HomeMy WebLinkAbout1996-008223 - decl PERMIT
CITY OF ORONO PERMIT TYPE:
�75d'h�11ey Parkway- P.O. Box 66 �;te;j�,�a T t�{=;
Crystal Bay, Minnesota 55323 Permit Number: i�R};_..,•�,:,
(612) 473-7357 Date Issued: - -
i}�=t%(�;;_�`_ir�
SITE ADDRESS:
It�l� LIt�Ii��i� L_r�
L'=�V
E�'. I . h�. � �:�7—f i`—;��:�:—f:�;-•��f_��i_;
DESCRIPTION:
ri�'i:�:;
E���i l��i�i�� F'���r��i t. TY��� 'w=l=—AGGIFi�h1E�I�EL
�;�a� i t�ii.�-��� W��3��:: TY�'t= C�E�.:,=::
:l�;L: l��C C#..,i���ti'Ir y �—:��
�,:�i7 i�{.i�t.�i.�•I i=+tl T j��=►�' t1�1!
���Tl 11'1'� ��;—�.��
C:}=s-r=.��s �::{�����• �.:�td t1L 1, F�E�_�I C�Efii I!i�t-
REMARKS:
FEE SUMMARY:
Vs=�i.._!1AT I��t�l �:; ,t i�ii i
���e Fe� �74 . 7�
F'��t� F�Nv��!� ���:�. �'ry
'._�i.,#t'�rt%.t]^�'? __—._-- —�`�.�.��..:.;
�'twf t.�I FeN �1:::4. :��.
CONTRACTOR: — �F���lic��-rt. — OWNER:
G+��i 1LEY DEN�IY 1°3S�1��1� :=��i�`A tt
�����_a �:t��R�t�:� �Cx :�r�. �.f�f 1 z± L Il�aD��t� L,�
t�i i i��fF TR i'=;T�1 tt�i 5�:;��°s t�Fii=;td+=i t'iN 55=�?��•�
i;F.f..') ��CC—�.��.:: t;l-,1;':ltl.7',•'—�,�%.�'.
� � � � �
TH� t 1��«�fi';�I fat��+.� I�y����,�r C�t�i.;�:_;i'� F'!�F i�t i'�a`�:I r���.? �`►a t�::��::r ��-i� �:t:�3._ ���iL`i=�.i�3:t�i•1r t�}i'_:
_ .. .._ _ _.. _.. _.. _ :,i 3 T _ 3 i_... ..�..� ! i'� 'j,i
'::�'�(;��' ��f l �t�i D �-��,-id-c`��:,-� �l�i (,'tf_i f��.--�.... ts'i_!�`t:_ ��`,� :=;��-;I (:: #'.;-fi°i�`L [t—lety�:�, '�i � . . r��;�_!� t.•��f r l,i��
� i�#�-if i�y;a ���i�I��i��1C:F.:= A��i�� �=�T���. ►�#= tr I��;�x�°=����?�t�� E,�_!i�L�I C�I�3 +�?�y�:�l�: �;::�;;,�_E:;;�.�•�;=l���; . �
_�
� - �.irn� (.�
A PLICANT PERM EE SIGNATURE ISSUED BY:SIGNATURE
� �
. _ r CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /0 r5 L��,OC�'v la4�Vt'_
PID:
DESCRIPTION OF WORK: ��:�.K
,
---------------------------------------------- ----------------------------------------------------�-----r�-*--- -------
ZONING REVIE� BY: � DATE APPROVED• q�;
BUILDING REVIEW BY: DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes v 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)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: L�'�a
� v Fire Department: Post Offce: School District:
V_�� Lot Area: Sq.ft. Acres Width Depth
5urvey Submitted: Yes �C No Date of Survey: p ni (=I l,C�
Proposed Setbacks: � ,
Front (Lake): "7� Right Side: (;3
Rear (Street): N (/� Left Side: l b.S
Adjacent Structures: �T7�Gt�c.� Wetland: Nl/3-
Building Height: Def. Hgt. �//�A- Peak Hgt. /J�/}
Lot Coverage: 0 ./c
Grading: Staff Approval Date: nl (A By: Council Approval Date:
Septic: Staff Approval Date: �1/ //� By:
Zoning File: # -- Resolution: /t -- Resolution Date: ---
Shoreland District: y�PS
Avg. Setback: O.t� Bluff Setback: ^11 A
Existing Proposed
Hardcover: 0-75'
75-250' 23 .°► 2� •4 ��.�- /,�en.�w47 ,S�(Z2
!"
250-500'
500-1000'
Hardcover Variance Required: Yes I�To_� Date of Council Approval:
REMARKS (in house):
10
� �
BUII.DING REVIEW CHECK LIST
UBC: �• 3 CONSTRUCTION TYPE: �/N
Sq Foota�e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
00
Estimated Construction Value: $ '�,D�� �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
OC Footing Septic Sewer Connection
� Framing Fireplace Lawn Irri�ation
Insulation (Masonry) Other
Wail Board (Mfg.) Well (State Permit)
_�LFinal Grading/Filling Electrical (State Permit)
Other
REiVIARKS (Pi 1 HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
RENIARKS(TO BE NOTED ON PERI�IIT):
27
:
T�r�l Fee: � � .��, i �" DateReceived:
Date Approved:
Entered By: ,� � �� Permit#: ��'� Z ��
CITY OF ORONO - BUILDING PER.II�IIT APPLICATION
ALL �YF'ORIVIATION�ILTST BE SUB�iITTED IN FULL BEFORE PLAN REVIEW WII.L
BE ST�iRTED
----------------------------------------------------------------- -----------------------------------------------
THE APPLICA:�1T IS: (circle one) OWN CONTRAC
JOB SITE ADDRESS: I O �� L��-.�...� `���� ZIP:
NAiv1E OF OW�IER: 1 `1. ��P(�� PHO��: (home) �(7 2 557y
(work)
MAILINGADDRESS: 1�1� �'���'0�^ �-'"� CITY: �*oru Z�:
CONTRaCTOR:�a.t...,.� p�l'��a�-�� PHONE: ��2- � I 1�q
vIOB PHO�IE/PAGER:
MAILINGADDRESS: °1S5 � � � `�- CITY: l�yY.na. .- ZIP: SS 3��
STATE LICENSE: # r^�
ARCHITECT/ENGliYEER: PHO�IE:
MAILING ADDRESS: CITY: ZIP:
v��,�; REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alt�rarion
PROPOSED`VORK(describe indetail): C'e�v�c7�� v, �('u.�Q\�.c.-� �.st�U�Z_r
�F r�,�.--�.�
�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOVIS: GARAGE STALLS: ATT. DET.
ESTIi�1ATED CONSTRUCTION VALUATION(escludingland): $ �b0 C7
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 Buildin� 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.
:�PPLICANT'S SIGNAT'URE: DATE: 7 �k� �
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA
Subd. 1. Type of data. The righ[s of individua]on whom the 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 co�dendal data concerning himself shall
be informed of: (a)the purpose and in[ended use of the requested data wi[hin the collecdng'state agency, polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
privace or confidencial data;and(d)[he idenary of o[her persons or endries authorized by state or fedecal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesogadve daca, pursuant to secaon 13.82, subdivision 5, to a law enforcement ofFicer.
The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertv tax refund
inscrucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals, and whether it is classified as public, private or confidenaal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data without any charge to him and,'if he desires, shall be informed of the conten[
and meaning of that data. Afrer an individual has been shown the private data and informed of ia meaning,the data need not be disclosed to him for
six months thereaftec unless a dispute or accion pursuant to this secrion is pending or addiaonal 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 ac[ual costs of making, cerafying, and compiling the copies.
The responsible au[hority shall comply immediately, 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 immediate compliance is not possible. If he cannot comply with the reques�
within that time,he shall so inform the individuat,and may have an addidonal five days wi[hin which to comply with the request,excluding Saturdays,
Sundays and legal hotidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest 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[he disagreement.
The responsible au[horiry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipieacs of
inaccurate or incomplete data, induding recipients named by [he individual; or(b) notify the individual that he believes the data to be correct. Data
in dispute shall be disciosed only if the individual's statemenc of disagreement is inctuded with the disclosed dara.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act rela[ing 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 aze notified that:
1. The information you furnish 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 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. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
� •/� t'� lr \
First vliddle Last
�5 So L �1��r Ss5 -�zt�
Address ��,.� S 5 ,� � � / �Z �'� '��g
b
C��, Sta[e Zip Phone
I unders[and my rights as stated above.
� —
Signature
���
� �
�'"�1
� -�
� � } � � � �
.�FL � � j � � � �1� ; ��
��� i F- j, -' '�
�= � z � � � = - -�
�;� cA w o N t' _ -�"
;� .� � �K e.'Y 3 d� o `, �
,�� � � •ts < � /
� � ._
� Q � -�� i / �'
� y
�, � � � � �; ': � �
� �� � 'P
� � �� � � � . � _ �
�,.� � � � U _ �f �'y�
OD C) � c �:, < ���CCC���rrr
`•� � Z >,- p: ' "� .
H- � M � �; ;`
> ��'-� �
� J Q S a $ ` x` �
�� � � � ,� � ;J �.. � � 3 �
�� W {� ,✓,� c� _, < � �
� D O < `'' r' � ; t
;<:.�, � � � Q � q � .� � 'D� +
�� .
�t •IC � u U � •^� ZL �Q
� Y ! !
� � ,:.;�'�� � � � s d -
� ��. �
_� � �- � �
;� �� =� .�
� � �
� � � x
(7� � i � p � ,
`� �`� (� � x �
. f . � ,, � `�
N -
� � ; � �
N � ; ; ,�
� ....._� � i�f �
a �, � ' �� �--- 7-�
�,� � � _
� � � v , � �
� _ � ,
� � �
� � �
� � 1 �.
x�.� _ ��
� �
C,_ .�___.—__._. �► � ------.�-�—, >
. � 1
� � ; ��
� < �\�' . , � .
� �,
�4� •'� \\ �- � �
> '� � �- �
J . i _
�� L �
��� ;
� ��
��z,,,Q �e
� �
�
�
�
_,�,;,�,y.,
` � �
� i
�
,
i
�
i
i ,� cr,
s.,.': �q�,a,l i +i;��;�i:
�, ��� a��ii� :„'.."�`�'
��� ��� �'��
...�� _ � ..,.,«.
p� r,:� ��ry
�i��R - � I..:. R�;.� 1w+• .jw�'ra`"'..�..
�'�'�U ��� ��^��� /�, OT�
r,,,,,,� ��L+��.,�,�'GEl F'`�v. °� �f �ri�r�P� �'���'R� i'y� � i
�y"�9°` /, �C_� b'J1TN u� ,, g- g 1'p `
`"+.,.� C ; /'!7"`�.t�'�"rG� J ��v�Ai�.:_.'L.e4 r3rt t��CJiIl.�Mt�
� r� 1'�� K�'�������
��°+, L`4R �o i �'+5r1�C:�d� ' I� S 1xs^�'.'4s . d;11 JJOI^�( . � ,�
.. : �re`�� 1'`�r s�r �a.k^"S;F+�� � xt►�'r.� ,,,e.
t,�_�e c^5*'ttt����,E ' r4� i�`�n`�`t�ic.us i+ +�a�e� ., r:�� �"�
;,•iY:.
��:hr?: c`"'�" ��t` �,t.rr,_ ��t�>� '�t�` qt ?,�-L i�1tv1",�.
nE .
�TSIi 'G���� �
. A�t`1f.. _ � ( ��1�� .
... •. f; :��_.P"t�d . .
��f...iF� . , i� .
�' t:+z � . � . .
„�
�1 , ��
�� ��� �
�c.���� C.� �-sz... -' �P ° r��,x oi-�,�� r�
v �
c. � .� g�—�
�f� -� �- � -����:�, Q����� �
�'a ,s� ~�.,r.�.r -- b d►-� Q�IQ�-
�: � �
_-�
f 1,
Z.y� f C� �s�` a.� t�.��
�0f��'�'^��' ��o�5��r� �
" -�--�- i 9 �
G a-�•��..0 �1�.S�� r�
V
b�� �'��G�
��
� . T.�...��,�o�-,,.�-... ,..�..�...,.�.
�'12�� rn�v� �r
. ��� '
� w ��+
� �,, ,M��,
--{a �-;n � �,.� /
�'�,'' �o v-�c.•r�a.�cL.. �
�� b o�S�- "� 5 n \ � ��'C x�;
baa�.. G �\\ . \
�-- �� i� -,
_ � �
�
�
�
�
► � � � �,
,r-.ri......_ � �.,,� � �-r.s,
�' � '� r2_'
.
� � = �a�� ��r -
_
�
G--__ Z Z' _:_..� � v �
Z� ,
� i�--f;-..� --�v��... I �' i
: �
s �
�t
�
-�'�.
�
yv
N
I
�\
\
t
V
"._- �--�----.�.��---'--a
�.__---� � � J
� _____
� w,
7� �
�
1
�, x
� ` �:
� �
- �� -
_ � �
� � s �
� � �fi'
� � JLa
V �t` ,p-`
�V
�
� )
v
C. ,� � � I � _3 .___
�
DATE TIME
CITY OF ORONO CALLED IN �' �'�-�� '
INSPECTION NOTICE SCHEDULED �- �f 1���� � c:
PERMIT NO. �i��'3 COMPLETED � _��
ADDRESS�1�/ `�'� � �. C���-��;��;:, �!�--�
OWNER ��'-t� CONTR. �� -� �F..t
TELEPHONE NO. �`{ � —�� ��!=' _�
� DES�.F�TION
� 01 FOOTINd�� 11 MECHANICALRI 18IXCAV/GRADINO/FIWN(3
� 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANOS
Q 031NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATEfl HOOK-UP 17 SITE INSPECTION
� OS FINAL 14 SEWER HOOK-UO O6 PROGRESS
_
~ 07 UEMQ–SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Z 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
W
a
�
J
O
�
2
O
�
W
�
Q
�
Z
W
�
W
�
�
d ORK SATISFACTORY:PROCEED
W � PROJECT COMPLETE
WL CORRECT WORK 8 PROCEED u ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. r pHOTO TAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR '= CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance.473-7357
OwnerlCont on i e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN �.��' `rs`'
INSPECTION NOTICE SCHEDULED �--�C� '�-�
PERMIT N0. COMPLETED �_
ADDRESS ��� /CJ/� �2���e,�� �S�v
�
OWNER ��`'�a. f'�f�1��.�-v�c��% CONTR. �'�
TELEPHONE NO. �/ 7�1 'l.�yd'C1 �ic�� y 7� - s`s- 7�L�r�
� DESCRIPTION __ __�7�i1�y2�'-r�e�
� 01 FOOTINO 11 MECHANICAL RI 78IXCAV/�RADINC3/FIWNQ
� 02 FRAMINCi 13 MECHANICAL RNAL 19 LAI�SHORE/WETLANDS
p 03 INSULATION 24/25 WOOD BUHNER/FIREPLACE 34
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION .
Q
= p5�►�q�, 14 SEWER HOOK-UO O6 PROGRESS
� 07 DEM4—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEMO—FINAL 15 SEPTiC INSTALL. 22 FOLLOW-UP
= 09 PLUMBIN(i RI 23 SEPTIC FlNAL 35 HARD COVER REMOVAL
v 10 PIUMBINCa FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
� �
a �
o d f (' �� �� �v� ��J
� � £' O V
0
�
W
�
Q
�
2
W
�
W
�
j
d WORK SATISFACTORY:PROCEED � PROJECT COMPLETE
W
� CORRECT WORK E�PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOFi
❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cali for the ne inspection 24 hours in advance.473-7357
OwnerlCont r o te:
Inspector. �'
White Copylinspector's File Canary CopylSfte Notice
D TE TIME
CITY OF ORONO CALLED IN i� - "�
INSPECTION NOTICE SCHEDULED '�%/-5/`''� ;� - � c`
PERMIT NO. cOMPLETED _ �FJ- �S' L �. 3c�
ADDRESS `�/`^ ,r� .�«1 �
' f'i
OWN ER—, �1T � CONTR. �.G �r, %%�:;��
/ - - - �
TELEPHONE NO. �' �_�'C� `>���
� DESCRIPTION ��(���� � � ' �
� 01 FOOTING 11 MECHANICAL RI 18 D(CAWGRADINQ/FIWNO
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNEFi�FIREPLACE '; 34 TREE REMOVAL
Q 04 WALLtiBD. �� 12 WATER NOOK-UP ` �--- 17 SITE INSPECTION
� 05 FINAL ' �� 14 SEWER HOOK-UO 06 PROGRESS
� T3`1 DEMO�ITE 27 SEPTiC MAINT. 21 COMPLAINT
J
Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING Fil 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINQ FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
W
a
J �/N/►�� dN ��c_/� f' ./�
0
�
�
� ' C'l�-PCIC /W/� /=�/'.c�l�� LP Cc.,�-�'�--r�-�
W
�
Q
�
Z
W
�
W
�
�
d�.�NORK SATISFACTORY:PROCEED � PROJECT COMPLETE
W
� L CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
OCORRECTUNSAFECONDITIONWITHIN HOURS. rpHOTOTAKEN
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.47�73�J7
OwnedContracto on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice