzther he is the subject
of scored dara on individuals,and whecher it is classified as public, private or confidenrial. Upon his further request, an individual who is the subject
of stored privace or public dara on individuals shall be shown�he dara wichout any chargo to him and, if he desires, shall be informed of the concent
ar.d meaning of chat dan. Afcer an individual has been shown�e private data and informzd of ics meaning, rhe dara need not be disclosed to him for
siz monchs chereafcer unless a dispute or accion pursuanc co �his secdon is pznding or addidooal data on the individual 6as been coliecced or creaced.
Tne res�onsibic au�horiry shall provide copies of the private or public data upon reques�by the individual subject of the data. The responsible authoriry
may require [he requesdng person to pay the accual coscs of makin2, cerrifying,and compiling[be copies.
'The responsible auchoriry shall comply immediacely, if possible, wich any request made pursuant to this subdivision,or within five days of
the da[e of che reques�,ezcluding Sacurdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the requesc
wichin rhac dme,he shall so inform[he individual,and may have an additioaal five days within which to comply wich the request,excluding Sacurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest[he accuracy or completeness of public or private
data concerning himself. To exercise chis right,an individual shall nodfy in wridng the responsible au�horiry describing the nature of the disagreement.
The responsible authoriry shalt within 30 days either: (a)correct ehz data found to be inaccucate or incomplece and attempc to nodfy pasc recipienu of
inaccurate or incomplece data, including recipien�s named by rhz individual; or(b)notify the individual that he believes the data to be correcc. Data
in dispuce shall be disclosed only if[he individual's statzmenc of disagreement is included wi[h the disclosed data.
The decerminaoon of the responsible aurhoriry may be appealed pursuant to the provisions of the adaunistrarive procedure act relacing to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�.hts of subjects of data", we would like to inform you tha[your request
for a pernut or license from the City of Orono or any of its deparcments 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 wich ocher local, state or federal a�encies to the ex[ent necessary to process
the pernut or license.
4. If your requested perm.it 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 process this application or permit.
Firsc �tiddla Lasc
Address
Ci�, Srate Zip Ptione
I underscand my ri�s as stated above.
�;�/�i�i?�____.-�_""
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Signamre
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. CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: `r'�„�
C�r�-�-=f�-.< i C�' 1 �
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PID: . ; . �� _� ..3 �,_3 L,c� � -�
DESCRIPTION OF WORK: (,'_���.5��i1l-t"r)� f=„�, s /t - --
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Z0�1ING REVIEW BY: DATE APPROVED:
BUILDING REVIEW BY: (,�� DATE APPROVED:
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes � No SEWER CONNECTTON
STATE SURCHARGE Yes X No WATER CONNECTION
�
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CH�CK LIST Zoning District:
Fire Department: Post O�ce: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. 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: 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):
7
.
.
BUILDING REVIEW CHECK LIST
�
�C� �� ��-' CONSTRUCTION TYPE: �tv�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x —
Garage x —
R =
TOTAL
Estimated Construction Value: $ �'(�, Q Q(�
Inspections Required: �Vork Requiring Separate Permits:
Site _�Plumbing Fire
Hardcover Removal ��chanical Water Connection
Footing ` Septic Sewer Connection
Framing �Fireplace Lawn Inigation
�Insulation (Masonry) Other
� Wall Board (Mfg.) Well (State Permit)
�Final Grading/Filling '� Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIE`V BY OTHERS: DAT'E:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERI�II�:
8
DATE G, pTIME
CITY OF ORONO CALLED IN ����'�� o' 'Zv
INSPECTION N T CE SCHEDULED ---x� ��
PERMIT NO. S� COMPLETE
ADDRESS n C '7x-� � �-�-��
OWNER -�'��'� �--CONTR. �'���
TELEPHONE NO. � �' � �-�`��
� DESCRIPTION ��'`r`��-,1.e-�-�
tL 01 � 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q ,02 FRAMING �� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q OS 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
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
Z
� COMM N S:
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d O WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
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� �CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �, pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473-73rJ7
OwnerlContractor si
Inspector. °
White Copyllnspector's File Canary CopylSite Notice
D E ��,;TIME
CITY OF ORONO CALLED IN � � - 9 %. 3 C�ar1�
INSPECTION NOTICE SCHEDULED 3_���� ���m
PERMIT NO. � � �� COMPLETED � � �
ADDRESS ' ' �
OWNER ' � �C ` CONTR. �.r�'-��e2. �'-��v
TELEPHONE NO. ���� " 7�C��
� DESCRIPTION
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q02 FFj�AdlN6�-�` 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q�LAT��= 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 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
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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��ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W
� C] CORRECT WORK&PROCEED L� ISSUE CERTIFICATE OF OCCUPANCY
O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. �-, pHOTOTAKEN
�NSPECTOR WILL REfURN
❑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
OwnerlContracto�n ite:
Inspector. G
White Copylinspector's File Canary Copy/Site Notice