HomeMy WebLinkAbout1998-009879 - deck/gazebo „ •
PERMIT
C�TY C3F ORONO PERMIT TYPE: �;#��� ;;��:��
2%50 Kelley Parkway- P.O. Box 66 t;t_;�;s�:::
Cr stal Ba , Minnesota 55323 Permit Number:
y y Date Issued: ���!�='�i'_��=�
(612)473-7357
SITE ADDRESS:
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APQLICANT'PE ITEE SI ATURE � ISSUED BY:SIG URE
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, Total Fce: � '���1. /� Datc Rccciv�d: //� � !
Entered By: ,,;� Permit#: '/,y 7;�
CITY OF ORONO - BUILDING PERMIT 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 CONTRAC_TOI �'
JOB SITE ADDRESS: ��J� �—�� (L j ��(;�� f,� ZIP: �
NAME OF OWNER: "�� `�J��/�� ��� PHONE: (home) � � �4��,�
,�
(work) --�
MAILING ADDRESS: ��� ��j_,)�(�j'�'�: �ITY: (,�����j���- ZIP: :�j 1 �
CONTRACTOR: � C, `i�j.`���L /(��- PHONE: C�'� =`� �"� (� � ��
CONTACT PERSON: �f'j � � � � MOBILE/ AGER: ;- ` ��� _
MAILING ADDRESS: ' " 'L ` " " �1L- CITY.�'':�V�S ;�'��'i�ZIP:—��
STATE LICENSE: # ;
-_�.
�,.�l�.l.����1���`�L � �1�.`' �r� �.'
ARCHITECT/�NGINEER: l�`.{L. ��1k�G� CJC,�= PHONE: 4�' �..��: ��
MAILING ADDRESS.� � >� � '. �L`� l ' --�JS. CITY��%L�1u.� ��ZIP: �.5�
NAME: � �� ���_ � REGISTRATION# ��Y'�`�'`
TYPE OF WORu�• New 1�=� Addition ccessory Structure �,_��
1�. __� �".. , i
Move �--- Remodel/Alteration Zan��era�ion
PROPOSED WORK(describe in detai�: � ?(,� - L `�,�,..%
� � � ,i - � � -,� �---� -� -
� � %
i i L1-1 .��'�-- �-'� �i=
STORIES: SQ. FEET OF EACH��t: (�' .��G �°�"7 ��--
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � �
a
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conforma ce with the ordinances and codes of the Ciry and with
the State Building Code; that I underst his is n t a permit and work is not to start without a
permit; and that the work will be in ordan h the approved plan.
APPLICANT'S SIGNATURE ,. ' � . � DATE: 1— �—%�
�,.
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
. , .
Sec.13.04 RIGI-ITS OF SUB.TECTS 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,political subdivision, or statewide
system;(b)whether he may refuse or is legatly required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidenrial dara;and(d)the idendry of other persons or enrities authorized by state or federal law to receive the data.
This requirement shall not appty when an individua► is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or vrooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request ro a responsibie authority,an individual shall 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 stored private or public data on individuals shall be shown the data without any charge to him and,if he desires, shail 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 thereafrer unless a dispute or acdon pursuant to this secrion is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority 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 hunse(f. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incomplete data,inciuding recipients 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 disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 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. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
C�ty Sta[e Zip Phone
I understand my rights as stated above.
Signature
6
• ` CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �0 0� ►-{C lZ 1 TA C�t. CJ��1�-
PID:
DESCRIPTION OF WORK: I��t� t �(�Z„��3o
------------------------------------------------- ----------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: � - 9 -� �
BLTILDING REVIEW BY: DATE APPROVED: � -9 -5�8
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 Districr. L(L-I A
Fire Department: � Post Office: wqTZ,,,v.Tye- School District: ptZ.eNp
Lot Area: Sq.ft. '�(�,�d 9 3��' Acres I Width �-v 1��( k�:Depth Z t I .Z Z
Survey Submitted: Yes� No Date of Survey: �-S-?3
Proposed Setbacks: t>ec,K laA2��O p�L1� (�z�;40
Front (Lake): �� I Z5�t Right Side: /SU�� !S� ��
Rear (Street): I )Z�% �75�� Left Side: 3�� S���
Adjacent Structures: 2 ( � � f"oo( Wetland: /1���"
Building Height: Def. Hgt. /lJ (✓d� Peal:Hgt. —
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: �" f_� " ( `y By: �,'��=�=/
(�. Zoning File: # Resolution: # Resolution Date:
�'I"�
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Vaziance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW C�IECK LIST
UBC: /Z � ,� CONSTRUCTION TYPE: ��
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
3�1 (�(:sG �"—•
Estimated Construction Value: $ ,
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
�Footing Septic � Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_�Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMIT):
8
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t:,�-. CERTIFICATE � UF SUR�lEY l
����� G� RE.Q"C uoQTUE.R� RAiL�vAY � . -
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� hereby certify that this is a true and correct representa'tion
of a survey of the boundaries af :
Lot 1, Block 2 , Fox• Hi�l � ' �
' And of the loc�tion �of all buildings , thereon, and all. vi.sible
�encroachmentg , if any, from or on said land . As surveyed Dy me
this Sth day of July, 1973 . � � .
1.;. ' .�_ .
�� ��� �� �� a.n urvey r ,• Minn. Reg . No. 9086
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,•.�� P�z�AREo FoR:
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� McC�M6S-KNUTSON ASSOC(ATES, 1NC. �7 'r5 ��� Q� DG� TC2 1�S Cd•
;�.� y -`' to.�vtrn� a��u�us� ur�evrrtu�i� un ru�u��t n►�wo.
ti1ft:.:�.r�",.l.� � `._,,,
44�u�MM./�I�eMtr�or w W1�Klil Vw4�toTa �Q�
7
DATE TIME
CITY OF ORONO CALLED IN � � ;l��' "���.� _`�����
INSPECTION NOTICEi ,-. . scHEou�Eo � " �� `� .a / �''���
PERMITNO. ��`� ��� r
COMPLETED LC- E�
ADDRESS ��-C `j ��=�,._ �- <,. . . / s -
OWNER ,�c-'.-�,t�,-. CONTR. �.�>� F.,_�� f�:� fl�..,,1 �
TELEPHONE NO. -. � .�
� DESCRiPTION
���FOO_T�_IN�O,.. 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FF�fING 13 MECHANICAL FINAL 19 LAi�SHORE/WETLANDS
Q 031NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z p4 yVqL.L gp, 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z OS FINAL 14 SEWER HOOK-UP 06 PROGFESS
~ 07 DEMO--SITE 27 SEPTIC MA�NT. 21 COMPLAINT
J
Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
I
� 10 PLUMBIN(3 FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d �WORK SATISFACTORY:PROCEED - PROJECT COMPLETE
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� L' CORRECT WORK 8 PROCEED C. ISSUE CERTIFICATE OF OCCUPANCY
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� Ci CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
i;CORRECT UNSAFE CONDITION WITHIN HOURS. - pH0T0 TAKEN
INSPECTOR WIL.L RETURN
�; STOP ORDER POSTED.CALL INSPECTOR ^ CITATION ISSUED
i: INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne�t inspection 24 hours in advance.473-7357
Owner/Con on ite:
Inspector. _
White Copyllnspector's File Canary Copy/Site Notice
DAT/ p(� TIME
CITY OF ORONO CALLED IN 5 2-'/4
INSPECTION NOTICE SCHEDULED � 9� �
PERMIT NO. 9'�' 7�/ COMPLETED Z� ��
ADDRESS %��S.� /".� � �
OWNER .�CC.�� CONTR. ��'�-< ����- ��t �
TELEPHONE NO. � �-�� ` �"� a`� U S �%y�—
� DESCRIPTtON ��vj�
� 01 FOOTING� 11 M�CHANICAL RI 18 EXCAV/GRADING/FILLING
Q NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 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
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 1G PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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� i'�CORRECT WORK&PROCEED -: ISSUE CERTIFICATE OF OCCUPANCY
W
O f 1 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ,� pHOTO TAKEN
INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR . CITATION ISSUED
Cl INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlCont c r si e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
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