HomeMy WebLinkAbout1996-008445 - deck . _ • w S 7 � ' ' '
, PERMIT
CI'TY OF ORONO PERMIT TYPE: r:�;;; ;��;;�i;
2750 Kelley Parkway- P.O. Box 66 Permit Number: '��?_=�t���
Crystal Bay, Minnesota 55323
(612) 473-7357 Date Issued: 1 :�`:`7 �=,:!'��_,
SITE ADDRESS:
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REMARKS:
FEE SUMMARY: j k if�'{ ^�
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C�/� S. /1/y?��1) ��d
APPLICANTlPERMITEE SIGNATURE � ISSUED BY:SIGNATUREy�-
� �
Total Fee: $ ,!%��-8��
Date Received: � '�r � �' -� �'���
Entered By: �. Permit#: ,�'� `�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
, ��,« �(ple se print al 'nformation) ,
�u���_-u�--- '�=�---.���---��.��.�--�=�-�-���.��-------------------
--- �
THE APPLICANT IS: (circle one) OWNER OR ONTRACTO
JOB SITE ADDRESS: ����� p"��a ,�ir��r ZIP: ,��`,���
NAME OF OWNER: ��,rs `,�- ��1 ��� PHONE: (home) -�7� -�01��
(work)
MAILING ADDRESS: /� �(j ,��.��...� CITY: /��� ZIP:�,��r!
CONTRACTOR: �-�-�t' p�; '����f�'�—
CONTACT PERSON: ` 1`vIOBILE/PAGER: ' S�— �'�.S S'�
MAILING ADDRESS:��g�'/S'r�,�`a�.•-� _CITY: ZIP: �:�'6-y�
STATE LICENSE: # ��fS'
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
�JAME; REGISTRATION#
TYPE OF WORK: New �"� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROP SED WORK(describe in detain: a��/nac� s- ,����� —
.� ,=�"'' /� � C�ci ,�' � � ` !�.
�� ,
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 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 roved plan.
�
APPLICANT'S SIGNATURE: � � DAT'E: ���—��
�-
NOTE! Parade qf 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.
9
� s
,
Sec.13.04 RIGHTS OF S[JBJECTS 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 secdon.
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 intended use of the requested data within the collecting§tate agency,polidcal subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidendal data;and(d)the identiry of other persons or enddes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgaave data,pursuant to secaon 13.82,subdivision 5, to a law enforcement o�cer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or nropertv tax refund
instructions 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 confidential. 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 6as been shown the private data and informed of iu 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 additional data on the individual has been collected or created.
The responsible authority shal!provide copies of the private or public data upon request by the individual subject of the data. 1'he responsible authoriry
may require the requesting person to pay the actual costs 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 request,excluding Saturdays,Sundays and legal holidays,if immediate 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 individual may contest the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.
1'he responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipiena of
inaccurate or incomplete 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 onty if the individua!'s statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to 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 pemut 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 shazed 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 pernut.
V1�c>1U ��C—�rc.� SGl� r'��
First Middle Last
���� /�i r� �r���e
Address
i��o� ��� ��G Y -�7�- -/o��
Ciry �State Zip Phone
I understand my r' ts as stated above.
Signature
• � CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /' _3 C .��� , , ;_., /, . ,��'<<_ �.����,�<
PID: �, _ �, �, ,_;, -,
�
DESCRIPTION OF WORK: ' '
L"
------------------------------------------------------------------------------------------------------------------------
ZONING REVIEW BY: �;,, � ,, �_ DATE APPROVED: r u �-ti 4�
BUILDING REVIEW BY� ' DATE APPROVED: � �; 3. ��,
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ��' No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SUR:I�ARG� Yes L/ No WATERCONNECTION
INVESTIGAT'ION-FEE Yes No ,�:� PARK FEE
SAC Yes No _� SITEINSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: �,1�-��
Fire Department: �/v�o:.-.�wa Post Office: ,�v�,�..�.-ti'� School District: 1.�:�°�T���
� �- 2-3�c,'� 'r Width Depth
Lot Area: Sq.ft. {0 3,'�(x, Acres
Survey Submitted: Yes v�- No Date of Survey: �{` '�' �:,..,'
Proposed Setbacks:
Front (Lake): �v I f� Right Side: Z 3 t i � �=~\
Rear (Street): I l�� '�' Left Side: 7 c:i� � t'`��
� �
Adjacent Structures: �-�—�y�c�f�-k-�' Wetland: e����
Building Height: Def. Hgt. /v !,�- Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: #i Resolution: # Resolution Date:
' (� Shoreland Dist:ict: __
�� Avg. Setback: Bluff Setback: L,ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): �G'�a c��� 7� <=�- G� '� D��n°+ f a,n.t v'k� h,�s��
� 26
BUILDING REVIEW CHECK LIST
UBC: � � CONSTRUCTION TYPE: �i�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gazage x =
x =
TOTAL
Estimated Construction Value: $ 3,�� `�—
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
,7t Footing Septic Sewer Connection
P� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
� Final Grading/Filling Electrical (State Pemut)
Other
REMARKS (IN HOUSE):
------------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------------------------------------------------
REMARKS(TO BE NOTED ON PERMIT):
27
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DAT TIME
CITY OF ORONO CALLED IN � "� � 9 7 �=�
INSPECTION NOTICE��� S SCHEDULED '/S �:�
PERMIT N0. COMPLETED '�
ADDRESS ID 3 U �'�-� Gc..
OWNER W��•�� CONTR.�� S � -
TELEPHONE N0. � �-z - � Oo.�
� DESCRIPTION (�J�.� �
W FOOTINCi 11 MECHANICAL RI 18 D(CAV/(iRADINC�/FIWNO
0 C3 13 MECHANICAL FINAL 19 LAI�SFIORENVETLANDS
03 INSULATION 24/25 WOOD BUHNEFUFIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= 05 FINAL 14 SEWER HOOK-UP O6 PROQRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
�Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBINO RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 28 CEDAR SHINGLES 38 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �WORK SATISFACTORY:PROCEED � PROJECT COMP�ETE
W CORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. r- pHOTO TAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR '^ CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-7357
OwnerlContract n s t :
Inspector. -
White Copyllnspecfor's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN 'y�i��`1 7
INSPECTION NO�IC� _ SCHEDULED '�'/i�/`�� // ClL%
PERMIT N0. � � ` COMPLETED � �
ADDRESS _���'�'iz.�_ . � . �, �%�_�
OWNER . �:�-��,=-.�t_ -� CONTR. ''� �-��
TELEPHONE NO. '�i� -i','�� _� � �
� DESCRIPTION _�� ����� � �
� 01 FO_O�TI-N-��� 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
�Q 02fRAMING� 13 MECHANICAL FINAL 19 LAKESHORElWETLANDS
Q �03yNSGLATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Z 05 FINAL 14 SEWEA HOOK-UP O6 PROGRESS
~ 07 DEM�-SITE 27 SEPTIC MAINT. 21 COMPLAINT
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�Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O /t I�CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
Owner/Contractpi
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