HomeMy WebLinkAbout1998-009940 - addition ♦ � � PERMIT
CITY OF ORONO PERMIT TYPE:
275� Kelley Parkway- P.O. Box 66 '•~'�;=�—'�'�-''�''
Permit Number. �'R-'`='`=��t-`
Crysial Bay, Minnesota 55323 S_;,�-� � w
�(612) 473-7357 Date Issued: �- � !'=�`�
SITE ADDRESS:
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AP IC T/PERMIT E SIGNATURE ISSUED BY:SIGNATURE ���
Total Fee: $� I ��` . � ( Date Received: ���'�l,,0�j,�'
Entered By: Permit#: ��1�(C�
,,
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 O CONTRACTO
/� �. • �'�I �� � -
JOB SITE ADDRESS: ��P�( � ��1`�'�"" 'J `�. IVI 1�-� ZIP: ��3=� �
NAME OF OWNER�,�c% `�1'a�D/} (,(���;7?�)q 0./ PHONE: (home)
(work)
MAILING ADDRESSs.�a� �� ��F� Si. CITY�i�r� �1�'� ZIP:�: ���1
CONTRACTOR: J LV�57",�_C°d o�.�'�t,'' . PHONE: C�C�� cf�/— d/� d�
CONTACT PERS N: T��- o sT MOBILE/PAGER: -r11- -��3� 330 • �0 1��
MAILING ADDRESS:f��g ,5�-'��.�S o, CITY:�/f�L� Z : a�'�'��3
STATE LICENSE: # / �a S�
ARCHITECT/ENGINEER: SAsn: �s 1�0% PHONE:
MAILING ADDRESS: CITY� Z��
rJAME; REGISTRATION#
TYPE OF WORK: New Addition ✓ Accessory Structure
Move Remodel/Alteration ✓ Land Alteration
PROPOSED WORK(describe in detai�:��� �oo� �bb��T%�� � -'L� ��i4� ��v�L��'�G
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
/ o,�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ / �� OoD•
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.
, 3 �
APPLICANT S SIGNATURE: � DATE: �
NOTE! Parade of Homes events uire separate permit approval by Police Department and
City Council 60 days prior to the event. on permitted events will not be allowed.
9
r
Sec.13.04 RIGHTS OF SLJB.TECTS 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,political subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
no[apply when an individual is asked to supply investiga[ive data, putsuan[[o section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or property 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 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 disclosed to hitn for
six months thereafter unless a dispute or action 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 authoriry
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
data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual 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 determination of the responsible authority 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 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. = full name is required to process this application or permit.
��l�/� 1� �� /i l—�
First �� Middle Last
� D ��l/�-�v
Address � � � � ���� ����
� ;�L S �'�'j n ��� 1/�-
Ciry State Zip Pho
I understand�-� as stated e.
/
Signature
e
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY,
ADDRESS OR LEGAL: ; !f - :: - . � ;' .
PID: �j - � 1 r � y
DESCRIPTION OF WORK:
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ZONING REVIEW BY: � DATE APPROVED: �z - i o • 9$
BUILDING REVIEW BY: DATE APPROVED: Z- �o• 5$
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes c/' No SEWER CONNECTION
STATE SUR�HARGL Yes � No WATERCONNECTION
INVESTIGAI'ION FEE I'es No PARK FEE
SAC Y�s No SITEINSPECTION
Number of SAC Units OTHER (specify)
=-----------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: L/?-/A
Fire Department: ,���(� (�(G� Post Office: ry�,q�pc,G Pc.4 iN School District: p(1oN c�
Lot Area: Sq.ft. /tf� C< cres — Width — Depth —
Survey Submitted: Yes_ L No Date of Survey: ons N=� �
Proposed Setbacks: , �
Front (L'ai�e): _ 1 25 Right Side: l5� a'
Rear (S�eet): $� � Left Side: f �!� � {'
Adjacent Structures: �Q7'7'�C HE� Wetland: /t!/A
Building Height: Def. Hgt. (�./G Peak Hgt. —
Lot Coverage: O. �L
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approvai Date: By:
Zoning File: # Resolution: # Resolution Date:
�' Shoreland Dist=ict: _
�� 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):
� 26
�
BUILDING REVIEW CHECK LIST
UBC: /��3 CONSTRUCTION TYPE: �/N
' Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ ��5�no� �u
Inspections Required: Work Requiring Separate Permits:
- Site .� Plumbing Fire
Hardcover Removal � Mechanical Water Connection
_ C,� Footing Septic Sewer Connection
oc Framing Fireplace Lawn Irrig�at��n,, ��f`��t
� Insulation (Masonry) Other
o( Wall Board (Mfg.) Well (State Permit)
a'" Final Grading/Filling _�C Electrical (State Pernut)
Other
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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):
27
DATE TIME
CITY OF ORONO CALLED IN �'� _C� /� �� ��`�
INSPECTION NOTICE��j,/Gj SCHEDULED .� '�-�%'�� �
PERMIT NO. �� COMPLETED �- �D
ADDRESS � � �
OWNER ' CONT <. � .d-�
TELEPHONE NO. �� '� U ���
� DESCRIPTION /2�G��QQ�c-��'i
LL� 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q O5 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
T09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
�
�
W
�
�
�
O
�
�
O
�
W
�
Q
�
Z
W
�
W
�
�
d ORKSATISFACTORY:PROCFED !: PROJECTCOMPLETE
W
� ❑CORRECT WORK 8 PROCEED i ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ;- PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CAL�INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the x inspection 24 hours in advance.473-73�J7
OwnerlContr r o s e-
Inspector.
White Copyllnspector's File Canary CopylSite Notice
D TE TIME
CITY OF ORONO CALLED W ���p ��'
INSPECTION NOTICE � SCHEDULED .� /L� '. c�c�
PERMIT NO. ��1`�L' COMPLETED
�
ADDRESS �' � .�� •
OWNER CONTR. � ■ 1z
TELEPHONE NO. '��J�� � � �� �
� DESCRIPTION
LL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 3 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 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
Z
� COMMENTS:
�
W
�
�
�
O
�
�
O
�
W
�
Q
�
Z
W
�
W
�
j
d �ORK SATISFACTORY:PROCFED ' PROJECT COMPLETE
W
� '.-; CORRECT WORK&PROCEED [ ISSUE CERTIFICATE OF OCCUPANCY
W
O C! CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
C1 CORRECT UNSAFE CONDITION WITHIN HOURS. : pHOTO TAKEN
INSPECTOR WILL RETURN
f 1 STOP ORDER POSTED.CALL INSPECTOR ' CITATION ISSUED
L. INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-73�J7
OwnerlContra 6r on s�it .
Inspector. �
White Copylinspector's File Canary CopylSite Notice
CITY OF ORONO CALLED IN
� •� a.s'
INSPECTION Nq�l E SCHEDULED [O. C��
PERMIT NO. �Y COMP E �
ADDRESS 3� ��
OWNER GU CONTR. a��%I��N`e�
TELEPHONE N0. __ g �O�" �� ��
� DESCRIPTION
� 01 FOOTING 11 MEC ICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 12 WATER HOOK-UP 17 SITE INSPECTION
OS 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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
W
a
� i G{. U�l \
0
a
�
o ��I��
W
Q /c�/o�
� /aa 8�
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� �c��1
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�
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W� WORK SATISFAC�RY:PROCEED C PROJECT COMPLETE
W Q CORRECT WORK R PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� U CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ` pHOTO TAKEN
INSPECTOR WILL RETURN
� CITATION ISSUED
❑STOP ORDER POSTED.CA�L INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-7357
OwnedContr r s e
Inspector.
White Copylinspector's File Canary CopylSite Notice
. . �� - ._ 1 .. - � . ' . . � � _ ' . - . .. . � � . �. . � \/��.- . . '._ � � �� . � . .
� . � Survey for: SYLVESTER CONSTRUCTION �
, \ - . _ � - . 3�`��6 ��� -. _
, � _ . . _ ,
. • DESCRIPTION: : . • . • .
� - _ . . Lo� �, Block 1 , RIDEI`�COMPANY
- STUBBS SAY ADDITION -
We hereby certify that this is a true .and correct representation of a survey of the bounda�
of the land above described and of the location of all buildings,` if any, thereon artd all �
encroachments, if any, from or on said land. Dated this 14th day of February, 1989.
,S- CARLSON & CARLSON, INC.
^ ��� ���� ��~ s � LAND SURVEYORS•
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��S � U�������1���A t .y Ce�,J!'�y -
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rry R. uture, Lan Surveyor
Minnesot license No. 9018 . -
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� � SfTE PLAN GRADING PLAN o
: �PPROVED-3L����0� n o� C � ; oi
� � APPROVED WITH REVISIONS � j �.�,,
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- '�. tAND�SURVEYORS �. '