HomeMy WebLinkAbout1997-008964 - addition PERMIT
ti�ITY` OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 :•:: e�; s: ;;�ui=
Crystal Bay, Minnesota 55323 Permit Number: .`.V.-�-��
+�;':�;-;�-+;-.:
(612)473-7357 Date Issued: .. = - .-•
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SITE ADDRESS:
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FEE SUMMARY: _
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APPLICANT%PERMITE GNATURE ISSUED BY:SIGNATURE
Total Fee: $ ;� t: _ Date Received:,���/��
Entered By: - ,' Pernut#: �";�' �f
CITY OF ORONO - BUILDING PERIVIIT 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) WNER R CONTRACTOR
JOB SITE ADDRES5: 3S—tf,s"� � .� i�1 ZIP: ,�3 7 f
NAME OF OWNER: J G ��—' U �vbar PHONE: (home) `f 7l— 7/ Y�
(work) �f?j—OS3'Z
MAILING ADDRESS: � ��.�'v y �/ CITY: O/'a�.�,--- ZIP:�S'��
CONTRACTOR: lj 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 detai�: r • � �o��
—���
STORIES: SQ. FEET OF EACH FLOOR: 3 Z�
NO. OF BEDR OMS: GARAGE STALLS: ATT. DET.
ed
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �j�c9 a�
I hereby apply for a building pernut 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 accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE:
NOTE! Parade of Homes even require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
,
Sec.13.04 RIGHTS OF S[JB.T�CTS OF DATA
Subd. 1. Type of data. The rights of individual oa whom the dara is stored or to be sto�ed shail be as set forth in rtus secaon.
Subd.2. Information required to be givea individual. An individual asked to supply private or co�dential data concerning himself shall
be informed of: (a)the purpose and incended use of the requested data within the collecdng'state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse or is legally roquired to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidenaal data;and(d)rhe idenury of other persons or endries authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgaave daca, pursuan[to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the nodce required under this subdivision in the individual income tax or aroaertv tax reCund
instcucrions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsibie 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 co�dential. Upon his furrher request,an individual who is the subject
of stored private or public dara on individuals shall be shown the data wirhout any,charge to him and;if he desues, shall be informed of the contenc
and meaning of that dara. After an individual has been shown the priva[e data and informed of ics meaning,the data need not be disciosed to him for
six months t}iereafter unless a dispute or action pursuant to this section is pending or additional data on the individual 6as been collected or crea[ed.
The responsible.authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible au[horiry
may require the requesring pe�son to pay the actual coscs of making, certify'►ng,and compiling the copies.
The responsible authoriry shall comply immedia[ely,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Samrdays,Sundays and legal holidays,if immediate compiiance is not possible. If he cannot compiy with the reques[
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with[he 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 oc private
data concerning himself. To exercise this right,an individual shall norify in wriring the rosponsible authoriry describing the nature of the disagreemenc.
The responsible authoriry shail within 30 days either: (a)correcc the data found to be inaccurate or incomplete and aaempt to nodfy past recipients of
inaccurate or incomp(ete data, inciuding recipients named by the individual;or(b)noafy the individual thac he believes the data to be coaect. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinarion of the responsible authoriry may be appealed pursuant to[he provisions of the administraave procedure act relaang 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 fumish certain private or
confidential information.
You aze notified that: r
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 pemut 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
v
Address
�/� — n—Cr--
C��, State Zip Phone
I understand my rights as st ed a ove.
Signatur
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 S�i S �►y P l.�c�:
PID:
DESCRIPTION OF WORK: r{�p� n on1
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ZONING REVIE� BY: � DATE APPROVED: ,5- '7- �?
BUILDING REVIEW BY: DATE APPROVED: 5-7-5 7
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes ✓" No SEWER CONNECTION
STATE SURCHARGE Yes ✓ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District: G.R-/C
Fire Department: yhoUN�p Post Offce: wAyZ,4 tva- School District: ;�;�5�•�n1=��
Lot Area: Sq.ft. �Vp cN�QAcres Width Depth
Survey Submitted: Yes�_ No Date of Survey: '3' Z?- � �
Proposed Setbacks:
�t (Lake): t OZ� '� Right Side: !35 � 5
B.�ar (Street): ��•%' '� Left Side: N�i'�
Adjacent Structures: A��r�ect Wetland: N��"
Building Height: Def. Hgt. p, �L Peak Hgt. p,��,
Lot Coverage: c9�k--
Grading: Staff Approval Date: By: Council Approval Date:
�U� Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: ��5
Avg. Setback: jJ'i/-�- Bluff Setback:
Existing Proposed
Hardcover: 0-75'
75-250' �.� 2`1.S
250-500'
SOO-lOOO'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
10
BUII..DING REVIEW CHECK LIST
UBC: IZ - �3 CONSTRUCTION TYPE: VIJ
Sq Footage S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
o.
Estimated Construction Value: $ 3 c�! 00 0 —
Inspections Required: Work Requiring Separate Permits:
Site oC Plumbing Fire
Hardcover Removal oC Mechanical Water Connection
oL Footing Sep[ic Sewer Connection
o( Framing Fireplace Lawn Irrigation
�( Insulation (Masonry) Other
o( Wall Board (Mfg.) Well (State Permit)
o< Final Grading/Filling p� Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
REVIARKS(TO BE�10TED ON PERI'�1IT):
27
FROM ', SCI-�BORGLANASI�l.E1'I t� F'HONE FdO. : 6129723221 Apr. 0B 1997 08:17�1 P�1
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DATE TIME,
CITYOFORONO CALLEDIN /�' ' .�- `l7 � � �%���%�i
INSPECTION NOTICE SCHEDULED �' - `� ' �� >
PERMIT N0. '-� COMPLETE
ADDRESS '` S�� ' -�--- �u �
OWNER �CL i'l�/��.-c—, CONTR. .���z��2�S�,._-
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TELEPHONE NO. `�� � � U<.:: 3 �
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
�Q 02 FRAMING 13 MECHANICAL FINAI 19 LAI�SHORE/WETLANDS
Q 03 INSULATION , 24/25 WOOD BURNER/FIREPLACE 34 TREE AEMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= O5 FINAL 14 SEWER HOOK-UP O6 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
� 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O Ll CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. - pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR GTATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
Owner/Contracto si
Inspector. ,
White Copyllnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN � ��' �j' °`'�/
INSPECTION NOTIC SCHEDULED ���
PERMIT NO. �� conn TEo u r� ' �'''"�
ADDRESS °��-�� `� v ^Q c!�u
OWNER ` CONTR. �l,t-�z,�:,'-s.��� �.�+,c�Z�
TELEPHONE NO. `7` �� � �', `� ���'
� DESCRIPTION ������-��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIWNG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE f1EMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= 05 FINAL i4 SEWER HOOK-UP 06 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
� 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d i_: WORK SATISFACTORY'PROCEED : PROJECT COMPLETE
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O C' CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
Owner/Contra o ite:
Inspector.
White Copyllnspector's File Canary Copy/Site Nofice
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