HomeMy WebLinkAbout1996-008484 - deck' - ]PERMIT
CITYa�F_�RONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �-;:_!T;�_i_7:tif:
Crystal Bay, Minnesota 55323 Permit Number: ;a�:}:^,_.�;_:,�
(612)473-7'�5`7 Date Issued: � :. ; . � ;,- -
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — t�F:c:,i i r�;;�t. —
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
- - - -
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Total Fee: $ ;.' � �� -� �� Date Received: c���,� %�_�.
Entered By: �, Permit#: �%f'�'r
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) ,,_OWNER OR CONTRACTOR
JOB SITE ADDRESS• `�� ` �0 �� �'�� �'��� � � A D ZIP: S�S:� C �
NAME OF OWNER: '�c�(� /1 �;�� n;,vA ��1� ��<<,c'���= PHONE: (home) u �'z "'� ��''
(work) ; _ �3�i Z--
MAILING ADDRESS: `� �`'� �t����w�U� 2�� CITY: �%'��`'L'�� ZIP: r�`3� �
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain:
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 in accor�iance with the approved plan.
� �_� C�' ��t+ �i f�
APPLICANT'S SIGNATURE: �--'' '� � f DATE:
NOTE! Parade o 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.
6
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Sec.13.04 RIGH'TS OF SUB.TECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set for[h in this secaon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting'state aeency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data:(c)any lmown coasequence arising from his supplying or refusing to suppiy
privace or confidenaal data;and(d)the idenriry of other persocvs or endaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigative data, pursuaat to secrion 13.82, subdivision 5, to a(aw enforcement officer.
The commissioner of revenue mav place the no[ice required under this subdivision in the individual income tax or propertv tax refund
instrucdons instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whecher it is classified as public, private or confidential. Upon his furrher request, an individual who is the subjec�
of stored private or public data on individuals shall be shown�he data wichout any charge to him and, if he desires, shall be informed of the con[ent
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 to him for
six months thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the individual has been collected or created.
The responsible authority 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 authoriry shall comp(y immedia[ely, 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 immediare compliance is no[possible. If he cannot comply with the reques[
within that time,he shall so inform the individual,and may have an addidooal 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 contes[the accuracy or completeness of public or private
data concerning himself. 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 attemp[to nodfy past recipie�ts of
inaccurate or incomplete data, including recipients named by the individual;or(b) notify the individual that he believes the data to be correct. Data
in dispute shall be disc(osed only if the individual's statement of disagreement is included with the disclosed data.
The detzrmination 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 pernut 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 fumish 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 [he City deny the pernut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pemut or license.
4. If your requested pernu[ 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.
�j c �» t�( AN �� �� ��
First Middle Last
�(I�'� �-F�G �u-ocp r-'c;�rD
Address -
��,��`, �M,�, S> :_: f, � y , _ ; �^ ��
Ciry State Zip Phone
I understand right�'as stated above.
'c—� _ � ��----
. �
Signantre
� ,
� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: "{iCtt� t-tti.;l-1'��==� l����
PID:
DESCRIPTION OF WORK: i����
-----------------------------------------r-------------------------------------------------------------------------------
ZONING REVIE�I BY: c�'� � �.ti DATE APPROVED: i� -� - `�b
BUILDING REVIEW BY: �,.t,,—. DATE APPROVED: ( � ti - 4 c�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes :� No
PLAN REVIEW Yes ✓'� No SEWER CONNECTION
STATE SURCHARGE Yes t/ No WATER CONNECTION
INVESTIGATION FEE Yes No ✓' PARK FEE
SAC Yes No f� SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: ���-i(3
Fire Department: �c�,v t� Post Off ce: �ti�li;�.v� School District: �,v r_�i`�,�;�;r
Lot Area: Sq.ft. 1(,�`t y Acres � 2'1 S Width ;�� Depth Z.3 `1' `1
Survey Submitted: Yes_� No Date of Survey: �Q? �-�- �7�
Proposed Setbacks: �.
�
Front(Lake): b Z� � Right Side: ZL( tl`
Rear (Street): I l��� t Left Side: i�•S :.��
Adjacent Structures: ��cl�c;�e� Wetland: 1�1 t�
Building Height: Def. Hgt. r�_ Peak Hgt. '""
Lot Coverage: ( 3 �7"�P
Grading: Staff Approval Date: �3 � �/1- By: '— Council Approval Date: �'
Septic: Staff Approval Date: �ti � �!� By: `—
Zoning File: # Zi 1;�,', Resolution: #.���L� Resolution Date: j i:�� :j `�►�
Shoreland District: �1-C `=�
Avg. Setback: ti �/� Bluff Setback: �` ��
Existing Proposed
Hardcover: 0-75
75-250' .��'',,�° �":i o
250-500'
500-1000'
Hardcover Variance Required: Yes . �- No Date of Council Approval: f b-Z3� `l(o
REMARKS(in house):
10
4 �
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BUII.DI�i 1G REVIEW CHECK LIST
uBc: (� � � co�vsTxucTTox �E: "vn�
Sq Foota�e S Per Sq Ft�
Basement x =
lst Fioor x =
2nd Floor x =
Garage x =
�c_�� ,�l? x i�-% �� _
TOTAL
c��-
Estimated Construction Value: � 1��'I Z-C
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
J` Footing Septic Sewer Connection
/� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
;L Final Gradin�/Filling Electrical (State Permit)
Other
REMARKS (Pi 1 HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REI�IARKS(TO BE NOTED ON PERI'�1IT):
27
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DATE
CITY OF ORONO CALLEo IN
INSPECTION NOT C SCHEDULED �
PERMIT NO. ��y,,�`� coMP ED �—
ADDRESS `�'V W�� �
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION C1cL1�
�OOTINQ 11 MECHANICALRI 18DCCAV/dRADINdlFIWNO
y FFiAMINO 13 MECFUWICAL FlNAL 79 LAI�SHOREJWETLANOS
Q 03 INSULATION 24R5 WOOD BURNEFi/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK�I/P 17 SITE INSPECTION
� OS FlNAL 14 SEWER HOOK-UO 06 PROORESS
�
� 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
W p7 pEMp--FINqL 15 SEP11C INSTALL 22 FQLLpW-UP
= OB PIUMBINO RI 23 SEPTIC FlNAL 35 HARD COVER REMOVAL
v 10 PWMBIN(i FlNAL 36 FOUNDATION iiEMOVAL
Z OWNER/CONTMCTOR TO MEEf YOU: YES_NO
��„ COMM NTS:
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OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECONERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP OROER POSTED.CALL INSPECTOR ❑CITATION ISSUED
O INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Cali for the next spection 24 hours in advance.473-7357
OwnerlContra r it :
Inspector:
White Copyflnspector's Fils Gnary CopylSite NoUce
QATE TIME
CITY OF ORONO (,� CALLED IN ' �C� _�� '�"L1 ��
INSPECTION NOTICE ` SCHEDULED l ( ''� I�.�f�S� �
PERMIT NO. ��� COMPLETED �"
ADDRESS f� ��� �'r 'h-�� cx`�c�. �
OWNER ��-- CONTR.���-�---
TELEPHONE NO. �—I�7 a " `��S 33
�
� DESCRIPTION ���
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
5 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
fl COMMENTS:
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTOTAKEN
�NSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL iNSPECTOR �=' CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the xt ins ction 24 hours in advance.473-7357
OwnerlContract e
inspector.
White Copylinspector's File Canary Copy/Site Notice
�C
DATE TIME
CITY OF ORONO �� �� CALLED IN ��/_9� �. G��
INSPECTION NOTICE � SCHEDULED -ZZ� � �
PERMIT NO. �� �� COMPLETED
ADDRESS 9Q '�'L'�- -
OWNER f'" C���LC'. CONTR. J�Z�'�
TELEPHONE NO. � 7� J S ��
i
� DESCRIPTION ,L,� -�-c��
l� O1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 5 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� EMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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
� OWNER/CONTRACTOR TO ME YOU:_YES_NO '
� COMMENTS: � �'n l�
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