HomeMy WebLinkAbout1994-006332 - fire damage repair ,� : ; PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -
Permit Number: � '� �.-�:'}.��'.�
Crystal Bay, Minnesota 55323 Date Issued: '�"V'��°-'� "�' �
(612) 473-7357 ,',��:����;�;��t�;
SITE ADDRESS: �
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APPLICANTPERMITEESIGNATURE ISSUEDBY SIGNATURE � �
y� '`' CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $��� Date Received:
Date Approved:
Entered By: '�(°� ( 33
Permit�: „ .2,
ALL INFORMATION MDST BE SIIBMITZ� IN FIII�L BEFORE PLAN REVIEW WII.L B$ STAR�D
(See Check-off List Enclosed)
----------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRSSS: � �o t�l �G���� �� t � � ZIP: 5�37�0
(work) �73-(�`1"�
x� oF owrlEx: l,t� �,(.�,,�� S y�21� PsorrE: (h ome) �1�J-►3��
HAILING ADDR.ESS: �1� ��Q�'-1 � CITY: l�- ZIP: �j���
CONTRACTOR: �� B-�� � '�--� PHONE: ���l� l�
MAILING ADDRESS: I��Oo �j7��'"� �-Q � u, CITY: P��y�e�t,l"� ZIP: ��7��� _
STATS I.ICENSE: $ ��'0 Z�10
ARCHITECT/ENGINEER: ��-- PHONE:
MAILING ADDR$SS: CITY: ZIP:
N�: RBGISTRATION u
TYPE OF WORK: New Addition Accessory Struczure Move
Demo �t Remodel/Alteration Renovate_� Land Alteration
PROPoSED WORR (describe in detail) : ►� � �� �� ' �'"� l��" la ���/
,�� �. `���Q..w.c� � cj�t.��� � �cC�.Q �>I�¢�l,o e�. � �t.�l t/l.��l u�
STORI$S: � SQ. FEBT OF EACH FI�OOR: �d`�� �
NO. OF B$DROOMS: ,� G�G$ STALLS: ATT.�_ DET. x
- o�
ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $ �O� o-� �
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the wor3c 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 wiI 1 be in accordance with the approved plan. •
1 DATE: � (SC�t
APPLICANT'S SIGNATURE:I���-�'� � _I �
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� -� t � ��� �, �T CITY of ORONO
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�'� " �' � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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� _ .�� ��� : On tJxe North Shore of Lake Minnetonka
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
].icense f rom 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 wi3.1 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 iocal , state or
federa3. agencies to the extent necessary to process the permit or
3icense.
4. If your requested permit or Iicense requires Councii action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review pri�a��
data on yourself.
6. Your full name is required to process this applicatian or
permit.
�,.� � , i�E���
First Middle Last
l�`� �z�� � r.��.
_ �
Address
�t��n.�,.. M rJ ��i ��k�
Ci—y State Zip
��7� ' � � ��
Phone
I understand my rights as stated above.
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Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • P[,'BLIC WORKS—473-7359
ASSESSING
--- — � ' �
�.� �G� �g �g�JEC15 OF DATA
Subdivision L T9Pe
of date- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section. An.individual asked to
Subd. 2. Information requir�
to be given in�vi�uel.
� 1 rivate or confidentiel data concernin a�amW hin the collecti g state gency,
supp y p
purpose and intended use of the requested
tem; (b) whether he ma� refuse or is legally
political subdivision, or statewide sys �c� any �own consequence arising from his
required to supply the requested date;
1 rivate or e°or�federallaw to receive the data.1tThis_
supplying or refusing to supp Y P Stat
other persons or entities authorized by 1 investigative data,
requirement shall not apply when an indi�viaia en orcementuo f lcer.
pursuant to section 13.62, subdivision 5,
The commissioner of revenue ms lace the notice re uired under this
subdivision in the individuel income tax or propert tax re und instructions instead o
on those orms. � -
Subd. 3. Access to data by
����L Upon request to e responsible
thorit an individuel shall be informed whe bliC h rivateeor confident al.e Upon his
au Y+ ublic data on
individuals, and whether it is classified as p �
�t8 with�ut any charge to him and, if he desires, shall
further request, an individu e who is the subject of stored private or
individuels shall be shown th of that data. After an individual has been
�e informed of the content end meaning the data need not be c�isclosed to
shown the private data end informed of i� uteorgaction pursuant to this section is
him for six months thereafter unless a �Sp n request by
' 'n or additional data on the individuel h� ate or public datarupoeated. The
, pendi g rovide c�pies of the pr require the
responsible authority shall p The responsible authority may ilin the
the individual subject of the data• certif n and comp g
requesting person to pay the actual costs of making, Yi g�
copies. 1 immediately, if possible, with anY re9uP`r
The responsible authority shall comp y
made pursuant to this subdivision, or within five daf slm�e�gteat�ompliance eisu the
excluding Saturdays, Sundays and legal holideys, with the
ossible. If he cannot comply with the request within that time, he shall so inform
P have en additional five days within which to comply
individual, and may �d le al holidays-
request, excluding Saturdays, SundaYs g lete. An individual may
Subd. 4. Proced�e �►hen data is not accurate or comP �mself. To
contest the accuracy or completeness of public or private data concerning
exer
cise thi.s right, an individuel shall notify 1 es rns�b etauthorty shall w thin 130
describing the nature of the disagreement. The r
da either: (a) correct the data found to be inac a tge including ree�Pi�� ngm at by
�
notify past recipients of inaccurate or incomplete + eement is
the individual; or (b) notify the individual that ha �Slstatementof disagr �orrect.
Data in dispute shall be disclosed only if the indivi �u�t to the
• included with the disclosed data. be gPpegled p
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases•
-t CHECR OFF LIST FOR ISSIIANCE OF PERMITS
"� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: '� �����-=0���'�/ If t L-L PID:
DESCRIPTION OF WORR: /C�2(:; �i41-^^A-G� /'���r�
------------------------------------------
ZONING REVIEW BY: /d/��� DATE APPROVED:
BIIII.DING REVIEW BY: DAT$ APPROVED: �f-/,5 -c1 y
-------------- -----
-------------------------_-------------------
FEES TO BE CHARGED: Misc. Fees Calculated By.
PERMIT Yes V �o
PLAN REVIEW Yes No r� SEWER CONNECTION
STATE SURCHARGE Yes� No WATER CONNECTION
INVESTIGATION FEE Yes No ✓�/ PARK FEE
SAC Yes No �/ SITE INSPECTION
Number of SAC Units OTHER (specify)
------------------ g
ZONING CHECR LIST Zonin District:
Fire Departme Post ffice: School istrict:
Lot Area: Width• Depth:
Survey Submi te : Yes No Date of urvey:
Proposed Se bac s:
Front Lake : Right S de:
Rear Stree ) : Left S de:
Adja nt St uctures• Wet nd:
Building eight: Def . gt. eak Hgt.
Avg. Set ack: Lot C verage:
Ex sting Pr posed
Hardcov r: 0-75 '
75-250 '
250-500 '
500-1000 '
Hard over Variance equired: es No Date of Council pproval.:
Grad ng: Staff Approval Date: By: Council App oval Date:
Sept�i c: Staf f Approva7. Date: ' BY=
Zoning File: # Resolution # : Reso�ution Date:
REMARKS (in house) :
BQII,DING REVIEW CHECK LIST �'. _
Y
IIBC:
2 ' 3 CONSTRIICTION TYPE: ,f�
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X =
2nd Floor X -
Garage � X -
x =
TOTAL
�
$stimated Construction value: S 3�? O�
Inspections Required: Work Requiring Separate Permi.ts:
Site Plumbing Grading/Fil�ing
Footing Mechanical. Fire
�Framing Septic Water Connection
�Insulation Fireplace Sewer Connection
WaJ�l. Board (Masonry) Lawn Irrigation
�Final (Mfg.) Other
Other Well (State Permit)
�Electrical. (State Permit)
----------------------------------------------------
REMARKS (IN HOIISE) :
--------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access : Existing New
Access Approval: Date BY=
--------------------------------------------------
�2F.JrtARRS (TO BE NOTED ON PERMIT) :
/�' DATE TIME
CITY OF ORONO CALLED IN '7� 3--y
INSPECTION NOTICE SCHEDULED ��.3 r"��
PERMIT NO. �aJ�–�,�� COMPLETED k ''�
ADDRESS / � ``���'�-� %�c�'
OWNER CONTR. �S�
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLINO
y 02 FRAMING 13 MECHANICAL FINAL 19 LAi�SHOREJWETIANDS
� NSUTATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 12 WATER HOOK-UP 17 SITE INSPECTION
Q �
Z 05 FINAL 14 SEWEFi HOOK-UO 06 PROGRESS
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Z 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. -, pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CA�L TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContract
Inspector. �-
White Copyllnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN 4
INSPECTION N TICE SCHEDULEO y'� '���
PERMIT N0. �� 2— COMPLETED V� �+l
,
ADDRESS
OWNER CONTR.
TELEPHONE �O. �S� �/'�/ 7
� DESCRIPTION �,Q.,(n�r�r�Cs
� 01 FOOTINCa 11 MECHANICAL RI 18 EXCAV/GRADING/FILLINd
gf� 13 MECHANICAL FINAL 19 LAY�SHORE/WETIANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq yyqLL gp, 12 WATER HOOK-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UO 06 PROGRESS
� 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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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 f 1 CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARFiANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContra on i :
Inspector.
White Copyllnspector's ile Canary Copy/Site Notice