HomeMy WebLinkAbout1998-010162 - addition PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��t��� +�j�;���_
Crystal Bay, Minnesota 55323 Permit Number: ��3 zF�:_�'
(612) 473-7357 Date Issued: i_�M,r�;�f=x;w�
SITE ADDRESS:
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CONTRACTOR: — �y'����1 �W=�}}t� — `=�1�� . L:�_- OWNER:
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APP�ICAN ERMITEE GNATURE C ISSUED BY:SIGNATURE
Total Fee: $ �/ �j ���� Date Received: `�'� � ' `%:�
_ Et�tered By: Pernut#: / ����2,
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CITY OF ORONO - BUILDING PERNIIT 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 OR��CONTRACTORy;
JOB SITE ADDRESS: .�-� ?� [��z� l/, t�,r `0!✓ ZIP: '-� -� ��
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NAME OF OWNER. �`t� +� `���%r•'t� ��A1'�i G�, i� �- PHONE: (home) ��� 3 ��'`'�
� (work)
MAILING ADDRESS: ' �� yt7�'� CITY• �.,'�'�`�'°�,'� ZIP: `03 �• �
F�< <=' �� 4:< �= � PHONE: �
CONTRACTOR: `- �'` -'-' � ' S �' Z�- ?�
CONTACT PERSON: ;=� �'� f' MOBILE/PAGER: L"� � k'oi �-� 3 7`
MAILING ADDRESS: ����; (T�-�%� �'l�L /. :% CITY: L���,�"���'��7� ZIP: :,.��3 �'/
STATE LICENSE: # ��-x'��� '�7?
ARCHITECT/ENGINEER:i`'�'� i.��`-t�-+1 r���!%—r� PHONE: �=' I�. �< .%1�-
MAILING ADDRESS: �/ � �j '� `�;�. CITY: �"'i�- '' ZIP:.:���Cj�-�___-
NAME: �.%'.:��`�=<.�� �<���-x REGISTRATION# ��>..���
..
TYPE OF WORK: N�w Addition � Accessory Structure
P�Iove Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � �� /✓��`�' ��'� �`�`�' ��� ' �� `-�'�`��" 'f��
. . - �t _
�/�� (' aa`,r �>''S / �!'� �/_�_ /f'/"i� 1� • d�''L� • �-l''�/ ,!�;j'��i" C��,�
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STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ �!', ���-��!
I hereby apply for a building pernut 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,,�c ordance with the approved plan.
� �.. � �� _ �-�=��
APPLICANT'S SIGNATLTRF: -'�-= >!-;'�. DATE:
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.
5
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 conceming himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any(rnown consequence arising from his supplying or
refusing to supply private or confidential dara;and(d)the idenciry of other persons or entiries authorized by state or federal law ro receive the dara.
This requirement shall not apply when an individual is asked to supply investi;ative data, pursuant to secdon 13.82, subdivision 5, to a law
enforcement o�cer.
The commissioner of revenue mav olace the norice reauired under this subdivision in the individual income tax or orooerN 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 individuafs,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 hirn 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 thereaher unless a dispute or acdon pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authoriry sha(1 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 authority shall comply immediately,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 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 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 completeness of public or
private dara concerning himself. To exercise this right,an individual shall noafy in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shali within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt ro nodfy
past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy the individual that he believes the data
to be correct. Data in dispute shall be disclosed orily if the individual's statement of disagreement is included with the disciosed data.
The deternunadon 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 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 Ciry 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.
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City State Zip Phone
I understand m}� righ s state above.
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6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR,OFFICE USE O�Y
ADDRESS OR LEGAL: _�� � � ? ���--t--T, ��-
PID• CJ`,� - ,�.1 f�� _
DESCRIPTION OF WORK: A��p �n o�
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ZONING REVIEW BY: DATE APPROVED: �-L�{ ��
BUILDING REVIEW BY: DATE APPROVED: y• z Y-��
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 � PARK FEE
SAC Yes No v SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: �����
Fire Deparcment: (��(,At(,� Post Office: (�..t,U�-1c.c� _— School District: p/LtaNNt7
Lot Area: Sq.ft. /�t� G�ANGL Acres — Width — Depth ^
Survey Submitted: Yes � No Date of Survey: orv t=�u3 U9•�1•�(
Proposed Setbacks:
Front (Lake): �J`5�I �' Right Side: ! 3(�� �'
�
Rear (Street): �(,�� t- Left Side: ,3S 1
Adjacent Structures: �TI14GbIz� Wetland: N��
Building Height: Def. Hgt. (y .�- Peak Hgt. "�
Lot Coverage: N (14
Grading: Staff Approval Date: By: Council Approval Date:
Se tic: Staff A roval Date: '��''" O BY� �✓
P PP
Zoning File: # Resolution: # Resolution Date:
A Shoreland District:
N.1 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
UBC: (Z-3 CONSTRUCTION TYPE: �6/�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
e�
Estimated Construction Value: $ �(0,�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal OC. Mechanical Water Connection
_�Footing Septic Sewer Connection
_�Framing Fireplace Lawn Inigation
_0�Insulation (Masonry) Other
�Wall Boazd (Mfg.) Well (State Permit)
�Final Grading/Filling _�Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMIT�:
8
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CITY OF �R�N �°�°� ; � 1
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I hereby certify that this is a true and ,� '°� t � �
correct representation of a survey of the �Z• — za �♦ �
boundaries of: I �e o "
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Lot 7, Block 1, THE NURSERY, Hennepin �4 �p�^/•�B y,t�
County, Minnesota. `�r `�,;Q '2 Q S !
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And of the location of all buildings, if R��.P'
any, thereon, and all visible encroachments, W �
if any, from or on said land. As surveyed "�
by me this 31st day of August, 1981 . o � I ��'�
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Thomas S. Bergquist � I �s�
P.egistered Lan.d Surveyor � �3s
�.�inn. Lic. No. 7725 I c' ��
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, SATHRE-BERG�UIST, IN.C. .00K ►�cE Prepared for: •
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i�LE HO.
T[i[o..oti[tia-��s-oaes �4 00-53
DATE TIME
CITY OF ORONO CALLED IN � �lC�
INSPECTION NOTICE v I �Z, SCHEDULED
PERMIT NO. ! COMPLETED L1 �
ADDRESS c��� � �Ut°� �--
OWNER CONTR.
TELEPHONE N� f' � �� `� �� "'����— l��
��SCRIPTION
� 0 OOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 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
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
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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O I-� CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
i' CORRECTUNSAFECONDITIONWITHIN HOURS. - pHOTOTAKEN
INSPECTOR WILL REfURN
C7 STOP ORDER POSTED.CALL INSPECTOR �-' CITATION ISSUED
� INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContra�tor ol� t
Inspector. �� V
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE t u � ��' scHE�u�E� � �Z=� �
PERMIT NO. COMPLETED �_
ADDRESS /��� ��i�1 �c� I V�
OWNER CONTR.
TELEPHONE N0.
� DESCRIPTION
� 01 FOOTING 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
ZWALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q�INAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 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
� COMMENTS:"'r ,/C 3 3 ��
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W� WORK SATISFACTORY:PROCEED �ROJECT COMPLETE
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �- pHOTOTAKEN
INSPECTOR WILL RETURN �- CITATION ISSUED
❑STOP ORDER POSTED.CAL�INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContrac�e�yo�te:
Inspector. ��
White Copylinspector's Fil Canary CopylSite Notice
/� DATE T�ME
CITY OF ORONO CALLED IN `����G %� `� �
INSPECTION NOTICE SCHEDULED _�����=� —.�=.3�
PERMIT NO. G' COMPLETED
ADDRESS���-� �Z �"'�'
OWNER ��'V CONTR._�.�iYYt��
TELEPHONE NO. �3 S 7.3 S �
� DESCRIPTION
ly� O1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
�� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� W� a�n— � 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
'� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� L7WORKSATISFACTORY:PROCEED ;= PROJECTCOMPLETE
W ❑ CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. , pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CA�L INSPECTOR ' CITATION ISSUED
C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor on site:
Inspector.
White Copylinspector's File Canary CopylSite Natice
/_ DATE �Q T2IME
CITY OF ORONO CALLED IN lL'r�L� �" �Jv���
INSPECTION NOT�CE � �, SCHEDULED �� -/� '�'��
PERMIT NO. lb I COMPLETED
ADDRESS � Ur/1 -R—
OWNER � �--^ � CONTR. -��
TELEPHONE NO. ���� S��Y"
� DESCRIPTION �'-G%�-G�C-f`Jt�t7
ty� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 2 FRAMING� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 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
� COMMENTS:
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� BEFORE COVERING
PERMANENT
iICORRECTUNSAFECONDITIONWITHIN HOURS. pHOTOTAKEN
INSPECTOR WILL RETURN
CITATION ISSUED
f7 STOP ORDER POSTED.CALL INSPECTOR
[� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next'nspection 24 hours in advance.473-73J�7
OwnerlContr o n it :
Inspector. �
White Copyllnspector's File Canary CopylSite Notice