HomeMy WebLinkAbout1992-004860 - change to 3 season PERMIT
G�TY OF ORONO , � PERMIT TYPE: �;t;��;;��,��;
' 1335 Brown Rd. South • P.O. Box 66 Permit Number: t-'+-':�`�`,{-!
Crystal Bay, Minnesota 55323 Date Issued: ��=�'='''�?`_�_
(612) 473-7357
SITE ADDRESS:
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REMARKS:
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CONTRACTOR: — ������ ����=t� � OWNF�R•.
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APPLICANT'PERMITEE SIGNATURE ISSUED BY:SIGNATURE �1
/ �
' CITY OF ORONO - BUIZDING PERMIT APPLICATION
Total Fee: $ / � ; . Date Received:1`.�_� - % �-
Date Approved:
Entered By: �
Permit�: '� �} � `
A�L INFORMATION MDST BB SIIBMITTSD IN FDLL BEFORE PLAN REVIEW WI7�L B$ STARTED
(See Check-off List Enclosed)
------------------------------------------�===_�--=�--------------------------
THE APPLICANT IS: (circle one) OWNER o��ONTRACTOR�
JOB SITE ADDRRSS: ���`�� (-� 7l�"��.��i ���°� ��� � �('t� F.:�I ZIP: � � �� /
(work) `,����' �`f�
NAML OF OWNER: � �L? ;��� PHONE: (home) 7�I "���� �
MAILING ADDRESS: � �� ' � "t i � '� ��. �� �'� CITY: � �� � /���� ZIP: .;� ��� � �
�
CONTR�CTOR:���� �i���' /j ,�� � .�"�r i� �i'' N �`� paorrE: ,��`� c i `�����-��
�f s
MATzzxc �nnr�ss: �, ;; �%� 7��{�1���J �= J ,+�U-.�cz�: � t�n1 r y�^`'�n. zzP: ��S� ���
STATS LICENSE: � r � �� '
ARCHITECT/ENGINEER: � PHONE:
MATLING ADDRBSS: CITY: ZIP:
NAME: RBGISTRATION �
TYPE OF WO New Addition Accessory Structure Move
Demo �. Remodel/AlterationJ-� Renovate Land Alteration
PROPOSED WORR (describe in detail) : �A I�E ���`�PU�S G t,�"f', r�l'���'� �x�C �f`'���_
Ot,v�(;� ���� ���\ i �l'�-� �j ��"�� ;�s, -� � � �5�. ��1S�C� ti
STORIES: � SQ. FEBT OF EACH FLOOR: �
NO. OF B$DROOMS: ? GARAGS STALLS: ATT. � DET.
�t �
ESTIMATED CONSTRIICTION VALIIATION (eaclnding la.nd) : $ � �� '��' �" r �'�`
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 wil 1 be in accordance with the appro d plan. . • '
t � - �r� ` ✓, `�
A.PPLICANT S SIGNATDRE': /ti� � � DATE: / .
�
� ` CHECR OFF LIST FOR ISSIIANCE OF PERMITS
� FOR OEFICE USE ONLY
ADDRESS OR LEGAL: / � / �� ° y=,x•� � - K�'PID: �.J�`� '' �� �" � -3 /`� l''C.'C% Z
DESCRIPTION OF WORR: C.y�A�y(�� Ff�-o✓►1 5�-2��s � �� �v,Daws i� Po2�H
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ZONING REVIEW BY: N�� DATE APPROV$D:
BIIILDING REVIEW BY: �� � ' DATE APPROVED: : Z -y`� ' r7 Z
----------------------a -----------------------------------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT , Yes J No
PLAN REVIEW Yes�No SEWER CONNECTION
STATE SURCHARGE Yes� No WATER CONNECTION
INVESTIGATION FEE Yes No� PARR FEE
SAC Yes No�� SITE INSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECR LIST Zoni g District:
Fire Department: Post Of�ice Sc�hool. istrict:
i / �
Lot Area: Width: Dep�h:
�
t
;'
Survey Submitted• Y s No Dat of Survey: �'
/� �
Proposed Setbac s: ' `
Front (La ) : � �� Ric�ht Side: �
� �� 1
Rear (St eet) : Le�t Side: �
� ,
% i
Adjacen Struct�res: F �letland:
I i
Building He' ght: De� . Hgt.+ �i Peak Hgt.
,
�
Avg. Setba � `� �� Lo�/ Coverage:
xisti,hig ,-Proposed
,
; ; ; __------
Hardcover. 0-75 ' ` � '
/ '� �,
75-250 ' �
;
250-500 ' �� ,�
I '/ '
� , /
5oo—i000 � ' ,
Hardc ver Variance e uired�/ Yes;� No Date of Council Approval:
,
Grad ' g: Staff Appr aI. Dat1'e:_ � By: Council Approval Date:
/
Sep ' c: Staf f Appr al. Da�e: BY=
i �
Zon ng Fi�e: # /Reso ution �: Reso].ution Date:
i
S (in house) ' �
�
BIIILDING REVIEW CHECR LIST " A
IIgC: �� R-3 CONSTRIICTION TYPE: -�Al-
Sq Footage $ Per Sq Ftg
Basement X =
lst Floor X -
2nd Floor X =
Garage X -
x =
TOTAL
Esti_mated Construction Value: $_� D�O o"
Inspections Rern�ired: Work Requiring Separate Permits:
Site P].umbing Grading/Fil.�ing
Footing �cMechanical Fire
_�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wa�J: Board (Masonry) Lawn Irrigation
Final. (Mfg.) Other
Other Well (State Permit)
�_Electrical. (State Permit)
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RF.MARRS (IN HOIISE) :
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REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
REiKARRS (TO BE NOTED ON PERMIT) :
� �
�
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� - � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike 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 Iicense 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 Zocal, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Counci3. action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�at�
data on yourself.
6. Your ful.l name is required to process this appl.icatian or
permit.
�/��Y�.�� ,�C� :��/'� ��i�/1.��
First Middle Last
/�i:J �,��r �-'/=L� ����_`� ��� ��d
.
Address
�� � �.% �.� C.% �l� �� �_�
City State zip
.'J �� � ��`��
T�
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Phone
I understand my rights as stated above. �
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BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359
ASSESSING
---- ------- -_ �
• .- -
513.04 RIGHTS OF SIIBJECTS OF DATA
Subdivision 1. Type of data- The rights of individuals on whom the data is
stored or to be stored shall be ss set forth in this section.
Subd. 2. Information required to be given in�vi�l' An.individual esked to
� supply private or confidentiel data concernina �gm�i�in the collect ng state agency,
purpose and intended use �f the requested �b� whether he ma� refuse or is legally
political subdivision, or statewide system;
required to supply the requested date; (c) any known consequence arising from his
supplying or refusing to supply private or confidentiel data; and (d) the identity of
other persons or entities authorized by state or federal law to receive the data. This_
requirement shall not apply
when an individual is esked to supply investigative data,
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav lgrt tax re�und instructeons insteadho5
subdivision in the individuel income tax or r��e
�n those orms. . --- - -
Subd. 3.
Aecess to data bY i����L UPon request to a responsible �
authority, an individuel shall be informed whether h f VBteeor eonfidential.e Upon his
individusls, and whether it is classified as public, p u�lic data on
further request, an individuel who is the subject��ge to himrlande if he desires, shall
individu8ls shall be shown the data withou�fan�y t �ta. After an individual has been
�e informed of the content 8nd meaning the data need not be �sclosed to
shown the private data end informed of its meaning,
him for six months thereafter unless 8 d?S u�e h� b en collected or crreatedtioT�e
, � pending or additional data on Lhe indiv�d
responsibie authority shall provide copies The hresronsibler u thorityt may� requ re tthe
the individual subject of the data• P
requesting person to pay the actual costs of making, certifying, and compiling the
copies. immediately, ii possible, with any request
The responsible authority shall comply of the date of the request,
mac3e pursuant to this subdivision, or within five days
excluding Saturdays, Sundg}'S and lege uestdwlthinithat t meghe shall so nfo m the
possible. If he cannot comply with th 9 �yithin which to comply with the
individual, and may have an additionel �ve days
request, excluding Saturdays, Sundays and legal holidays.
. Subd. 4. Procediu'e when data is not a�a ivate data iconce nnng himself• To
contest the accuracy or completeness of publ�c or pr
exercise this right, an individu8l shall notify in writing the responsible authority
describing the nature of the disagre�d to be nacciu'pate or incomplete and att mpt to
days either: (a? correct the data fo
notify past recipients of inaccurate orV a�p�t he beI evesdthe datalto be correct
the individusl; or (b} notify the indi
Data in dispute shall be disclosed only if the individusl's statement of disagreement is
• included with the �isclosed date. ealed ursuant to the
' The determination of the responsible authority may be app P
provisions of the administrative procedure act relating to contested cases.
DATE � TIAQE
CITY OF ORONO CALLED IN / �- �- a- � `U�
INSPECTION NOTI E SCHEDULED /a -/G, -�1.� /� � °v ��
PERMIT NO. � �n C COMPLETED ' �
ADDRESS ��-- � ` � �G
OWN ER ��� �'��`�-'r�-.-. CONTR. �_I� ��C�'i� /J t� I ���/S
TELEPHONENO. ��� ' �� � �
� DESCRIPTION
� Ot FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q FRAMI 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
� 03 I TION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
� 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Z
Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
Q
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
Z
� COMMENTS:
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d Y�WORK SATISFACTORY:PROCEED [__ PROJECT COMPLETE
W �7 CORRECT WORK&PROCEED I ISSUE CERTIFICATE OF OCCUPANCY
O ' C1 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ,- pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR C CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
e
Call for the next inspection,�4 hour �in advance.473-7357
,�
OwnerlContractor on site: '
� . .
Inspector. '
�
White Copyllnspector's File Canary Copy/Si�Notice
DATE TIME
CITY OF ORONO CALLED IN �'3
INSPECTION NOTIC�E SCHEDULED 9� `i'3 d
PERMIT N0. - � COMP�ETED �� �l
ADDRESS �� � ��
OWNER_�<<�, �z`��n� CONTR.
TELEPHONE NO. .�� '�.�.�.5
� DESCRIPTION �,����-���� �'
t1r 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
� 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADING/FILLING
�
031NSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANOS
� 04 W L BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Z
Q 05 FINAL 13 METER SET(TURN ON 17 SiTE INSPECTION
� —SITE 14 SEWER HOOK-UP O6 PROGRESS
J 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
Q
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL. 23 SEPTIC FINAL
Q OWNERICONTRACTOR TO MEET YOU:_YES�NO
Z
� COMMENTS: � � .2 - � �
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d ,�i WORK SATISFACTORY:PROCEED [ PROJECT COMP�ETE
� [; CORRECT WORK&PROCEED C: ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING 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
OwnerlContractor on site:
Inspector. ����� ' '���' '�
White Copyllnspector's File Canary CopylSite Notice
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IDENTIFICATION OF PREMISES REQUIRED
Approved Addresses Shall Be Displayed,
Plainly Visible And Legible From The
Stfeet Fronting The Property
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REVISIONS.
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PLEKKENPOL BUILDERS
8609 HARRIET AVENUE SOUTH a I
BLOOM., MN 55420 888-2225 MN Lic #1797