HomeMy WebLinkAbout1995-006748 - renovate/remodel PERMIT
CITY OF ORONO PERMIT TYPE:
42750 K�Iley Parkway- P.O. Box 66 Permit Number: - -
Crystal E�ay, Minnesota 55323 ``� ` °'�` '�
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(612)47�-7357 Date Issued: �-3t-f�i_�'°:��-�
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATUNE �
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CITY OF ORONO - BUILDING PER�LIT APPLICATION
Tot�l Fee• $ r�� -�, ,�/� Date Received: �� J-�-�- `�S
, Date Approved:
�ntered By: � .'r> Permittt: (�- � �/ �'
AT•T• INFORMATION MIIST BE SDBMITTSD IN FIILL BEFORE PLAN REVIEW WILL BB STAR�ED
( See Check-off List Enclosed)
-------------------------------------------------------------
THE APPLICANT IS: (circle one) WNE or CONTRACTOR
JOB SITE ADDRSSS- �`��-'� ��Y I�L�i�r cG;:l�.��c, ZIP: 5� 3% �
(work)
NAML OF OWNER- C'� �Y l�-c �-�� PHONE: (home) �7/-SZ��
MATLING ADDRESS: �C'.ac,X //� CITY: /�A�'.g,<«c ZIP: SS 3�jZ
CONTR�CTOR: �� 1:J" �`�'�`y'`- PHONE: C� �3 -/o i i
MATLING ADDRESS: CITY: �`'�'-� Frt�c ���r ZIP:
STATS LICENSE: �
ARCHITECT/ENGINEEF22: PHONE:
MATLING ADDRBSS: CITY: ZIP:
gAMg: RBGISTR.ATION n
TYPE OF WORR: New Acidi_tion Accessory Structure Move
Demo Remodel�jAlteratio�' x Renovate Land Alteration
PROPOSED WORR (describe in detail) :T<� cl.�m c��✓ S�i ec� f�'� �2`'�'�• �"��``��'`�'S�r`�
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STORIES: � SQ. FEBT OF EACH FLOOR: ��Cj�`
?70. OF BRDROOMS: LI GARAGE STALLS: ATT. DET. _3
ESTIHATED CONSTRIICTION VALIIATION (eacluding land) : $ /jnc.�
I hereby apply for a building permit and I acknvwledge 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 Buiiding Code; that I
understand this is not a permit and work is not to start without a permit; and
�hat the work will be in accordance with the approved plan. �
_
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APPLICANT'S SIGNATDRE: ;'`� � �;,-�-� �"- DATE: �(J Jc-�•.-r > >
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'�' ' k ,`.;� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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'� • . � On the North Shore of Lake Minnetonka
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DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish wil. I be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may rea,tiire that
the City deny the permit or license.
3. The information may be shared with other iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii action
to approve, some information may become public.
5. Yau have certain rights under M.S. 13.04 �o review pri�a��
data on yourself.
6. Your full name is reqciired to process this aorelica�icn o�
permit.
----
..�'�t,-.-� r � ���-��- � `-'�=�Z
First Midd e Last
� �l�� �- j ��'y ��C� u;
Address
C 2c.ru� rv�2 S �3 i/
City State Zip
�(`J / �- S Z� ��
Phone
I understand my rights as stated above.
��,/C_i
Sign� ure
BUILDING&ZONING—473-7357 • ADMINISTRATION&F[NANCE —473-7358 • PUBLIC WORKS—473-7359
ASSESS[NG
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4
513.04 RIGH'I5 OF SIIgJgCTS OF DATA
Subdivision L Type of dat�- The rights e ti�viduals on whom the data is
stored or to be stored shall be as set f orth m th�s s An.individuel asked to
g�d, Z. Information r��
to be given indivi�uaL
� su 1 rivate or confidentiel data concernina 8mwi�in the collect ng state agencY,
PP Y P uested
purpose and intended use of the req tem' �b� whether he may refuse or from his
political subdivision, or statewide sys �own consequence arising
required to supply the requested dat8; (c) anY �d (d) the identity of
supplying or refusing to supply private or confidentiel data;
other ersons or entities authorized by state or federal law to receive the data. This.
p 1 when an individuel is esked to supply investigative data,
requirement shall not app y to a law enforcement officer.
pursuant to section 13.82, subdivision 5,
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individual income tax or ro ert tax re und instructions instead o
on those orms. . -— - _
Subd. 3. Access
to �ata bY in�i�� Upon request to a responsible
authority, an individual shall be informed wh bli� pr vate�or confidentiel.e UPon his
individuals; and v+►hether it is classified as p � ublic data on
� ta }urn and, if he desires, shall
further request, en individual who is the subject of stored private or
indiyiduels shall be shown the date witho of�hat da a• After an individual 1�as been
�e informed of the content and meaning the data need not be �isclosed to
shown the private date and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
- endin or additional data on the individual has a eeor p�li� �taruponarequest by
+ p g uire the
responsible authority shall provide copies of the F �ible authority may req
the individual subject oft�e actual�cos h of ma�k�ing, certifying, and compiling the
requesting person to pay -
copies. if ssible, with any request
The responsible authority sha]1 comQly immediatelY, P°
made pursuant to this subdivision, or within aa e �f Simmediateatcompliance eisunot
excluding Saturdays, Sundays and legal holi ys,
ossible. If he cannot comply with the request within that time, he shall siinforth the
P have en additional five daYs �'+►ithin which to comp y
individual, and m S turdeys, Sundays and legal holidays.
request, excluding
Subd. 4. Proced�e �►hen deta is not accurate or complete. An individual may
contest the accuracy or completeness of public cr private data concerning
himself. To
the responsible authority
exercise this right, an individu8l shall notify � ��e authority sha)1 within 30
describing the nature of the disagreement. The respo
de,ys either: (a) correct the data found to be inae a tg�i°cl dingpec pients namedt by
notify past recipients of inaceurate or incomple �
the individuel; or (b} notify the individuel that�au�Stetementof disagreement is
Data in dispute sha]1 be disclosed only if the mdi
• included with the disclosed data. � 8ppe�ed pursuant to the
' The determination of the responsible authority may
provisions ef the administrative procedure act relating te contested cases.
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DATE TIME
CITY OF ORONO CALLED IN ��3/ ��:�
INSPECTION NQT��� SCHEDULED � � % � %�- � �
PERMIT N0. << COMPLETED �� l.�
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ADDRESS � � % -c- c1'-F
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OWNER �%,. ��'.��c�' CONTR. �i,(.� ,-..0
TELEPHONE NO. ��/ - �? ,Y:!
� DESCRIPTION %���1�.r��L'i
� 01 FOQIIAIC� 11 MECHANICAL RI 18 EXCAV/GRADING/FIWNG
02 FRAMING���� �� �.713 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
U3lFSU—LATIQN' � 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Q 44 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
= OS FINAL 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEMQ—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
Q 07 DEMO—F�NAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� - CORRECT WORK 8 PROCEED - ISSUE CERTIFICATE OF OCCUPANCY
W
O C 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
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n xt inspection 24 hours in advance.473-7357
OwnerlContr r ite:
Inspector. .
White Copyllnspector's Fil Canary CopylSite Notice
v�
ATE• TIME
CITY OF ORONO CALLED IN �����-
INSPECTION NOTICE SCHEDULED i/-�L�/�J"� , •�
PERMIT NO. � COMPLETED �_ N
ADDRESS •
OWNER`'1�e��-e.-u CONTR. t
TELEPHONE NO. �7/- 7.���5�
� DESCRIPTION ��C�
� 01 F I 11 MECHANICALRI 18EXCAV/GRADING/F�WNG
� __ 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 03 INSULATIO _` 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
Z OS FINAL 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O [�:ORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 � 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.473-73�J7
OwnerlContra r n site
Inspector. -
White Copyllnspector's File Canary CopylSite Notice
DATE TIME �
CITY OF ORONO CALLED IN
INSPECTIONNOTICE SCHEDULED Z'L-SS 2�3c�
PERMIT N0. �_7�3' COMPLETED
ADDRESS 3`�6C� �tY P��C-C
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIWNd
y 02 FRAMING 13 MECHANICAL FINAL 19 LAi�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� �W BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= 05 FI 14 SEWER HOOK-UO 06 PROGRESS
F` 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
2 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContrac i :
Inspector. ��-
White Copyllnspector's File Canary CopylSite Notice
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