HomeMy WebLinkAbout1993-005676 - attached gar _ _
PERMIT �
�CITI� OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 �;�_�Z L'C���r�{�
Orono, Minnesota 55356-0815 Permit Number: t�t.��H��
(612) 473-7357 Date Issued: i .;f s:��_::;
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SITE ADDRESS:
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PLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE � `
L � A
� CITY OF ORONO - BUILDING PERMIT APPLICATION
� -j ;� ,��-J � .
� :� �- Date Received: �'
Total Fee: $ ��- �
� Bate Approved:
Entered By: .�� _
Fe�it u• �'CG 7 �
AT.T• INFORMATION MUST BE SIIBMITTED IN FULI� BEFORE PLADI REVIEW WII.L B$ STARTED
(See Check-cff List Enclosed)
--------------------------------------------------------
q*gg APpLICANT IS: (circle one) O�V'i�IER or CONTRACTOR
JOB SITE ADDRSSS: I�f`1 b C�tJ� �' lJ���i l�� ' �I�,�O _ ZIP: ����(D
(work) ��1�" K.el�
NAMF: OF OWNER`� �� � PHONE: (home) �'�.d Jv
MAILING ADDRESS: ITY:�.� �j ZIP: ����Cd�
CONTRl�CTOR: P$��'
MAILING ADDRESS: CITY: ZIP:
STATE I�ICENSE: �
ARCHITECT/ENGINEER: �P VI �r�C� P$��'
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure rlove
Demo Remodel/Alteration Renovate Land Alteration
1 � �
PROPOSED WORR (describe in detail) : �i
�����] C
STORIES: � SQ. FEET OF EACH FLOORs �-�' ! S ` �
NO. OF BEDROOMS: GARAGE STALLS: ATT.� DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding Iand) : $_,�i 1 ►l.V � -
I hereby apply for a building permit and Z 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 rmit and work is not to start without a permit; and
that the work wii 1 be in cord ce w' h the approved plan. �
! � Z� �-I
APPLICANT'S SIGNATIIRE: DATE: ' ..L�_
s.--
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�
�I'�"Y O� O�iON�
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
i
- � ' � a On the North Shore of Lake Minnetonka
- 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 permit or license.
3. The information may be shared with other Iocal, s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii act�on
to approve, some information may become public.
�. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to process this application or
permit.
-'�'� a[o� �C�
First Middl L st
q� (�► l,a.��
Address
�r�a ,� �53�C.�
City State Z1p
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Phone
I erstan my rights as stated above.
Signa e �•
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—�i73-7358 • PUBLIC WORKS—473-7359
ASSESSING
�r ----------- �---- ---- ------- � � �
�.Q,� RIGHZS OF SIIB.7ECT3 OF DATA �
Subdivision L Type cf data- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section.
. Subd. 2. Information required to be gi�� ��n�l" An.individual asked to
- ' 1 rivate or confidentisl data concerning himself,n t� ccllect g stat agency,
supp y p uested data withi
purpose and intended use of the req tem;
political subdivision, or statewide sys (b) whether he ma� refuse or is leg y
. required to supply
the requested date; (�) �Y �own consequence arising from his
' supplying or refusing to supply private or confidential date; and (d) the identity o
other persons cr entities authorized by stat ueolr�e�kedlto supply�in est gat ve� da a
requirement shall not apply when an individ
pursuant to section I3.82, subdivision 5, to e law enforcement officer.
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individuel income tax or ro ert tax re und mstructions instead o
on those orms. . - �------ �--�� " ,
Subd. 3.
Access to data by individusL IIpon request to a responsible
authority, an individuel shall be informed�he b�c'hP=ivateeor confidential.e IIpon his
individuaLs, and whether it is classified p ublic data on
further request, an individual who is the subject of st trQe�mri�ae�he desires� shall
individu8ls shall be shown the data withou�t an�y i�� �ter an indi�du���ed to
6e informed of the ccntent and meaning the data need not be
shown the private dats and informed of its u��T�Bction pursuant to this section is
him for six months thereafter unless a disP -
� ending or additional data on the individ�h h�8te or p blic dataruponarequest by
' p rovide coples of p
responsible euthority shall p The respcnsible authority may require the
the individuel subject of the �te� certif n and comp�ing the
requesting person to pay the actual costs of making, Yi g�
copies. it possible, with any request
The responsible authority shall comply immediatelY,
made pursuant to this subdivision, or �t��e��ySimmediateg cflmpliance eisu not
excluding Saturdays, SundaYs and legal S15
ossible. If he cannot comply with the request within that time, he she11 so in�h Lhe
P hsve en additionel five days within which to comply
individual, and m Saturdays, Sundays and legal bolidays•
request, excluding
Subd. 4. Prxed�e when data is not accurate or complete. An indi�iduel mgY
• ublie or private data concerning himself• To
contest the accuracy or cornpleteness�of P in writin� �e �Ponsible authority
exercise this right, an individ�� S� notify �ible authority shall within 30
describing the nature of the disagreement- The respe
days either. (a) correct the data found,to�ete iuiae��ei°�uding reciQ ents nemedt by
notify past recipients of insccurate or inc lp
the individual; or (b} notify the individual that he believes the data to be correct.
Data in dispute shall be disclosed only if the individuel's statement ef disagreement is
• included with the disclosed data. � g�pe�ed pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating te contested cases.
�-�-�1��� � s v
ATF_ TIME
CITY OF ORONO CALLED IN a�/9�
INSPECTION NOTICE SCHEDULED o2. i/9� 3.'30
PERMIT NO. COMPLETED ��_ iA '
ADDRESS� L% � r � � l�z/.
OWNER �� J��,,�� CONTR. ��D�
TELEPHONE NO. _ �3 - �����
� DESCRIPTION �l�'9i�����
� 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
O
Z 0 BD. , 12 WATER HOOK-UP 34 TREE FEMOVAL
05 FINAL G���2�/13 METER SETITURN ON 17 SITE INSPECTION
h 07 DEMO—SITE � 14 SEWER HOOK•UP O6 PROGRESS
� 07 UEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENT •
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W� WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CEFTIFICATE OF OCCUPANCY
� C CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ;- pHOTOTAKEN
INSPECTOR WILL RETURN
I CITATION ISSUED
C STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlCont� omsite:
Inspector. .- '��
White Copyllnspector's Fil� Canary CopylSite Notice
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