HomeMy WebLinkAbout1999-012178 - new residence PERMIT `�
Ci'T� .�F ORONO PERMIT TYPE: - - -
2750 Kelley Parkway - P.O. Box 66 Permit Number: �'°-_��%�";'�'``
Crystal Bay, Minnesota 55323 Date Issued:
(612) 249-4600 _ - -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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OWNER
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ ,�'� �J�G� .C�� Date Received: /�' ��
Entered By: _�,. Pernut##: ��, / '7�'
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 CONTRACT013,.�
JOB SITE ADDRESS: 2���� ���i c.,� ��t t/�� wr.�/ ZIP: � � 3� 1
NAME OF OWNER: PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �'q t 4G�,.� v� �� '�3L�� L��z.� PHONE: �l 3�i- ✓�:.��
CONTACT PERSON: ?V/ l-�'��'�� �c�� MOBILE/PAGER ����� --7�.a�
MAILING ADDRESS: �»� ��r�w�.a� c,��i CITY: ti����/��- ZIP: ��'3�,`�
STATE LICENSE: # / � ���
ARCHITECT/ENGINEER: K�����..� ���'_� �+ PHONE: �51 -��.��_-..-,
MAILING ADDRESS: CITY: ZIP:
N��: �-��,�� �,���,, r��- REGISTRATION#
TYPE OF WORK: New � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: s�-.-c c�' :�M ��y �-E��
STORIES: � SQ. FEET OF EACH FLOOR: �i.3 ��-� �Li�v�
NO. OF BEDROOMS: S 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 wark 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
pernut; and that the work will be in ac�ance with the a�roved plan.
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APPLICANT'S SIGNATURE: .:.---=' � DATE: �� /2 -��
NOTE! Parade of Homes even�s�require separate pernzit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SfJBJECTS 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 forth in this section.
S�bd.2. Information reqirired to be given individual. An individual asked to supply privau or confidenaal dara conceming himself shall
be mformed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdiPision,or statewide system; (b)
whether he may refuse or is legally required to suppiy the requested data;(c)any Imown consequence arising from his sapplying or refusing w supply
privaLe or confidenaal dara; and(d)the idendry of other persons or entities authorized by state or federal law to receive tbe data. This requirement shall
not apply when an individual is asked to supply investigadve data,pursuant to section 13.82,subdivision 5,to a law enfio�ement officer.
The commissio�r of ievern►e mav nlace the notice tewired under tius subdivision in the individual income taz or oronertv taz�efund insttucdons
instead of on those forms.
Subd.3. Access to data by mdividual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
srorefl data on udividuals,and whether it is c�ed as�blic,private or confidential. Upon his further request,an individnall who is the subject of stored
private or public data on individuals shall be shown the data without any chazge to him and, if he desires, shall be infocmed of the content 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 siz months
theteataer unless a dispuee or action pursuant to dris secdon is peading or additional data on the individual has been collecsd or cieated. The responsible
authority shall provide copies of the private or public data upon request by the individual subject of the data. The respo�ble authoriry may require the
requesting person to pay the acwal cosu of making,certifying,and compiling the copies.
The cesponsble authority shall comply immediately, if possible,with any roquest made pursuant to this subdivision,or within five days of the
date of the request,excluding Sawcdays,S�ndays and legal holidays,if immediate compliance is not possible. If he cannot�mply with the request within
d�at time,he shall so inform the individual,and may have an additional five days within which to comply with the ieques�excluding Saturdays,Sundays
and legal holidays. ',
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or complzseness of public or private data
conceming himself. To exercise this right,an individual shall noafy in writing the responsible authority describing the�re of the disagreement. The
responsble authoriry shall within 30 days euher. (a)correct the data found to be inacwrate or incomplete and attempt to nodfy past iecipients of inaccurate
or i�omplere 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 disclosed only if the individual's statement of disagreement is included with the disclosed data.
The detemrinauon of!he responsi'ble authoriry may be appealed pucsvant to the pmvisions of the administretive 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 fiunish 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 permit or license.
3. The informarion may be shazed with other local, state or federal agencies to the eztent 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 pri�ate data on yourself.
6. Your full name is required to process this application or permit.
Z I// �E/3.o✓dc<�
First Middle Las�
35�.� �r��� �..-,i
Address
�t ��.-ni/Z�—,,lc-� ./(.t•..< �J�� �'3� —0��.::g
Ciry State Zip Psone
I understand m rights as stated above.
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Signature
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' - . CHECK OFF LIST FOR ISSUANCE OF PERNIITS
FOR OFFICE USE ONLY •
ADDRESS ORLEGAL: ZS��S c_i TTc.� oRc t-�-►4� w�4 y .
PID: '
DESCRIPTION OF WORK: rv�W (� S '
ZO.�tI�i G REV�W BY: ~~~_� DATE APPROS�ED: /r/z2�QS
BUII.DPTG REV�W BY: � DATE APPRO`ED; �,/��-z /g�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes �/' No
PLAN REV�W Yes c� No SEWER COIVNECTION
STATE SURCHARGE Yes � No WATERCONNECITON
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes ci No � ° STTEINSPECTION
Number of SAC-Units 1 OTHER (specify)
ZOY�TG CH�CB LIST Zoning District: L Q-��
Fire Deparcment: (,CN h (i4�l,c Post Office: C�n3� V4�c: School District: Q- �N 6
Lot Area: Sq.ft. Acres 2•Z � Width /R��t�/L �p� 3 7 I .7 �
Survey Submitted: Yes oC No Date of Survey: I!-ly'9`j
Proposed Setbacks: �
Front(Lake): I'7�� { Right Side: � ���
Reaz(Street): 11�9 � '} Left Side: 3��
AdjacentStructures: �J//f- Wetland: N/14�
Buildin�Height: Def. Hgt. 3o Peak Hgt. 3S'
Lot Coverage: /�1 I� �
Grading: Staff Approval Date: l I •L 2 • 9q By: � Council Approval Date:
Septic: Staff Approval Date: _ �+! �A By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland Disuict: v�5
Avg. Setback: o•1� Bluff Setback: N I/} Lot Cover�,°e: N/A.
Ezisting Proposed
Hazdcover: 0-75' �
75-250' z 3�l�
250-500'
500-1000'
Hazdcover Variance Required: Yes No Oz. Date of Council Aoproval:
REMARKS ('in house): -
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BUII�DING REVIEW CHECK LIST
UBC: R' � . � CONSTRUCTION TYPE: ��
Sq Footage $Per Sq Ftg •
Basement . . x = .
�, lst Floor . . z . _ .
2nd Floor x = . �
Garage x =
a —
TOTAL
Estimated Construction Value: $ 15 n,c�o o�`"
Inspections Requirec�: tiVork Requiring Separate Permits: �
Site ol Plumbing Fire
Hardcover Removal < Mechanical � � Water Connection
a F��g ' Septic _�L Sewer Connection �
�� _g Framing .� Fireplace_ �Lawa Irrigation . .
�,Insulation _�(Masonry) Other
�j-Wall Boazd o� (IVtfg.) _�Well(State Permit)
�" F�� Grading/Filling _�Electrical(State Permit)
Other �
REMARKS(IN HOUSE): . ' . .
� REVIEW BY OTHERS: DATE:
Access: Existing New �
Access Approval: Date gy;
RENIARKS (TO BE NOTED ON PERivII1�:
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTIC��� 7Q� SCHEDULED �o�'��q�q! y'dz'
PERMIT NO. v COMPLETED ( `— � ` ( � ' `�'
ADDRESS � L -��'��C�I�G�
OWNER CONTR. �
TELEPHONE NO. ���J`68��
� DESCRIPTION /`���� !��,
� OTI 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q ING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/F�REPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
fl ENTS:
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� �IORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
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W C7 CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDiTION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor on site:
Inspector.l�� �
White Copyllnspector's File Canary CopylSite Notice
CITY OF ORONO CALLED IN
- °.,/ ?�� 6 � �
INSPECTION NOTICE SCHEDULED ^ '�O I �
PERMIT NO. 5�121�IS COMPLETED —� "� �n
ADDRESS oZg Zo� ��1�� �C.�1aw�c�,ae�.y—
OWNER CONTR.����-�+��
TELEPHONENO. -r`v�f.9-- '�9D�—
� DESCRIPTION �t�C . O .
l� 01 FOOTWG 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/N/ETLANDS
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03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 W 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� O-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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W�WORK SATISFACTORY:PROCEED /!�NrtOJECT COMPLETE
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❑CORRECT WORK&PROCEED �SUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION �TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ' CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
OwnerlContra tor on site:
Inspector. ' �
White Copyllnspector's File Canary CopylSite Notice