HomeMy WebLinkAbout1998-011072 - addition PERMIT
` �ITY OF ORONO PERMIT TYPE:
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2�0 Kelley Parkway- P.O. Box 66 Permit Number:
, Cry:lal Bay, Minnesota 55323 '-'� ;`-'.'�
(612) 4�73-7357 Date Issued: v
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SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: -. r;�=�:�; ; ;-;;�,-�t. -
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PPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE � �'
. Total Fee: $ /�jQ.,C'� Date Received: ��/.3/�r'
Entered By: l'� Permit#: ��� �1-z--�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan re�-iew w�ll be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: /��S�—�/i/��-� ��'�Cl�' ZIP: �S>�j/
NAME OF OWNER: �f}/YI�'S ft-, S�c.�'Y,()�'� PH01�TE: (home) 5�73���/%
(work) ��u�O�-�'��s�y
MAILING ADDRESS: /� kS��'�1-��/-f-�'� � A�(-�ITY:C��C�'��7�1 ZIP: S S >9/
�
CONTRACTOR: PHO�TE:
CONTACT PERSON: 1�70BILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHOYE:
NIAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition •� Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � ��%�/-�-C��
STORIES: �_ SQ. FEET OF EACH FLOOR: � ��
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ����� �-�
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 be i ordance with the approved plan.
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APPLICANT'S SIGNATURE: , � ���C ' ��� DATE: /� � � �`�'
�
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 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the dara is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given indi�idual. .an indi�idual asked to supply private or confidentia(data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data u i[hin the collecting state aeency, political subdivision,or statewide
system;(b)whether he may refuse or is IegaUy required to supply the requested data;(cl any known consequence arising from his supplying or
refusing to supply private or confidenrial data;and(d)the idenriry of orher persens or entides authorized by state or federa!law to receive the data.
This requirement shall not appty when an individual is asked to supply imesrieative daca, pursuan[to section 13.82, subdivision 5, ro a law
enforcement officer.
The commissioner of revenue mav place the noace requirzd under this subdi�ision in the individua(income tax or prooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request co a responsible auchoriry, an individua(shall be informed whether he is the
subject of stored data on individuals, and whether it is classified as public, prnate or confidential. Upon his further request,an individual who
is the subject of srored private or public data on individuals shall be sho«n rhe dsta wi[hou�any charee to him and, if he desires, shall be informed
of the content and meaning of that data. After an individual has been shown�he privatz data and informed of its meaning, the data need not be
disclosed to him for six months thereafter unless a dispute or action pursuan[to[his secrion is pendin;or additional data on the individual has been
coilected or created. The responsible authoriry shall provide copizs of the pri�ate or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pa� �hz actual costs of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately, if possiblz,witi'�any request made pursuant ro this subdivision,or within five days
of the date of the request, excluding Saturdays,Sundays and leeal holidays, it immediate compliance is not possible. If he cannot comply with
the request within that time, he shall so inform the individual, and may ha�: an additiona(five days within which to comply with the request,
exc(uding Samrdays, 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 conceming himself. To exercise this right, an individual shall nooiy in wri[ing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either. ia)corrz��[he data found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incomplete data,including recipients named b} the individual;or(b)notify the individual that he believes the da[a
to be correct. Data in dispute shall be disclosed only if thz individual's statement of disaereement is included with the disclosed data.
The determination of the responsible authoriry may be appzaled pursuant[o thz provisions of the administrative procedure act relating
to contested cases.
DATA PRI�'�CY .�.DVISORY
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 an}� 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 license
requested.
2. You may refuse to supply data, but refusal ma� 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. 13.0� (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
����S ��o,F�if/'�' ��S�.QC/�
First Middle Last
/ � ����' / Ti��--� l�/J�
Address �
l�C��t����� i�,c� .�S.�>/ ����- ��C
Ciry State Zip Phone
I u derstand y rights as stated above.
' �/���'� (. � r L/�e�
/LC �
Signa e
6
CHECK OFF LTST FOR ISSUANCE OF PER�I�iITS
� FOR OFFICE USE ONLY
' ADDRESS OR LEGAL: l� �5 �-!L R�T rac,C. �v�+�` ' .
PID:
DES CRIPTION OF WORb: ,�r�,� ,,�o„� �
ZO�TiYG REVIEti'V BY: � (��_ � � DAT'E APPROVED: � Z- � -`1� `-
BUII..DliYG REYI.Eti'Y BY:. � . DATE APPROVED: �L-fh-.9�
�'EES TO BE CHARGED: - � � Misc. Fees Calculated By:
P�cRMIT _Yes �/`' No .
PLAN REV�� Yes ,/� No SEWER COVNECTiON
STATE SUR`H�RG�, Yes r/ No ti�ATER CONNECTION
TivVESTIGAZZON-FEE Yes No PARK FEE
SAC Yes No SITEINSPEC�ION
Number of SAC Units ��OTHER (specify)
�ONI3�'G CFiECK LIST zoning Districc: L2- l 1� � ~
Fire Department: (;o,�� L.A�1c.G Post Office: �..� U�tc.e School District: _�Ror.�o �
Lot Area: Sq.ft. �{2�337.� Acres .9� �Vidth 1�$1.e� h,t�. Depth _�3 Z.:'�`� �4 ve �
Survey Submitted: Yes p� No Date of Survey: S-l o-�(o
Proposed Setbacks:
_ Froat (�'ce7: . (35 _..__Rigfi2 Side: �1 ' t. . _ _� _ '
Rear (S�tettj: sS� Left Side: �(,v t
Adjacent Structures: (�r���.��-,r� tiVetland: �s r
Buildino Heioht: Def. Hgt. 4 k. Pea.k Hgt. O•1�.
Lot Coveraoe: �i�lo
GradinJ: Stafi Approval Date: ^ . By: — Council Approval Date: -'
Septic: Staff Approval Dace: -- gy; -- .
Zoaing File: � � -- Resolution: � '— Resolution Date:� — •
Shoreland Dis�-ict: ' /Uv
Avg. Secbac?c: Bluff Setback: LotCove�age: � _
' • Existin� Proposed �
Hardcover: 0-75'
75-250' • � '
250-500' . •
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
�
RE1�L?�RKS ('in house):
? � _ . - .
. ' ��:� � .26 •
BUILDIlVG REYIE� CHECK LIST . . .
UBC: . R • 3 CONSTRUCTTON TYPE: � �
� Sq FootaJe $ Per Sq Ft�
. Basemen[ X . - _ - _
.. . . lst Floor . � . - X . . . .
2nd Floor . . . _. _ . .
• . .x .. . � . . � �
Gara�e - X — . . , ,
x —
TOTAL
Estimated Construction Value: � � � ��0 0� .
— Inspections Required: • Work Re uirine F
Site 9 b Se arate Pecmits:
Piumbing Fire . �
Hardcover RemovaI -
OC Footin� Mechanical Water Connection .
oC Framiuo Septic Sewer Connection ' .
Fireplace �� �Q
_f�Insulation _. �ation
_�, Wall Board �aSO�Y) Other . � .
.ti F�� � �1f�'� Well (State Permit) �
Other Gradin�/Filling _�_Electrical (State Perm.it)
. REiI�ARhS (IN HOUSE): � ----------- � -
-------------------- �
-----------
REVIEtiV BY OTHERS: ----- -
� - -----
DATE: -----
Access: Eziscin� Netv -
-- —_
• Access Approval: Dace .
-------------------------------- By�
REi1�IAR�'S (TO BE NOTED ON PERitiII'T); � . -
� � � . . .
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e.M./���ores B��chrl�a,r, � ^,,'"� G ,
,� �. .E Pi•o,o. Line.Ext ` �� �� -
I HEF.EBY CERTIFY THAT TfIIS IS A TRUE AND CC�:tItLCT REPRE:F.�ITATION
OF A SURVEY OF THE BOUNDARIE;: OF:
LOT 4, BLOCK 2, FOXHILL
.
AND OF THE LOCATION OF ALL BUILDINGS, THERF:ON, AhD ALL VISIIILE
ENCROAC1�lII�1'I'S� IF I�NY, FROM OR ON SAID LAND. AS SUAVEYF:D BY
ME THIS lOth DAY OF MAY 1966. -,�. ��'-
,-.
Revised To Show ProQos�d J ^� �' � ���~"`�-y• �
Novse 1.•3-ll .. i: /�' �:.�,�ts. � •.i•• , ,,� i ,
Land Surveyor Minn. Fieg. No. 7979
/��COMB,S' - ,�i�/U TSo�c/ /�SS o ci,4 TC5 /,�c.
E�y�i�t�ars---�'t✓i-��yiors .
DAT TIME
CITY OF ORONO CALLED IN ������
INSPECTION NOTICE SCHEDULED //oZ-Z�99 /D 'C��
PERMIT NO. / �� COMPLETED `L��
ADDRESS �
OWNER CONTR.
TELEPHONE NO. � �.� - �C���
� DESCRIPTION ��
l� 01 FOOTING 11 MEC ANICAL RI 18 EXCAV/GRADING/FILLING
� FRAMI 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORKSATISFACTORY:PROCEED G PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
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� �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
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next spection 24 hours in advance.473-73�J7
OwnerlCon n ' e:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice
DAT- � �J TIME
CITY OF ORONO CALLED IN �o� " '�1c� D .� 7Q ih
INSPECTION NOTICE SCHEDULED % - � �L"z)Cd/y1
PERMIT NO. ��/�� COMPLETED
ADDRESS , J �
OWNER � ONTR.�iJ'/�C1 �„L�-1.�:��,/�/�LD
TELEPHONE NO. ���� �O�-'�.::�
� TION ��� ���-�-
1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLA�NT
J 07 DEMO-FINA� 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� WORK SATISFACTORY:PROCEED C PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN �
�' CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContra r 't :
Inspector. �
White Copyllnspector's File Canary CopylSite Notice
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