HomeMy WebLinkAbout1998-010121 - add/remodel .� _ _ T
, PERMIT
' CITY OF ORONO PERMIT TYPE: ;t;�,���i t�j�;
2750 Kelley Parkway- P.O. Box 66 t���a�;��
Cr stal Ba , Minnesota 55323 Permit Number: _
y y Date Issued: �-j�!�:�=�=��-�
(612)473-7357
SITE ADDRESS:
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F'. _ . �`� . = 17-1 i�' �._—�=;—i�i_i�i:�;
DESCRIPTION:
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REMARKS:
FEE SUMMARY: -
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CONTRACTOR: V1�NE�.:_ — ��:�:_ ,��,�-�t. --
��€�"_I"T���LLE .r���i�#
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�:t,�-��'i..•f!' ��L� n"��»1 "lih';ML_'._� �I_I �{t_ F-jl ! �t_ii-ij�.. �:`. �,��i.�l. � l,:l_I[':i-':_�{=}�`,��.� L,<� i t-; �`-;:_�._ i..�Y..;�: I_.3-
t;��;i��tvi�� f=ihi�I id�tt�i��'�� Hi�i�� =�7;a��== r_.�= t°i I a�t�{r�°=�;�iT�� ���1 I;�G;I�v:� 4_ .,s;:;+ ;,r i;±t 1�;'.��3..._r�j"= .
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE . �.
Total Fee: $ %d �� 7� Date Received: ����i ''�
Entered By: C� Permit#: /C>/�,/
�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
---------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
.'' �"`� �/�//� ' S7�`�Gl� ZIP: 6j� � �
JOB SITE ADDRESS: �� � �
c-��
NAME OF OWNER: �vtl �y' G-�����/ � PHONE: (home) �l ��/��—_
, (work) 7 � � '�
MAILING ADDRESS: ' � � iV/Gt f' S',/�d��TY: c_� ZIP: �S�` /
_ �
f1 ' '��
CONTRACTOR: l�.�','� �.,_ �"�_-'���'�,,�":-_ PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: Z�:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: EITY: ZIP'
N�,�: REGISTRATION#
TYPE OF WORK: N�w �_ Addition Accessory Structure �
P�Iove Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�:� Q�.c.K
STORIES: SQ. FEET OF EACH FLOOR: �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �=-'�" �` "
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: �� G�' �� ,��.�� DATE: �/� —/ �'� � �
NOTE! Parade o�'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.
5
� .
Sec.13.04 RIGHTS OF SLJBJECTS 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 fonh in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself
shall be informed of: (a)the purpose and inrended use of the requested data withu►the collecting state agency,poliacat subdivision,or statewide
system;(b)whether he may refuse or is legaQy required to supply the requested data;(c)any Irnown consequence arising from his supplying or
refusing to supply private or confidential dara;and(d)the identiry of other persons or entides authorized by srate or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82, subdivision 5, to a law
eaforcement officer.
Ttte commissioner of revenue mayplace the notice rewired under this subdivision in the individual income tax or orocem tax refu�
instrucdons instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidendal. 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 content and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be
disclosed to him for six months thereafter unless a dispute or ac6on pursuant to this secaon is pending oc addidonal data on the individual has been
collected or created. The responsible authoriry st�all provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require the requesdng person to pay the actual costs of making,certifying,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 dare of the request,excluding Saturdays,Sundays and legal holidays,if icnmediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the individual, and may have an addidonal five days within which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An i�ividual may contest the accuracy or completeness of public or
private dara coc�cerning himself. To exercise this right,an individual shall nodfy in wririag the responsbte authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt W noafy
past recipients of inaccurate or i�omplete data,i�luding recipienu named by the i�ividual;or(b)nodfy 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 detemtination of the responsible authoriry may be appealed pursuant W the provisions of the administrative procedure act relating
to contested cases.
�ATA 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 �ity 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 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 eztent necessary to
process the permit or license.
4. If your requested pemut 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
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signature
� 6
, v �
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 35C�5 C.�v�►v�S-t'o N Av�
PID: -
DESCRIPTION OF WORK: ��c.�
ZONING REV�W BY: DATE APPROVED: Y- �•�� ,
BUII..DING REVIEW BY: DATE APPROVED: Y• � •5's3 ,
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes _� No SEWER COTfNEC"ITON
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: (,2-1 L �
Fire Department: �y10un,�p Post Office: WA�/Z�4T14 �School District: W eS'T"�1=-�
Lot Area: Sq.ft. b�1 ZS Acres . I S Width � Depth so'
Survey Submitted: Yes � No Date of Survey: $•ZA•�l7
Proposed Setbacks:
�
Front(Lake): IS.7 Right Side: 2�•Z
Rear(Street): tu•3 Left Side: 1 0`t �
Adjacent Structures: �4'�'r�c I+c.'� Wetland: N ��
Building Height: Def. Hgt. /� //� Peal:Hgt. VJ 1 A
Lot Coverage: ?.b,b
Grading: Staff Approval Date: N/A By: � Council Approval Date: —
Septic: Staff Approval Date: /v//} By: —
Zoning File: # ZLUS' Resolution: # Resolution Date: sQPt �.Z ,5 7
Shoreland District: N o
Avg. Setback: Bluff Setback: Lot Coverage: ZS-�
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Vaziance Required: Yes No Date of Council Approval:
REMARI�S(in house):
7
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BUII..DING REV�W CHECK LIST
UBC: /Z•3 CONSTRUCTION TYPE:� 12�3
Sq Footage $Per Sq Ftg , -
Basement � x =
lst Floor x =
2nd Floor x =
Garage x =
R =
TOTAL
Estimated Construction Value: $ Z t�o �'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
� Hazdcover Removal Mechanical . � Water Connection
ot Footing Septic Sewer Connection
�Frami�g Fireplace Lawn Irrigation
. Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit) .
_�Final Grading/Filling Electrical (State Permit)
Other .
REMARKS(IN HOUSE): �
REVIEW BY OTHERS: � DATE:
Access: Existing New
Access Approval: Date By:
REMARI�.S (TO BE NOTED ON PERMI�:
8
i��O�O COP� M LIVINGSTON AVENUE M — �j��� �;
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LEGAL DESCRIPTION OF PREMISES:
" Lot 1, 81oc�c 4, Navarre Heights.
This survey interids to show the boundaries of the above
described prapefty, �d the location of � existing house
thereon. !t c�oes not purport to show ony other improve—
ments or encroachrr�ents. �
• : Iran m�icer four�d
Bearings shown are bosed upon on ass�ned datum.
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED �' �c��7it
PERMIT NO. � �OZI COMPLETED � � '
ADDRESS �
OWNER CONTR. �
TELEPHONE NO. '�7�-C7�/�
� DES�61eT,�.ON ��� •
� e�fFOOTINC 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALI. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEEf YOU:_YES_NO
� COMM .
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��ORK SATISFACTORY:PROCEED C PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �, pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
L CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspe tion 24 hours in advance.473-7357
OwnerfContractor it
Inspector.
White Copylinspector's File Canary CopylSite Notice