HomeMy WebLinkAbout1993-005113 - remove chim/rep roof PEI$M�T �
CITY OF ORONO PE�MIT TYPE: :,: :, - -.
2750 Kelle Parkwa • P.O. Box 815 `�'`'`�--'�`'`�"`'
Y Y Permit Number: ;_;t_;�; �:_
Orono, Minnesota 55356-0815 ' Date Issued: t;�;�i�Y.;'�a:::
(612) 473-7357 -�
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT% RMITEE SIGNATURE ISSUED BY:SIGNATURE C Q�)
, � CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
�
Date Approved:
�ntered By:�l A,�]
Permit�: ��/�
e`�I.L INFORMATION MIIST B$ SIIBMITTED IN FIILL BEFORE PLAN REVIEW WII.L B$ STAR�ED
(See Check-off List Enclosed)
----------------------------------------------- -._ .
fiHE APPLICANT IS: (circle one) OWNER o�CONTRACTOR '
JOB SITE ADDRSSS: �4�� /�?-��NCabi�'� i�' ZIP: 5�3� �
(work) b�'3-"Z��:.3
�� oF owrr�z- �� �F� .���� PaorrE: (home) 4--]I 'c1�"1 �T
�iAILING ADDR.ESS: �-�S J��J/�Ul!'(�f��`i A�L. CITY:��2k Zt�'i� ZIP: �?.�'1 I
CONTRACTOR: �� ���z�`-� n�r���i .�n► �c_ PaorrE: ¢�Z-�� d S
?�iAILING ADDR.ESS: l �� C�•T�( �..L� 1� CIZ7: a ZIP: ��
STATS LICENSE: � �J��-�—
ARCHITECT/ENGZNEER: ' PHONE:
MATLING ADDRBSS: - CITYs ZIP:
N�: _ RSGISTRATION n
TYPE OF WORR: New Addition Accessory Structure Move
Demo_� Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) :�'f1�0�� �/ ���J.�1��—; �"�� '�- -
f ��/ ���
STORI$S: - SQ. FEET OF EACH FLOOR:
NO. OF B$DROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eaclnding land) : $ 5� � a� �
� 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
snderstand this is not a permit and work is not to start without a permit; and
that the work wiI 1 be in accordance with the approved plan.
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APPLICANT•S SIGNATUF2E: e DATE: y -
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��3��,. ,;? Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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�'"_ � a � : On th,e NortJz 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
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 wiZl 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
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii. action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Yaur fulZ name is required to process this applicaticn or
perfiit.
✓
�2�� . �`� � r
First Middle Last
I I�� C�� IZD , I�
Address
i L�II/n � j� �S �(���-
City State Zip
�� � - �� I �
Phone
I und stand my righ stated above.
�
Signa ure
BUILDI:VG&ZONING—473-7357 • ADMINISTRATION&F[NANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESS[NG
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7 r.
513.04 RIGHTS OF SIIBJECTS OF DATA
Subdivision 1. Type of data- The rights of individusls 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 indivi�uaL An.individual esked to
supply private or confidentiel data concernin�g �amW hin the collect g state agency,
purpose and intended use of the requested
(b) whether he ma� refuse or is legally
p�litical subdivision, or statewide system; �oWn consequence arising from his
required to supply the requested data; (c) any
supplying or refusing to supply private or confidential data; end (d) the identity of
other persons or entities authorized by staau��e8skedlto supplyinvest gat ve date,
requirement shall not apply when an lndlvl
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The c�mmissioner of revenue m8 rolertv taX re�und instructeonsui steadhos
subdivision in the individual income tax •r R �
on those orms. . --- - -
Subd. 3.
Access to �ata bY in���• UPon request to a responsible �
authority, an individusl shall be informed whether h��gteeor confident al.e Upon his
individuals, and whether it is classified as public, p ublic data on
further request, an individusl who is the subject of se tr�e�mri�ae if he desires, shall
individuels shall be st�own the dat8 withou�f an�y ��g. �,f ter an individual hes been
�e informed of the content and meaning the data need not be �isclosed to
shown the private data end informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or ectian p
, pending or additional data on the indivif the hr vgte or p blie datarupongrequest by
responsib le au t hor i t y s h a ll p r o v i d e c o p i e s o P r e a u i r e t h e
the individual subject of the ciata. The responsible�Qa{f°n1 tY�a compiling the
requesting person to pay the actual costs of making, Yi g�
copies. ssible, with any request
The responsible authority shell comoly immediately, if po
made pursuant to this subdivision, or with�aa e��f Simmediategtc mpliance eisu not
excluding Saturdays, SundaYs and legal YS
possible. If he cannot comply with the request within that time, he shall sp in�or h the
ha.ve sn additional fve daYs Within which to com ly
individual, and maY Bnd Ie al holidays.
request, excluding Saturdays, SundaYs g
Subd. 4. Procediu'e �►hen data is not sccurate or complete. An individual may
contest the accuracy or comQleteness of pno� ° inrwri ing tthe�r sponslb e au hor ty
exercise this right, an individuel shall Y
describing the nature of the disagreern to beTnaccura e or in omplet and att mpt to
days either: (a) correct the data found
notify past recipients of inaccurate orV��p�t he believesdthe datalto be correct
the individuel; or {b) notify the indi
Data in dispute shall be disclosed only if the individual's statement of disagreement is
• included with the disclosed data. ealed ursuant to the
" The determination of the responsible authority may be aPP p
provisions of the administrative procedure act relating to contested cases.
CHECR OFF LIST ,FOR 3SSIIANCE OF PERMITS
'`' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z�13S O�Nw�� �t PID:
DESCRIPTION OF WORR: ��'/� -----------------
-------------------------------------
ZONING REVIEW BY: !'1���' DATE APPROVED:
BIIILDING REVIEW BY: �G/I�Lw--- DATE APPROVED: S -G-53
---------- --------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes f No
PLAN REVIEW Yes No ✓ SEWER CONNECTION
STATE SURCHARGE Yes r/" No WATER CONNECTION
INVESTIGATION FEE Yes No !� PARK FEE
SAC Yes No � SITE INSPECTION
Number of SAC Units OTHER (specify)
-------------------------------- g
ZONING CHECR LIST Zonin Distri t:
Fire Department:
Post Office: School Dist c :
Lot Area: Width: Depth:
Survey Submitte : Yes No Dat of Sur ey:
Proposed Setbac s
Front (La e) • R' ght Side.
Rear (St eet) • eft Side.
Adjacen Stru tures: Wetland:
Bui J.ding He' ght: ef . Hgt. Peak Hgt.
Avg. Setba L t Cover ge:
Existing Propose
Hardcover 0-75 '
75-250 '
250-500 '
500-1000 '
Hardc ver Varianc Req ired: Yes No
Date of Counci Approva�:
Grad ng: Staff App ov I. Date• By: Council A proval. Date:__
Sep ic: Staff Appr v 1 Date: By=
Zoning Fil.e:# Resol tion # : Resolut on Date:
REMARKS (in house) :
BIIILDING REVIEW CHECR LIST ' '
.�•
__------,
jJgC: � (L` � CONSTRIICTION TYPE: .�Lly--
Sq Footage $ Per Sq Ftg
Basement X =
lst Fl.00r X -
2nd Floor X -
Garage X -
X =
TOTAL
$stimated Construction Value: $ �d�� o"`�
Inspections Required: Work Requiring Separate Permits:
Site � P�umbing Grading/Fil.J.ing
Footing Mechanical Fire
_gFraming Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Lawn Irrigation
�Final (Mfg.) Other
Other We17� (State Permit)
Electrical. (State Permit)
-------------------------------------------------------------------
REM2�RRS (IN HOIISE) :
--------------------------------------------------------------------
REVIEW BY OTHFRS: DATE:
Access : Existing New
Access Approval: Date BY=
----------------------------------------------------------
REMARRS (TO BE NOTED ON PERMIT) :
� �
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTIC� SCHEDULED
PERMIT NO. ��� COMPLETED �-2- S 3 3�aZ�
ADDRESS LY3S Q�^' �v�ny
OWNER CONTR. CArCPC-v�'�E�,S GD�vS�
TELEPHONE NO.
� DESCRIPTION
ly 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q �FRAMING 11 MECHANICALFINAL 18EXCAV/GRADINGIFILLING
y 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHOREM/ETLANDS
Z04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q OS�'INAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 10 PLUMBING FINAL 23 SEPTIC FINAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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d j�GJORK SATISFACTORY:PROCEED �E�'PROJECT COMPLETE
W��[�CORRECT WORK 8�PROCEED �� ISSUE CERTIFICATE OF OCCUPANCY
O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �. PHOTOTAKEN
INSPECTOR WILL RETURN
C STOP ORDER POSTED.CALL INSPECTOR �' CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73rJ7
Owner/Contractor on ite:
Inspector.
White opy/lnspector's File Canary Copy/Site Notice