HomeMy WebLinkAbout1999-011562 - inground pool ERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: ' ''' `" °
E Crystal Bay, Minnesota 55323 . _ �. _ _-.-
(612) 473-7357 Date Issued: _ �_ _ _
SITE ADDRESS: �
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: — F;�=�w�� i ���.�;�: — OWNER:
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APPLI ANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ ��5. C7�7 Date Received: ,G�� i� ��i� i
Ente�r.ed By: ,('�i • Permit#: // ��
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review w-ill be started.
(please print all information) __ .._ .-. ,_..__...�.,4
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THE A.PPLICAI�"I' IS: (circle one) Oti�NER OIt�ONTRACTO�R�'"J�
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l>:: �. �r�: :. . ;� ��.�-��.f.�, ZIP: � % • �
JOB SIT'E ADDRESS: `
/_� �ri ,:�, t � ,`,.. t ,. f,. (i '..�. �� �1 lJ
� ••� A.� j.,. LJ .�• �
NAN1E OF �ti�'ER: f- i:' � 7 �;;;.,r PHONE: (home) `
e:.--,
(work)� _ `�� .' �1,� �'���
1�IAII�ING ADDF.ESS: . `� y,.�''. CTTY: t� �-.: 4� r�. ,.:;� ZIP: S { �'��
' � �' ,r _ ,. �`' J _ '}`�^ ,f - L`;,� ' �... ``�
CONTRACTOR: � `�°�'�t` ` -' PHONE• �� .? L ' ...�
COiv'TACT PERSON: j� � �' r IYiOBLLE/PAGER: 6 � 1 - � "r �� � '' � �
MAII,Ltii'G ADDRESS• G� -: �i r ; .. �,� .�.�i.. CITY• /;�� ' , ZIP. ; �; '�' .�, .�
STATE LICE�'SE: # � -''
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ARCHIT'ECT/EI\'GItii 7EER: PHO�'E:
MAII.I�'G ADDRESS: CIT'Y: ZIP:
�T�,ME: REGISTRATION�
TYPE OF WORK: New f�, Addition Accessory Structure
Move Remodel/Alteration Land Alteration
�
PROPOSED'4VORb'(describe in detain: �- ���0 �� �� �` � '�k` �`- '' f
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. �ET. �,
�Z / cz �; �
ESTIi�iATED CONSTRUCTION VALUATION (excluding land): $ � �
I hereby apply for a building permit a.nd I acknowled�e that the information above is complete and
accurate; that the work will be in conforailance with � ordinances and codes of the City and wich
the State Build�n� Code; that I understa�d this is ntt �. permit and work is not to start withou a
permit; and th�� the work will be in acc' r e�e' i�Y�,l`the approved plan.
I �� L� � �� �%
APPLICA��T'T'S SIGNATURE: ` ��` Dr�'TE: '
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. �
Sec.13.04 RIGHTS OF SUBJECTS OF DaTa '
Subd. 1. Type of daca. The righ�s of individual on whom[he dara is scored or to be scoced shall be as set for�h in chis secaon.
Subd.2. Iatormation reqirired to be given iadiridual. An individual asked to supply private or confidearial dara conccrning himself shall
be infor¢:ed o,`: (a)the purpost and intended use oE the requuced dara withia the eollecdng�tate ageaty,polidcai subdivision,or sratewide rysum;
(b)whe�er he may rtfuse or is.legally requir_d to suppiy[he rquesc:d data;(c)any laiown coasequeace arising from his supplying or refusing to supp[y
privace or connder.dai daa;and(d)[�e ideaary of o�herpeaoas orenddes autrorized by sca�e or fede�l law to rnceive t�e data. 'Ihis requ'uemeat shall
noc appty when an ir.dividua!is asked co supply invesdgadve daa,pursuanc ro seccon 13.82,subdivision 5, to a(aw enfo�cemenc officer.
'[�e_cernmissioner oF revenue mav viace che nodc- rauird und-r this subdivision in che individual income rax or orooem taz refurd
instrucdons inscead of on those forms.
Subd.3. ?.ccess to data by individuaI. Upon requesc to a responsibie authority,an individual shall be informed whtther he is che subject
of stor:d dara on individuais,and whether it is classiFi:d as public, private oc confidendal. Upon his further rquest,an individual who is th:subjecc
o(stored private or public dara on individuals shall be shown[he dara wichout any charge to him and;if he desires, shall be informed of the coaten�
and meaning of that data. After an individual has been shown the privac:dan and informed of ic�mcaning,the data need noc be disclosed to him for
siz monchs thereafter uniess a dispute or acrion pursuanc to this secdon is pending or addidoaal data on the individual has been collecud or erear_d.
The responsible au[horiry shall provida copies of�he privac�or public data upon request by the individual subject of[he data. The tesponsible authociry
may require �he requesring person to pay ehe accual cosu oi ma]cing,cerrifying,and compiling the copies.
The responsible authoriry shalt comply immediately, if possibie,wi�h any tequest made pursuant to this subdivision,or wichin five days of
the date of�he cequest,excluding Sacurdays,Sundays and legal holidays,if immedia�e compliance is not possible. If he canaot comply with the tequesc
wi[hin that ame,he shall so inform the individual,and may have an addi¢oaal five days wichin which to comply wi[h the request,ezcluding Sacurdays,
Sundays and lagal holidays.
Subd.4. Procedure whea data ts not accurate or complete. An individual may contest cha accuracy or completeness of public orpri�•ate
dara conceming himself. To exercise this right,an individual shall nodFy in wridng che responsible au�horiry dtscribing the nature of the disagreemeac.
� The responsible au�horiry shall within 30 days eitt:er: (a)correct[ha data found to be inaccurate or incomptece and aaempc to nodfy pasc recipiencs of
inaccurate or incompte�e data, including cecipien�s named by che individual; or(b)nodfy the individual that he believes the data to be correcc. Data
in dispuce shall be disclosed only if the individual's statcmen�of disagreement is included with�h:disclosed data.
The decerminaaon of che responsibla auchoriry may be appealed pursuant to the provisions of chz adminis�arive procedure act relaang to
contested cases. -
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Ri;hts of subjeccs of data", we would like to inform you tha[your request
for a permit or license from the Ciry 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 Ciry deny the permit or license.
3. The information may be shazed wi�h ocher local, state or federal agencies to the ettent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
S. You have certain ri�hts under M.S. 13.04 (available upon request) to review priva[e data on yourself.
6. Your full name is required to process chis application or permit.
Firsc �fiddle L.asc
Addcess
Ciry i Sace Zip Phone
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I underst d y s as stated above.
1 i��/) .
Signanire
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CHECK OFF LIST FOR ISSUANCE OF PERl�1ITS
. FOR OFFICE USE ONLY
� ADDRESS OR LEGAL: j `�� � un �� ��v_��. �..
PID:
DESCRIPT'ION OF WORK: �s �.��,�: o -
ZOr'Pi TG RE'VIE`V BY: DATE APPROVED: G � �c� -�i/
BUILDI�i tG REVIEW BY: DATE APPROVED: � •�b •� y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓' No
PLAN REVIEW Yes �' No SEWER CONNECITON
STATE SURCHARGE Yes r% No WATER CONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZOIVIVG CH�CK LIST Zoning District:
Fire Depar[ment: �'� Post Office: .���> J�� School District: Z. � �� C��/vt�_
Lo[Area: Sq.ftJU Acres T Width �Q�h./ �- Depth ' e� ��
Survey Submitted: Yes_� No Date of Survey: pn.l �'((,�.3`
Proposed Setbacks: � �
Front (Lake): Right Side:
/ � -1
Rear(Street): �J Left Side: --
a�'' � �
Adjacent Structures: � Wetland:
Building Height: Def. Hgt. � Peak Hgt. /V �
Lot Coverage: /�1 ( ('
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: ��
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No� Date of Council Approval:
RENIA.RKS (in house):
7
BUII�DING REV�W CHECK LIST
�C: � �N�'�—CONSTRUCTIONTYPE: �n/�,2
Sq Footage $Per Sq Ftg
Basement h =
lst Floor x =
2nd Floor x =
Garage R =
z —
TOTAL
Estimated Construction Value: $� (� ' ��
Inspections Required: Work Requiring Separate Permits:
S ite Plumbing Fire
�Hardcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
�F�� Grading/Filling �Electrical (State Permit)
Other
REMARKS(IN HOUSE): .
REVIE`V BY OTHERS: LA l�:
Access: Existing New
Access Approval: Date gy;
RENIARKS (TO BE NOTED ON PE12ivII1�:
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CITY OF ORONO CALLED IN �D�E/ �� ��� �
INSPECTION NOTI�C-�� . �scHE�u�Eo �
PERMIT NO. ��:J �� COMPLETED �_��"
ADDRESS � 'C�/ C�E� �
�L �/„�.-t4:-- CONTR. l��n�ai �`�" -,
OWNER �' �in ,
TELEPHONE NO. � �' e " �' � C 3
� D AN
�
01 FO &' 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
Z04 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO �
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�f�l WORKSATISFACTORY:PROCEED C PROJECTCOMPLETE
W O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
Q ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. �- pHOTO TAKEN
INSPECTOR WILL RETURN
r CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins ection 24 hours in advance.473-7357
Owner/Contra r n sit '�
inspector. � ��
White Copyllnspector's File Canary CopylSite Notice