HomeMy WebLinkAbout1997-008738 - remodel PERMIT
CIT� O�ORONO PERMIT TYPE:
2750 Kel ley Parkway- P.O. Box 66 "-�,f.?�m 3`u'..�
Permit Number: t ��� �� �
' Crystal Bay, Minnesota 55323 � �' `'�'`=�_,_
(612) 473-7357 Date Issued: ;:;:;�:,;,_;,.•
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: -- : _ .. _ �.�. _ - ._ . . _.... _ OWNER:
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L � �'� /97 Pay 107.75 -, J
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APPLICANT�PER EE SIGNATURE ISSUED BY:SIGNATURE �'�'��
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' Total Fee: $ ��' ',1 '�-� Date Received:
- Entered By: ���,'_� Permit#: � ��=���
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 O CONTRACTO�-
JOB SITE ADDRESS: 'ZSSc, ��,� 4-- ZIP:
NAME OF OWNER: _`" I����r� �����,y?«�e:: PHONE: (home)
(work) =-��,� -c,�. 7�"'= -
MAILING ADDRESS: �s�; i--�,� ;-,- CITY:C�t�.:-.�:. ZIP:
CONTRACTOR: �f` ����,�ti ,�: �s -_ �� _PHONE: �1-�d -�--��-3
CONTACT PERSON:``(�F�„��5"��.L�,� MOBILE/PAGER: ��4.c: d 77�
MAILINGADDRESS: 2u7?Q( Liti:,u�:-��.TH fi�� .�;ti CITY:=�;�.�; r ZIP: ���:
STATE LICENSE: # Dc��-�a-
ARCHITECT/ENGIlVEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N��; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�` Land Alteration
PROPOSED WORK(describe in detain:��-„-��,..��t..v�>., r-��-=���, t�;,..rr. (.v�'s�•�c� -'��yFei
i s "/"/ -" �� c, r / i.. �•�ij; �.Crj��� �,�'--�tr�� G.�' ..%�„ L�/�,�r ��-�5 f' /�a r� %<. �il�Nc�
�,..13�� �_��...�,i G��.�:�i� C.LiL�,t��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ (� c>��c •,
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 bej�-•a��dr �.nce ' h the,�ppzs�ved plan.
� �
APPLICANT'S SIGNATURE: _ � , DA'TE: T�c,�97
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGH'TS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as sec forth in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be infomted of: (a) the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is leeally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply
private or confidenaal data:and(d)the identiry of other persons or endries au[horized by state or fede�al law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place che norice required under rhis subdivision in the individual income tax or propertv tax refund
inscrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject
of stored data on individuals, and whecher 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 wi[hout any charge to him and, if he desires, shall be informed of the content
and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pending or additional data on the individual has been collected or creaced.
The responsible authoriry shall provide copies of the private or pubtic data upon requesc by the individual subject of the data. The responsible au[horiry
may require the requesting person to pay the actual costs of making, cerafying, 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 reques[
within that time,he shall so infornt the individual,and may have an addido�al five days within which to comply wi[h the request,excluding Saturdays,
Sundays and lega(hotidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himseff. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days either. (a)correc[the data found to be inaccurate or incomplete and attempt to norify past recipieats of
inaccurate or incomplete data, including tecipiencs named by [he individual; or(b) notify the individual that he belizves 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 determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 cercain private or
confidential information.
You are notified that:
1. "I'he information you furnish will be used to determine your qualification for the pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pernut or license.
3. 'I'he information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested pernut 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.
�1 JT'�v..�� S LJ - � ��z,��� -
First �Siddle Last
Z774I ��,i v;, y• r� �t�.�. . /l.� f�
Address
'S�. ., � 1"?L ��==� ��s �;��:��
C�n, State Zip Phone
I u erstand my righ� as sta a ove. .: I „
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Signature
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BUII..DING REVIEW CHECK LIST
UBC: � ' 3 CONSTRUCTION TYPE: �^�
Sq Foota�e � Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
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Estimated Construction Value: $ (o�,��o
Inspections Required: Work Requiring Separate Permits:
Site ,�_ Plumbing Fire
Hardcover Removal o( Mechanical Water Connection
Footing Septic Sewer Connection
_ ►� Framing Fireplace Lawn Irrigation
�( Insulation (Masonry) Other
� Wall Board (Mfg.) Well (State Pemut)
oL Final Grading/Filling � Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By�
RENIARKS(TO BE NOTED ON PERi'�1IT):
27
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CHECK OFF LIST FOR ISSUANCE OF PERMITS '
FOR OFFICE USE ONLY �
ADDRESS OR LEGAL: Z�� r= � X ST
PID:
DESCRIPTION OF WORK: j?x,-�u.��a-�-`- r iv� s N sP/�-�` �°� �/�
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ZONING REVIEV6� BY: N�� DATE APPROVED:
BUILDING REVIEW BY: DATE APPROVED: z'� • S �
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �� No
PLAN REVIEW Yes No -� SEWER CONNECTION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District:
Fire Department: Post Offce: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Q• Building Height: Def. Hgt. Peak Hgt.
� �.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By�
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
10
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CITY OF ORONO CALLED IN �� '�T '��
INSPECTION NOTICE-, ,� SCHEDULED �-� " � � � "�
PERMIT N0. �S � �� COMPLETED 3' �� �1 �' ��-'
ADDRESS ;_-�'�C-' �`� �Sfi
OWNER I�'I Ql /�l i�X�g�._ CONTR. � � � �-Y��-�.
TELEPHONE NO. ��L r � �
� DESCRIPTION
� 01 FOOTINO 11 MECHANICALRI 18EXCAV/dRADINO/FIWNO
�Q �2 FRAMI_ NG_ 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
0 - INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq yyqLL gp, 12 WATER HOOK-UP 17 SITE INSPECTION
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= pg F�ryq� 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEMQ—FINAL 15 SEPTIC INSTALL 72 FOLLOW-UP
= 09 PLUMBINQ RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d E�WORK SATISFACTORY:PROCEED - PROJECT COMPLETE
� ❑ CORRECT WORK&PROCEED G ISSUE CERTiFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
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 Copylinspector's File Canary Copy/Site Notice
CITY OF ORONO CALLED IN 3�T�J 7 TIME
INSPECTION N TICE3 SCHEDULED ����/P'7 �� � O c�
PERMIT NO. � �� � COMP�ETED �_ �L�
ADDRESS ��s S�� C� � c�� �J�t �
OWNER -�//���"�O��a�--- CONTR. ���.� .
TELEPHONE NO. �`fG' - '� 7 7 � ,
� DESCRIPTION ���,���c,f'i
� 01 FOOTINO 11 MECHANICAL RI 18 EXCAV/�RADINC3/FIWNQ
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q p3 Iy$� 24l25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL t4 SEWER HOOK-UO O6 PROGRESS
F` 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
�Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVEfl REMOVAL
v 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d WORKSATISFACTORY:PROCEED _- PROJECTCOMPLETE
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� ❑CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
� O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � PHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the t i s ction 24 hours in advance.473-7357
OwnerlContractor sit
Inspector. "
White Copyll�spector's File Canary Copy/Sfte Notice