HomeMy WebLinkAbout1999-011779 - addition y , , PERMIT
��TY OF ORONO PERMIT TYPE:
2'S�0 Kelley Parkway- P.O. Box 66 _ ' � 3��v:;
Permit Number: ' -��'.��_::
Cr'�:tal Bay, Minnesota 55323 �.�::. s ! . _
�73-7357 Date Issued: _ _ _
SITE ADL�RESS:
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APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE � �`
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y Total Fee: $ ��(c- � �t i Date Received: �- /- f,`'`
Entered By: C',� Pemut#: ��F7-)�
CITY OF ORONO - BUILDING PERIVIIT 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 CONTRACTOR �I
JOB SITE ADDRESS: L�7 `f �^�'
��-�1 C� ! �-F✓� � ZIP: �
NAME OF OWNER: 1��+� {L► �a- ��✓�5�� - PHONE: (home) �-7�- O3�7
(work)
MAILING ADDRESS: 2�r�-5� -' ��� �'� �t✓eCITY: �j('�yil� ZIP: S� � �
CONTRACTOR ��v i-�5��� CJ��t�r c�C.ttic�� �h� PHONE: �7�--(��/ ��
CONTACT PERSON: S .1`�-- 1VIOBILE/PAGER: �Z�-- '� � ��
MAILING ADDRESS: '��- 1-�p r`��.c c � ���
ITY: �i v�, � ZIP: S—" S�j
STATE LICENSE: #
ARCHITECT/ENGINEER: ��-Wl�_- .�� �4�'_)c:t L�-�PHONE:
MAILING ADDRESS: CITY: Z��
NAME; REGISTRATION#
TYPE OF WORK: New Addition_�� Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: `C1GY � � � �'�C- v�` `� a SL
�i ' � C'�S '' � =' l f'�c�C�:v.. ��
STORIES: 2- SQ. FEET OF EACH FLOOR: � 7�
NO. OF BEDROOMS: � GARAGE STALLS: ATT. >C DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 3'Y� S l�
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 cc rdance ' the roved plan.
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APPLICANT'S SIGNATURE: -_ DATE:
_
NOTE! Parade of Homes events require sep�rate permit approval by Police epartment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
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Sec.13.04 RIGHTS OF SiJBJECTS OF DATA
Subd. 1. Type of data. The righu 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 concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency,polirical subdivisioo,or statewide system;
(b)whether he may refuse or is legaliy 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 idenrity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigarive data,pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund
instrucdons instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shal(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 srored 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 ro him 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 authority
may require the requesting person to pay the actual costs of making,certifying, and compiling the copies.
The responsible authoriry 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 concerning 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 norify past recipients of
inaccurate or incomplete data, including recipienu 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 disciosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the admirustrative 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 fumish 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 pernut 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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�-�� ��� � �l`� ��
First Mi le Last
�?O - �- � � r�� e �r i v 2__._
Address
� �� M� ��� ( � _ � 7�
C�ty State Zip Phone
I underst 'ghts as stated above.
--�
Signature
. �
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z1`�t S C TH L L. A V L
PID:
DESCRIPTION OF WORK: In fJ,r�� ri o�► -
-------------------------------------------------- -------------------------------------------------------------------
ZONING REVIEW BY: � DATE APPROVED: � -!z�4 5
BUILDING REVIEW BY: DATE APPROVED: � -r z-9`3
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓' No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SUR`HARGL Yes ✓ No WATERCONNECTION
INVESTIGATION FEE I'es No PARK FEE
SAC Y,:s No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: L R ' � �-
Fire Department: ryk�v..�� Post Office: yvwv n�f1 .. School District: w PST�N Kh
Lot Area: Sq.ft. �S;�U�'r' Acres 3`{ Width t c!o ' Depth �Sa`
Survey Submitted: Yes p� No Date of Suryey: �i' 3� ��(
Proposed Setbacks: , ' �
Front (L-zrkcj: y S�•2? Right Side: '�� .39
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Rear (St�eet): �� Left Side: �")�'1•0 3
Adjacent Structures: �q-rT�c 1�� Wetland: /V r/�-
Building Height: Def. Hgt. C�.k: Peak Hgt. �
Lot Coverage: `�`��
Grading: Staff Approval Date: -- By: Council Approval Date:
Septic: Staff Approval Date: By�
Zoning File: # — Resolution: # -- Resolution Date:
Shoreland Dist_�ict: �_5
Avg. Setback: N I A Bluff Setback: N (�- Lot Coverage: 9 ��
Existing Proposed
Hardcover: 0-75'
75-250' 1•10 1 O•$
250-500' '1 Z.2 5 0
500-1000'
Hardcover Variance Required: Yes No �- Date of Council Approval:
REMARKS (in house):
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BUII.,DING REVIEW CHECK LIST �
UBC: /Z- 3 CONSTRUCTION TYPE: V� -
' Sq Footage $ Per Sq Ftg I
Basement x = ;
lst Floor x = �
2nd Floor x =
Gazage x =
R =
TOTAL
Estimated Construction Value: $ 3�.,Svo�'
Inspections Required: Work Requiring Separate Permits:
Site 0< Plumbing Fire
Hardcover Removal K Mechanical Water Connection
_� Footing Septic Sewer Connection
�r Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
Final Grading/Filling it Electrical (State Pernut)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS(TO BE NOTED ON PERMIT):
,
27
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HARDCOVER CALCLTI.ATION WORKSHEET
SETBACK ZO�YE: (CIRCLE ONE} Q-75' 75-Z�0' 25Q-�00' S0a-1000'
EYiS'TIP+'� x�uDCOVER Ii�1 ZO`�E
X = 'Z S.F.
A. House
Lrngth Width
= S.F.
" = S.F.
� = S.F.
x
= S.F.
B. Gara�e X
= S.F.
C. Driveway X _
x
_ S.F.
= S.F.
D. Sidewa(k X _
x
_ S.F_
X = csj� S.F.
E. PatioiDecic = �� S.F.
x
= S.F.
F. Landscape X _
S.F.
Underlain X _
_ S.F.
By Plastic X
t3o�iaec Watl = 2 � S.F.
G. Other �� x � �S
TOTAL HARDCOVER IN ZONE - � � � �� S.F. A
TQTAL PROPERTY AREA IN ZONE G - F,7��'r�' _ S.F. B '
A ` �� = B �� O x ]00 = I ,�e %
PROPOSED HARDCOVER IN ZONE _ S.F.
A. House X
Length W idth ,
= S.F.
X = S.F.
X = S.F.
x
X = �O� S.F.
B. Gara�e _
= S.F.
C. Drive�vay X _
X — `Z S� S.F.
= S.F.
D. Sidewa3k X _
x
_ S.F.
= S.F.
E. Patio/Deck x _
x
_ --- S I S.F.
= S.F.
F. Landscape X =
S.F.
Underiain X _
_ S.F.
By Plasric x
= S.F.
G. Other X
TOTAL HARDCOVER IN ZONE - 712 ' S.F. A
TOTAL PROPERTY AREA rN ZONE - � '1 S.F. B
a "1 t Z -
= s �.~l�1� X iao = t o, 5 ��a
11 �
CITY OF ORONO CALLED IN T^ � ' �—J
INSPECTION NOTICE SCHEDULED �C o7l0 �a 30
PERMIT N0. O f I�]7 q COMPLETED Z ��-r�
ADDRESS a�y� �� �V�-
OWNER CONTR. � •S . `��I��►—�
TELEPHONE NO. �""��I �I" �o�Y7 �D
� IPTION
� 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
Z04 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
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
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION W�THIN HOURS. `, pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
C CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor on site:
Inspector./L'�C'c����~�
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED J j i�i 7 ��
PERMIT N0.�C�( 77q COMPLETED
ADDRESS ���� ��1�C�. �L�—
OWNER CONTR. � S � ����-1.
TELEPHONE NO. ��� '' 'l��(7�
� DESCRIPTION �►'� �c4cEl�l'C►�
�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
,� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� IN�LATION • 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FfNAL 14 SEWER HOOK-UP O6 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 FOUNDAT�ON/REMOVAL
� OW N ERICONTRACTOR TO M EET YOU:_YES_NO
� COMMENTS:
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. = pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CA�L INSPECTOR �� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance.473-7357
Owner/Contract e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN ��-'2-z`�� '3` l�
INSPECTION N TI E SCHEDULED �l �.�3 �
PERMIT NO. COMPLETED � �L �� 3� ��
ADDRESS � 7�� �fh�=/ ��/r
OWNER �<,1 �� P n S c n! CONTR. J � "����k.� C� •
TELEPHONE NO. � �T � � 7 S�
� DESCRIPTION �� ��'�" � ���-
ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICA�FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WAIL 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
� 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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� ❑ CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. - pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContra tor on site:
Inspector. `'��a-YL.���'M1 �
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTIC �/ SCHEDULED 2--�j '���
PERMIT NO. � �7 / COMPLETEO � '� �`f 2��
ADDRESS �� � � �C�- � � TL'
OWNER CONTR. -,� � �t Sy�"�-✓
TELEPHONE NO. ��� ^ ��� �'
� DESCRIPTION
l� 01 FO 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q SULATION 24/25 WOOD BURNER/FIREPLACE 34 TFEE 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
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/CONTRACT TO MEET YOU:_YES_NO
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� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContractor on site:
inspector.����-�( �l�'1 <
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULEDb, 3��-
PERMIT NO.___l,l�_ COMPLETED��lt� � -'��
ADDRESS �7 � �,i�
OWNER CONTR. �
TELEPHONE NO. a�-�SSQ�
� DESCRIPTION ��QI�'l�
lV 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICA�FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 5 F 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DtMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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� BEFORE COVERING PERMANENT
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INSPECTOR WILL RETURN
fl STOP ORDER POSTED.CALL INSPECTOR ` CITATION ISSUED
C; INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46�0
OwnerlContr tor on site:
Inspector. �"�'l�C �.�C�3
White Copyllnspector's File Canary CopylSite Notice