HomeMy WebLinkAbout1998-010099 - roof bump out PERMIT
CITY OF ORONO PERMIT TYPE:
-275� K�Iley Parkway- P.O. Box 66 �.;.:i; i;;i�ft;
Crystal Bay, Minnesota 55323 Permit Number: ;;; �;t,;�.�s.�
(612) 473-7357 Date Issued: i_j�_;:.i,� ,:,�;��
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: — �':���::� ; r��-,t. —
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AP ICANT PER NATURE ISSUED BY:SIGNATURE
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, Tatal Fee: $ � ��� � � � Date Received: �� %3_ `I�
Entered By: Permit#: � !� '
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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) NE OR CONTRACTOR
JOB SITE ADDRESS: G � �P • ZIP: �'���' �,
�
NAME OF OWNER: 1 � � �vt , � l�► PHONE: (home) �G�-��fy,2-
a-vt o� s-h r-- �S n,� 7� (work) 7`? � - � �'�` l
MAILING ADDRESS: � � L �' �` CITY: C��✓,,�„ ZIP: •�� �'�
CONTRACTOR: ��C PHONE: t-I D �l - 1�f�-(Z .
CONTACT PERSON: Y� i . ' MOBII,E/PAGER: ���(� -- �� f J �
MAILING ADDRESS: ' ) C i�a��/ CITY: f'�r�� U ZIP:
STATE LICENSE: #
,, � _ ��1c� ��c;-S�-.
ARCHITECT/ENGINEER:�,�.{1S-� � �'�,�,5 C�6�'►�c't��`w PHONE:
MAILING ADDRESS: � j-D C�'��4���c�c ��-�i.F CITY: (�hu Sf��` ZIP: �3! ,
NAME: C�.t,L,� �( n�..�- �-r- REGISTRATION#
TYPE OF WORK: New Addition�_ Accessory Structure
P�Iove Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � �-� ��c:�S��P� �!� ��/s o �-�. 94-
w4����-� v� [� I c 5 G 1- -�- i'✓1 �. ���'��' �'�,'�� ;. � _ � P..�c�� F��,� P l�,S!°
I 5 � �u�.
STORIES: �. SQ. FEET OF EACH FLOOR: l D ,�(c �C L _
NO. OF BEDROOMS: �_ GARAGE STALLS: ATT. �_ DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 13,6oa'=
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 accordance with the approved plan.
,
APPLICANT'S SIGNATURE: 'I'E� /`
NOTE! Parade of Homes events equire separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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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 shail 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 starewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising fcom his supplying or
refusing to supply private or confidential data;and(d)the identiry of other persons or enades 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, to a law
enforcement officer.
The commissioner of revenue mav vlace the notice rewired under this subdivision in the individual income tax or nropertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry, 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
disc(osed to him for six months thereafrer unless a dispute or acdon pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediarely,if possible,with any request made pursuant to this subdivision,or within five days
of the date of the request, excluding Saturdays,Sundays and legal hotidays,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 comply with 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 compleceness of public or
private data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either. (a)coaect the data found to be inaccurare or incomplete and attempt to noafy
past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)nodfy the individuat that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry 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 �ity 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 fumish 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.
f'l v�ct��.�:� �-�. �S �1-,� t�,
First � C�,,� C;� S�L_ Middle ,� �,�� Last
�L% �'��►-�F t �(C,t c-c�
Address ,
�Y�� v �ti1 � � ��� ��� �- � �� 7
Ciry State Zip Phone
I understand my rights as stated abo .
5
Signature
6
1 .`�
. CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �O CY�NET Pc�c�:
PID:
DESCRIP'TION OF WORK: � �oo F �3�.NQ r���
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ZONING REVIEW BY: DATE APPROVED: �r-I S" �'i d
BUILDING REVIEW BY: ,,� DATE APPROVED: y •t�-,,"'S£�'
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WAT'ER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CI3ECK LIST Zoning District: �12-�3
Fire Department: �e�vc�(�_� Post Office: � " School District: (��n�O
—�—
Lot Area: Sq.ft. /v'o G/�f�M�QAcres Width ^` Depth ^'
Survey Submitted: Yes x. No Date of Survey: o� r'ic� //-1• 7!
Proposed Setbacks: � ,
Front (Lake): b 5 �- Right Side: S�•u "h
t
Rear (Street): )$S �� Left Side: t � r
Adjacent Structures: �4f7'?�}G!'PL-T�j Wetland: /1��/9'
Building Height: Def. Hgt. U.��- Peal:Hgt. '-'
Lot Coverage: U
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:
REMARKS (in house):
7
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BUILDING REVIEW CHECK LIST
UBC: f 2 ' 3 CONSTRUCTION TYPE: �(�
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
Site �_Plumbing Fire
Hardcover Removal _�Mechanical Water Connection
Footing Septic Sewer Connection
_e�Framing Fireplace Lawn Inigation
o( Insulation (Masonry) O[her
_�Wall Board (Mfg.) Well (Sfate Permit)
o�-Final Grading/Filling �Electrical (State Permit)
Other '
REMARKS(IN HOUSE):
y
'_'_"---------------------------------------------------"'_"---------'----------------'-----'_-"_"-----------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMII�:
8
Plat of Surve}• , ��
for Jan F'lckett ��
31ock 2 S���:n L�{e Addition �pp
or �ts 3 �n� �., � Y
E�nne�:in G�unt;;, ?'in:,e�ota I
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CITY �� Q���O
o� SITE r�LA�J G�ADiNG PLAN „
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DAT q, TIME
CITY OF ORONO CALLED IN � l • ����n"'
INSPECTION NOTICE SCHEDULED 6 3�3: P'``
PERMIT NO. C��U�� COMPLETED
ADDRESS � �C`�G�-� ��Gl(SZ .
OWNER Af'1C�1'2�� S�'nU��-� CONTR.���
TELEPHONE NO. �F� '�442
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q FRAMING �-/ ++�S�c�-- 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
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
� OWNER/CONTRACTOR TO MEEf YOU:_YES_NO
� COMMENTS•
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W ❑WORK SATISFACTORY:PROCEED C PROJECT COMPLETE
� �'CORRECT WORK 8 PROCEED C] ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �l PHOTOTAKEN
INSPECTOR WILL RETURN
C' CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CAL�TO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance.473-7357
Owner►Contract i e:
Inspector.
White Copyllnspector's Fil Canary CopylSite Notice
lG'��{ a�';t
CITY OF ORONO cti��Eo iN �
INSPECTION NOT CE SCHEDULED �30
PERMIT N0. � COMPLETED Q'�3 r.i
ADDRESS � � �� ��C-�
OWNER -Sh'1 t� CONTR. ��I�
TELEPHONE NO. `LdfL�� � -1 �
� DESCRIPTION
� Ot FOOTING 11 MECHANICALRI 18D(CAV/GRADING/FIWNG
Q 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q SULATI 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= 05 FINAL 14 SEWER HOOK-UO 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
2 09 PLUMBING Fil 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINC�a FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMM NTS:
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W
� [_ CORRECT WOfiK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY
W
O C�;CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITION WITHIN HOURS. r- pHOTOTAKEN
INSPECTOR WI�L RETURN
C STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
!
SPECTION REQUIRED.CA�L TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContractor on site:
Inspector.��C��CL✓'i�
White Copyllnspector's File Canary CopylSite Notice