HomeMy WebLinkAbout1993-005774 - remodel interior . PEI�MIT T
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CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: '``-'= ' � ` � ' �-
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Orono, Minnesota 55356-0815 °-'`-'`�' '`�
(612) 473-7357 Date Issued: � ; .;..;,; ,:,_ -_,
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SITE ADDRESS:
DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: OWNER: - �"�:��x.:;. :� - -=t. --
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APPLICANTi RMITEE SIG ATURE ISSUED BY SIGNATURE
CITY OF ORONO — BUILn1NG �ERMIT A.PPLICATION
i
Total Fee• $ �l C�� S ' `1�-� Date Received: // ��-��
� Date Approved:
Entered By:_�> ' /
Permit�: � ��`�
ALZ INFORMATION MIIST BE SDBMITT� IN FDLL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circie one) OWNER or CONTRACTOR
' '`I �"._� - ,g''.., „ � j %° �f�(�,-�`� ZIP:
JOB SITE ADDRSSS� �
(work)
NAME OF OWNER: F � � v �;�=c �f '��'` •C PHONE: (home)�Sr ;'_ �', � �`�-
MATLING ADDRESS: I� 4 � �'I r:�. ' '. CITY:�i-+ tiGY�:-'i`-`a ' ".- ZIP: � .. �; -�' �
/ ;
CONTRAC'1'OR: � � J �J �'�°'^ �.�+=j�� �- PHONS:
�iAILING ADDR$SS: ^"' :��v �/, '' et., ' 'r�:� CIZ'Y:��i /��> (cyY"..-'' . . ZIP: �i� .:�� ��
STATS LICENSE: �
ARCHITECT/ENGIN�: � . PHONE:
MATLING ADDRBSS: CITY: ZIP:
g�� R.BGISTRATION ,ar
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate ,� Land Alteration
f !
;_ .,.._
PROPOSF.D WOR.R (describe in detail) : - ( . � :'.�'F
STORI$S: SQ. FEET OF EACH FI,OOR:
NO. OF BSDROOMS:_� GARAGE STAIaLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding Iand) : $ ��,+���` �
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 wil 1 be in accordance with the approved plan. ,
; � � fi �� �'` � . ,
APPLICANT'S SIGNATIIRE s `� ,' � �- ,-r`,.�' .*�`._ ... • DATE:��— ,'',� -� '�.✓
r
� CHECR OFF LIST F�R ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRRSS OR LEGAL: ��13 C•R'115�¢L �la4GL- �'ID=
DESCRIPTION OF WORR: f��'�'t'O���- � SN��� � ONC.�
--------------------------
----------�-----
ZONING REVIEW BY' N��/4' DATE APPROVED: 1/• Z 3'S3
.
BIIILDING REVIEW BY: � 1.��"'�- DAT$ APPROVED: /�` Z3'S ?J
----------------- - ------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �No
PLAN REVIEW Yes ✓�No SEWER CONNECTION
STATE SURCHARGE Yes �No WATER CONNECTION
INVESTIGATION FEE Yes No v�" PARK FEE
SAC Yes No �� SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------------------
ZONING CHECR LIST Zon ng District:
Fire Depar ent:
ost Office c ool. District:
Lot Area: Wi th: Dep h:
Survey Sub itt d: Yes o Date of Survey:
Proposed S tba s:
Front (Lak ) : Rig t Side:
Rear (Stree ) : Lef Side:
Adja ent Str ctures: Wetl nd:
BuiJ.ding eight: ef . Hg . P k Hgt.
Avg. Setb ck: Lot Cove age:
Existi g Propo ed
Hardcove : 0-75 '
75-250 '
50-500 '
5 0-1000 '
Hardcove Variance Req ' re : Ye N Date of Council pproval:
Grading: Staff Approval Da e: By: Council Appr vaJ. Date:
Septic: taff Approval. D t : BY=
Zoning F le:# solut on #: Resol.ution D te:
REMARRS (in house) :
BQILDING REVIEW CHECR LIST . • �
IIgC: � (L'3 CONSTRQCTION TYPE: �A-
Sq Footage $ Per Sg Ftg
Basement x -
lst Floor x -
2nd Floor x -
Garage x -
X -
TOTAL
00
Estimated Construction Value: $ �,0 00
Inspections Reqnired: Work Requiring Separate Permits:
� Site �Plumbing Grading/Filling
�Footing �Mechanical Fire
_�Framing Septic Water Connection
oCInsu�ation Fireplace Sewer Connection
_�cWa�l Board (Masonry) Lawn Irrigation
_�Final (Mfg.) Other
Other Well. (State Permit)
p� Electrical. (State Permit)
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REMARRS (IN HOIISE) :
-------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------•
REMARRS (TO BE NOTED ON PERMIT) :
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����� ¢�� C ITY of ORONO
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Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� - � � 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 like to inform you that your request for a permit or
Iicense 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 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
federa.I agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii. actian
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 �o review pri�a��
data on yourself.
6. Yaur full name is required to process this applicatian or
permit.
f � s',., ''\
1 �N s, , ; 4,.- yJ f""� , `--''- ,�- /i °}""�,,� ,�'r
irst Midd e Last
���� �� e��� ""..✓�� ,�� �
Address
+°I ��� �° ' �, ,;'.ti i�:. � / �✓ �;� S�'..���� !
City State Zip
�,�„,�-� 'f' �'"�* ��t �""".
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Phone
I understand my rights as stated above.
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S gnature �
BUILDING&ZON[NG-473-7357 • ADMINISTRATION&FINAVCE -473-7358 • PUBLIC WORKS-473-7359
ASSESSING
_.__ ------- - �
�.p,4 RIGfl'TS OF SIIB.7ECTS OF DATA
Subdivision L 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 �d t� � ��� ����" An.individual asked to
� supply private or confidentiel data concera agtam 1 hin the c�llect g state agency,
purpose and intended use of the request
(b) whether he ma� refuse or is legally
political subdivision, or statewide syste�c� gny �own consequence arising from his
required to supply the requested date;
supplying or refusing to supQly private or confidentiel data; and (d) the identity o
other persons or entities authorized by state or federal law to receive the data. This_
1 when an individual is asked to supply investigative data,
requirement shall not app y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individual income tax or property tax re und instructions instead o
on those orms. . - -- - -
Subd. 3.
Access to �a.ta by in�viduel• UPon request to e responsible "
authority, an individuel shall be informed whether h=�gteeor confident al.e Upon his
individuels, and whether it is classified as public, p ublic data on
further request, an individusl who is the subject of e to�mrl�ae if he desires, shell
individuels shall be shown the data withou�t anh ��ta. After an individual has been
�e informed of the content and meaning the data need not be disclosed to
shown the private data and informed of its u���action pursuant to this section is
him for six months thereafter unless a �sp
, � pending or additional data on the individ�h h� gte or p blic datarupon request by
responsible authority shall provide copies of p require the
the individuel subject of the data. The responsibl cert f �nity and compiling the
erson to the actual costs of making, Yl g'
requesting p P8Y -
copies. immediately, if possible, with any request
The responsible authority shall comply
made pursuant to this subdivision, or with lida e �f Simmediateg compliance eisu not
excluding Saturdays, Sundays and legal Ys�
possible. If he cannot comply with the requese �t�withintwhich toh omP1Yn'"J�h the
individuel, and may have ar► additional fi Y5
request, excluding Saturdays, SundaYS and legal holidays.
Subd. 4. Procefiu'e �►hen data is not acc�ate or complete. An individual may
himself. To
contest the accuracy or completeness of public or private �tthe�responsible authority
exercise this right, an individual shall notify in �'��e authority shall within 30
describing the nature of the disagreement. The respo lete and attempt to
days either: (a) correct the data found to be inaccurate or incomp
notify past recipients of inaccurate or incomp�t he beI'e esdthe datalt� be correct
the individuel; or (b) notify the individuel eement is
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the disclosed data. � 8ppe�ed pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases•
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PERMIT NO. ��7� COMPLE
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� DESCRIPTION
lL 01 FOOTING 16 WELLTEST PUMP
Q02 FRAMING 11 MECHANICAL FINAL � 18 EXCAV/GRADINGIFILLING
� 031NSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
� 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
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Q 05 FINAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
J 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
? 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITION WITHIN HOURS. - pHOTOTAKEN
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