HomeMy WebLinkAbout1990-003414 - grading/fill PERMIT
CITY OF ORONO PERMIT TYPE: t,�:���; �r��=�;4��;
1335 Brown Rd. South • P.O. Box 66 Permit Number: ''=!='��`''
Crystal Bay, Minnesota 55323 Date Issued: ` �' `�"s�`:��`#
(612) 473-7357
SITE ADDRESS: i�_���: ��;;��;;C��;��_,°; F°+;����T l�:t�
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FEE SUMMARY: _ � - - -
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CONTRACTOR: 01AI�E�r�.N �,��.;
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APPLJCf � _�_' SIGNATURE _ SSUED BY:SIGNATURE
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i - CHECR OFF LIST FOR ISSIIANCE OF PSRMITS
FOR OFFICE USE ONLY
, �nx$ss oR r.Ec�.: gZ-..� c�ss �t. PID: �—J � � - Z3 2 3 �oI `I
. . DESCRIPTION OF WORR: �G /� � �O �-`7 `� � �'�"'`'�~
` � ------------------------- --- -------------------.---------- �}'
y ' BIIILDING REVIEW CHECR I�IST ' : �r !`-
IIBC: CONSTRIICTION TYPE:
l Sq Footage $ Per Sq Ftg
Basement x =
: ';- = lst Floor x =
- 2nd Floor x =
� _ Garage x =
�,:;.;>:;;;::� x =
.:;;.;
' TOTAL
�.:;.:�.:::':
Bstimated Construction Value: $
Inspections Required: Work Requiring Separate Permits:
_ Site Plumbing Grading/Filling
- - _- Footing Mechanical Fire
.. Framing Septic Water Connection
, . Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
Final (Mfg. ) Well State Permit
�;;:k;:r Other Electrical (State Permit)
- - - R$MARRS (IN HOUSE) :
Rh'VIEW BY OTHERS: DATE:
; Access: Existing New
: ...:�•-..
� ' �� Access Approval: Date
::£�.��<`- ---------------------------------------------By--------------------------------
REMARRS (TO BB NOTED ON PERMIT) :
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CITY OF ORONO - BDILDING PERI�IIT APPLICATION
; Total Fee: $ Date Received: f/- (n -`�D
�, Date Approved: j)- �5%- ��Z�
Entered .By: -�t ,. (�%� ��
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� Permit#: �� % ��
AT.T• INFORMATION MDST BE SQBMITTED IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
------------------------------------ ----------------------------------------�
THE APPLICANT IS: (circle one) WNER or CONTRACTOR
JOB SITE ADDRESS: ��� � �� ;'P� i")e�')� �� /� ZIP: J � > �I�
(work) ��`�'--,�j;:�'j�,
NAML OF OWNER: �� �I I u c�,� \�I ) � �'-��c�`, PHONE: (home) `"�7!-� y�J�
MAILING ADDRESS: � �'�� (Jc14':�y �i.>_j�� �� /�c� CITY: �'�'< � � ZIP: -���.�' � �
,
CONTRACTOR: ,�-� f� PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration_�
PROPOSED WORR (describe in detail) : C� !�� �1 1�i.�.� �'� �Q �� �� `-
IG ld C�S '�d-i�E' �� / lr C. C l� S C(G( c� �Il P-E� fQ I lxG� �'l V1�; .�"
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BBDROOI�IS: GARAGE STAI,LS: ATT. DET.
ESTIMATED CONSTRUCTION VALIIATION (excluding land) : $
I hereby apply for a building permit and I acknowledge that the informatio
above is complete and accurate; that the work will be in conformance with th
ordinances and codes of the City and with the State Building Code; that
understand this is not a �ermit and work is not to start without a permit; an
that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATITRE• v �, DATE: � f "' � `' �, �1
(Ple se fill out the reverse side f his form)
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��,�_,,r' ',�,�,,y�'� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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�� . �''F"'"� On the North Shore of Lake Minnetonka
DATA_,PRIVACY ADVISORY
In accordance with M.S. 15.165, "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:
l. 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. 15.165 to review private
data on yourself .
6. Your full name, and date of birth are required to process
this application or permit.
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First Middle Last
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Address
_ . _ ---- -�- ----- -- ---- - _...__ -- -- --� -_- . .--- -� __. -- --- -�---
City State Zip
_ _ _ ---- - -- _ _._
Phone
I understand my rights as stated above.
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Signature
BUILIlING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING