HomeMy WebLinkAbout1996-008665 - finish space/garage �- PERMIT
� CITY OF ORONO
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE:
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Permit Number: .�;;;;�;�._:;,�
Crystal Bay, Minnesota 55323 - =- - - -
(612)473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR• _.. >,_�;:�i. =. __:;��;. -... - .- . �..r._�. OWNER:
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A ICANT/P ITEE SIGNATURE ISSUED BY:SIGNATURE -�
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� Total Fee: $ __%��i�, (�'�1 Date Received:
Entered By: ,��-� Permit#: �%��- �s
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CITY OF ORONO - BUILDING PERNIIT 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 CONTRACTOR
JOB SITE ADDRESS: a,Z�S , �� � �^�^�" ZIP:
NAME OF OWNER: ��'�� PHONE: (home)
i (work)
MAILING ADDRESS: ;�?.S� ��,,CITY: ZIP:
�
CONTRACTOR: J � �� PHONE: `�?� --0 6 ?l
CONTACT PERSON: ., MOBILE/PAGER: �7�-�s s.�
MAILING ADDRESS: •7; � �,.�,� �,�. CITY: � ZIP: .S�3� �
STATE LICENSE: # �3 q y
ARCHITECT/ENGINEER: �(��'���'% PHONE:
MAILING ADDRESS: CITY: ZIP:
NAl'V�; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detai�: ,-a-�o� w�• ��✓' U
STORIES: �_ SQ. FEET OF EACH FLOOR: � y�
NO. OF BEDROOMS: '> GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /`�a-�v � _
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 Ciry 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: !� �3 9 d�
NOTE! Parade of Homes events require separate pernzit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
6
� '
Sec.13.04 RIGH'I'S OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data wi[hin the collecdng'stace ageocy, poliacal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requestzd data;(c)any Imown consequence arising from his supplying or refusing to suppty
privace or confidendal data;and(d)the idenriry of other penons or enddes auehorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigauve data, pursuan[to secaon 13.82, subdivision 5, co a law enforcement officer.
The commissioner of revenue ma� place the notice 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 authority,an individual shall be informed whethet he is[he subject
of stored data on individuals, and whecher it is classified as public, privaee or co�dential. Upon his further request, an individual who is the subjecc
of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content
and meaning of rhat data. After an individual has been shown[he 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[he individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon reques[by the individual subject of the data. The responsible au[horiry
may require the requesting person to pay the actual cosu of making, cemfying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the requesi,excluding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the reques[
within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal ho(idays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accumcy or completeness of public or private
data conceming himself. To exercise this right,an individual shall no[ify in writing[he responsibie authoriry dzscribing the nature of the disagreement.
The responsib(e authority shall within 30 days either: (a)correc[the data found to be inaccurate or incomplete and atcempt to norify past recipients of
inaccurate or incomplete data, including recipiencs named by the individual; or(b) notity the individual that he believes the data to be correcc. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinacion of the responsible authority may be appealed pursuant ro 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 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 may require that the City deny the pernut or license.
3. The information may be shared with other local, state or federal a�encies 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.
j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
E. Your full name is required to process this application or permit.
Firs� r � !/�Q �
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7�z �l�� I��`
Address
[h w� �ws f �n /Ldr.� S�3/'� ��'j0—UL-. 7/
��n, State Z�p Phone
I understand m rights stated above.
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Signatu
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� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z� �A�v4Nv4RK DR
PID:
DESCRIPTION OF WORK: �,,,,�SH s��c� c9.�.�e,� Ca a1L��
T
ZONING REVIEW BY: DATE APPROVED: N tA
BUILDING REVIFW BY: DATE APPROVED: �z-3►,q�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes ✓� No SEWER CONNECTTON
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTTON
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District:
Fire Department: Post Offce: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
�. Lot Coverage:
� Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500'
S.�-1��
Hazdcover Vaziance Required: Yes No Date of Council Approval:
REMARKS(in house):
10
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BUII.DING REVIEW CHECK LIST
UBC: �Z-3 CONSTRUCT'ION TYPE: �E�
Sq Foota�e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gazage X =
R =
TOTAL
Estimated Construction Value: $ ( `'� 'S�O
Inspections Required: Work Requiring Separate Permits:
Site � x��� Fire
Hardcover Removal oC Mechanical Water Connection
� Footing Septic Sewer Connection
_� Framing Fireplace Lawn Irrigation
p[ Insulation (Masonry) Other
_�Wall Board (Mfg.) Well (State Permit)
.L Final Grading/Filling � Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date BY�
REMARKS(TO BE NOTED ON PERMIT):
27 �
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DATE � TIME
CITY OF ORONO CALLED IN /—/C ` "
INSPECTION NOTICE /_� SCHEDULED / "� �' �
PERMIT NO. '��'�`� - COMPLETED �_ ���
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� 01 F 11 MECHANICAL RI 18IXCAV/ORADINO/FIWNO
�Q 2 FRAMINO`, 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 0.3 INSl7[71T1�N 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq yyq�,�gp, 12 WATER NOOK-UP 17 SITE INSPECTION
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� 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMd—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBIN(i RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBINCi FINAL 36 FOUNDATION REMOVAL
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❑STOP ORDER POSTED.CALL INSPECTOR
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ATE TIME
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Z 05 FINAL 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEMQ—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMO—FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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INSPECTOR WILL RETURN
❑STOP ORDEfl POSTED.CALL INSPECTOR
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❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-7357
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White Copyllnspeclor's File Canary Copy/Site Notice
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D TE TIME
CITY OF ORONO CALLED IN ' �t�- :/
INSPECTION NQTICE SCHEDULED � � ,,'/ " C '-
PERMIT NO. -� �-,-��: COMPLETED � � �
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Q 03 INSULATION 24/25 WO00 BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
� FINAL f 14 SEWER HOOK-UO 06 PROGRESS
J 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPUIINT
W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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Call for the xt i pe n 24 hours in advance.473-7357
OwnedContracto
Inspector. �
White Copyllnspector's Fik Canary CopylSite Notice