HomeMy WebLinkAbout1991-003578 - install bathroom PERMIT
CITY OF ORONO PERMIT TYPE: �:E�I�..C�I�#��
1335 Brown Rd. South • P.O. Box 66 Permit Number: �'i�`'��''
Crystal Bay,,Minnesota 55323 Date Issued: ��'�'�;'?J=�'x
(612)'473-7357
SITE ADDRESS:
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CONTRACTOR: -- ►�r�F�1 i��}�f� -- OW�VER
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APPLICA T�PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� " ' CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ 1C.0 � � � � Date Received:
. � , Date Approved:
Entered By:
Permit#: cj 7 �
ALL INFORMATION MDST BE SIIBMITTED IN FOLL BEFORE PLAN REVIS'W ieIILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
T� APPLICANT IS: (circle one) OWNER or CONTRACTOR
Jos si� Annx�ss: _���� Lu r,'� z��,�_ zzP: 5535/
(work)
NAI� OF OWNER: �'�P�a'iZ /77ic�5 S PHONE: (home) �/- C1o?.z?
IKAILING ADDRESS: 3�,/�� L�-1 r,`� /�1/,� CITY: /l/��,�.e ZIP: -�535/
CONTRACTOR: �C����'1 �p/�S� PHONE: y�a� /�r 7.�—
MAILING ADDRESS: a(o5�G.L 5��/�� ��v� CITY: �7p��q� Z IP: 'rj�3�
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remo�e�/Alteration�� Renovate Land Alteration
PROPOSED WORR (describe in detail) : 'Z'�s+�a.�-� ! h4t�hi�� v���� L�w.�S��S__
iu 1 � G � r� ` Aow.us,�.• r� o s /�.S
c+�.r��r^'
STORIl3S: �-' SQ. FEET OF EACH FLOOR:
NO. OF BSDROOMS: � GARAGI3 STALLS: ATT. DET. �-� ,
I�STI1�lATED CONSTRQCTION VALIIATION (esclndinq land) : $ `� ��1J, � _
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 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. �
' • � �'/I �C� �' ' � —�� -
�PPLICAIQT S SIGNATOR$. DATE:
C�'�Y of OROl�TO
� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
s - � �: 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 Iike to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confidentia]. information.
You are notified that:
1. The information you furnish will be used to determine your
qualification for the permit or Iicense 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, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva��
data on yourself.
6. Your full name is required to process this application or
permit.
i ✓� 1/t� �' �jt�l
irst Middle Last -
aCos�� �5� %�/„� •
Address
o/�l���?c� l7�1� S5 ���
City State Zip
y-��-�� ��-- ,
Phone
I understand my rights as stated above.
r �, ��_ �_ -
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Signature �
BUILDING 8c ZONING—473•7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING -
�.04 RIGHTS OF SIIBJECTS OF DATA
gubdivision L Type of d��e- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section.
g�d. Z. Information reqaired to be g��� ����L An.individuel asked to
� ' su ply private or confidentiel data concerning himself shall be informe�a�e a8ency,
P
purpose and intended use of the requested data within the colle�� or � legally
political subdivision, or statewide system; (b) whether he ma�
the requested date; (c) any known consequence arising from his
required to supply rivate or confidential data; and (d) the identity of
supplying or refusing to supply p
other persons or entities authorized by staau��e�kedlto supplyeinvest ga�ve da a
requirement shall not apply when an mdivi
pursuant to section 13.62, subdivision �, to a law enforcement officer.
The commissioner of revenue ma lert tax re�und mstructio�nsteadhos
subdivision in the individual income tax or r•
on those orms. . --- - ,
Ac� � �� � ����y Upon request to a responsible
Subd. 3.
authority, an individual shall be informed�wheutbh�c'hp �a eeor confidential.e UPon his
individuels, and whether it is elassified p ublic data on
turther request, an individual who is the subject of st troe�mri�v�e�if he desires, shell
individuels shall be shovm the data witho of�hat dat�a. After an individuel hes been
�e informed of the content and meaning t� �ta need not be �isclosed to
shown the private data end informed of its uL�nBa��on pursuant to this section is
him for six months thereafter unless a d�SP
ending or additional data on the indivf dusl hM 8teeor public dataruponarequest by
� p require the
responsible authority shaIl provide cop1esThe respcnsible authori�ty maY �in the
the individuel subject of the data• ��rtif n , and comp g
requesting person to pay the actual costs of makinB� Y�
copies. immediatelY, it possible, with any requesi
The responsible authority shall comply ' of the date of the request,
made pursuant to this subdivision, or within five ��immediate compliance is not
excluding Saturdays, Sundays and legal holideys, .
� within which to comply with the
ossible. If he cannot comply with the requ et within that time, he shall so inform t e
p have sn additionel fi YS
individual, and m S turdays, Sundays snd legal holidays.
request, excluding
Subd. 4. Procefiu'e when daffi is not accurate or complete. � ��m�. To
contest the accuracy or completeness�of public or private � the�responsible authority
exereise this right, an indi�� s� notify � ��e authority shall within 30
describing the nature of the disagreemeaL Z'r►e resP° lete and sttempt to
days either. (a) co�of insce8urate or�'incomple e a tae in�ding pecipients named by
notify past recipien
the individusl; or (b) notify the individuel that he believes the data to �ement is
Data in dispute sha]1 be disclosed only if the individual s statement of disagr
• included with the diselosed data• � BQpealed pursuar►t to the
' The determination of the responsible au�thority m o contested cases.
p r o v i s i o n s oi the administrative procedure act relating
CHECK OFF LIST FOR ISSIIANCE OF PSRMITS
FOR OFFICE USE ONLY
ADDRES S OR LEGAL: ��ZZ �-'yQ��-- !��� PID:
DESCRIPTI ON OF WORR: �1VSTA�t-L. QJ9-��l_��'�^� 1� ��N''p"'�����s W/�1^�fl�
------------------------- ---------------------- b��-�b�ES-�=------
ZONING REVIEW BY: ��� DATE APPROVED:
BIIIZ,DING REVIEW BY: DATE APPROVED: � -'� ��(
FEES TO BE CHARGSD: Misc. Fees Calculated By:
PERMIT Yes V/ No
PLAN REVIEW Yes d �IVo SEWER CONNECTION
STATE SURCHARGE Yes �� No_�� WATER CONNECTION
INVESTIGATION FEE Yes • No / PARK FEE
SAC Yes No ✓ SITE INSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------
ZONING CHECR LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Wi th: Depth:
Survey Submitted: Yes N Date � urvey:
Proposed Setbacks :
Front (Lake) : Right ide.
Rear (S r et) : Left Si e:
Adjacent St cture : Wetla
�
Building Heigh : D . H t. eak H
Avg. Setback: Lot Coverage:
Exis ' g P posed
Hardcover: 0-75 "
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File:# Resolution #: - Resolution Date:
REMARRS (in house) :
__ _ ,_ -
- .
BIIII.DING REVIEW CHECR LIST
QBC: S� �L ' � CONSTRIICTION TYPE:
Sq Footage $ Per Sq Ftg
Basement X =
lst Floor X -
2nd Floor X =
Garage X -
x =
TOTAL
Bstimated Construction Value: $ �, o�a�A
Inspections Required: Work Requiring Separate Permits:
Site �Plumbing Grading/Filling
Footing Mechanical Fire
�Framing Septic Water Connection
Insulation Fireplace Sewer Connection
�Wall Board (Masonry) Other
�Final (Mfg. ) Well State Permit
Other Electrical (State Permit)
REMARRS (IN HODS$) :
-------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
,
Access Approval: Date BY�
-----------------------------------------------------------------------------
R$MARRS (TO BE NOTSD ON PERMIT) :
P�4L�Vi C�NS�'�UCTiO l OF ' _PAGES
�2695 Wested e Blvd. �'
9 �,�
� Mound, MN 55364 PROPOSAL
(612) 472-1972
PROPOSAL SUBMITTED TO: PHONE DATE
�C55 `r�7/ - �J'�� 7 � — / �— �'7/
S7REET JOB NAME
�y� . L r.�`. 1a-v ��
C1TY,STATE.Z/P � J08 LOCATION .
/�.t.:t C�C'�.('r'-� I'Yl iU • � .� ��7 � �
ARCHI7ECT DATE OF PLANS JOB PHONE
SPEC/F/CATIONS
WE HEREBY SUBMIT SPECIFlCATIONS AND ESTIMATES FOR THE FOLLOWING:
>=-�,-►� �� Lvc�f 1�. •�2 ���-r..r���:�. G ne.,t la��
�P����.lL �l�G� ! �� � �L.lL c r /i' Y�G'..\ , �L �t:i'i''!,l L.L-. �(�t^(- . f.�t S
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`T'� C�C: tI �n,3 ��-L�_ � �i�� � L.rJ.' ►-��C�4.> /4� /LrLe�':�.teQ
� �J 3 w\� G,�� ` � ���c" l.�Ci`�F����CC�.-+-`_ �Yl�'C �,�1 d Ss7iC ,
� f�S�r7.C_L L��'!'�! � �/'C Ca�'C•_Q._LC� C�C�1 �(�/L�L..Q.. L�S i Y-�-`L�
�i'�.� l l��G�C� YL�^ l'@ J /, �J ��Ci.�X�' . 'T�it-J'ST`I�LL. �G._#; /lf' �F-C"1 L
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T'�-'3 T.a.`� i��cy 2S �1-c:2 C,��:�--� 'F—1�,_,��c:c.�•_•_ .�..c i�,�� �;�:; {�-�,\
�,C Z,`T �r�Gr '-'c-c� � �l'��,..�h r LG:� � ��l�L...� (/L.�G._.l �L �/l� �d :�tZ
i �1 U."� j�' : i �c:U G i✓�• '�;�:3�Yt� �-C �Z )!V � ��'x/�✓t r
. i��.rt.s.-��..� :C.� 5:�r��i� �L.,l., ��>w.��� �o:Z �'.1 0 �J .
�PAYMEI�YTn-4 r c.��-�c�� 'T r.� tZ z w.� �LL., i.�b{�� �,�,.� �eb ���.
WE HEREBY PROPOSE TO FURNISH LABOR AND MATERIALS COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATlONS FOR THE SUM OF:
J��.J-!t_Yl.� ` i'�Q'vL-�Ci� �.X � �'1 lit..i-C lWt.�.YL C�/LQ � ' l%sl'`-1,/'T v LT+[.110LLARS(S � O 7 V , c✓
WITH PAYMENT AS FOLLOWS ,/ � •� S����_�� �� •j � � !�� ��r� u � %� .����' �'
�� J �' .J ��3� r�� b
CONDITIONS: ALL MATERIAL IS GUARANTEED 7t7 MEET SPECIFICATIONS.ALL WORK 1tJ BE COMPLETED IN A PROFESSION L, IMDRKMANLIKE MANNER ACCORDING R7 STANDARD
PRACTICES.ANY ALrERATION TO OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COS7S WILL BE IXECUTED ONLY UPON WRITTEN ORDEAS,AND WILL BE BILLED AS AN
EXTRA CHARGE OVER AND ABOVE THIS ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACClDEN7S OR DELAYS BEYOND OUR CONTROL.OWNER lt7 CAARY FIRE,TORNADO,AND
OTHER NECESSARY INSURANCE. WORKERS ARE FULLY COVERED BY WORKMEN'S COMPENSATION/NSURANCE.
NOTE:THIS PROPOSAL MAY BE WITHORAWN BY US IF NOT ACCEFTED W/TH/N
_S�� OAYS. '
AUTHOR/ZED SIGNATUAE
I ACCEPTANCE
THE ABOVE PROPOSED PRICES,SPECIFICATIONS ANO CONDITIONS ARE SATISFAC1i�RY AND HEREBY ACCEPTED.YOU ARE AUTHOR/ZED Tt7 COMPLETE THIS W'ORK AS SPECIFIED.PAYMENT WILL
BE MADE AS INDICATED ABOVE. `�i��'
SIGNATURE
DATE ACCEPTED SIGNATURE
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C ' DATE TIME
CITY OF ORONO CALLED IN �
INSPECTION NOTICE SCHEDULED "� �����
PERMIT N0. �S 7�COMPLETED M 2,�
ADDRESS �
OWNER �Y� m .� � CONTR. �P.vv�,
TELEPHONE NO. �( ? a I R7a,
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 16 WEILTEST PUMP
02 FRAMIN 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
y 24/25'WOOD BURNER/FIREPLACE 19 LAKESHORFJWETLANDS
Z 04 WALL BD. 12 WATER HOOK•UP 34 TREE REMOVAL
Q OS FINAI 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO-SITE 14 SEWER HOOK•UP O6 PROGRESS
Q 07 DEMO-FINAL �� 27 SEPTIC MAINT. 21 COMPLAINT
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J 10 PLUMBING FINAL 23 SEPTIC FINAL
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� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADINCa/FiLLING
y 03 IN 24/25'WOOD BURNER/FIREPLACE 19 LAKESHORENUEfLANDS
� D. 12 WATER HOOK-UP 34 TREE REMONAL
Q 05 FINAL 13 METER SETlfURN ON 17 SITE INSPECTION
� 07 DEMO-SITE 14 SEWER HOOK-UP O6 PROGRESS
v 07 DEMO-FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOWUP
J 10 PLUMBING FINAL Z;i SEPTIC FINAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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JD� AT�/E TIME
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� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
y 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHOREM/ETLANDS
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 F NA 13 METER SET(TURN ON 17 SITE INSPECTION
� �SITE 14 SEWER HOOK-UP 06 PROGRESS
J 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOWUP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
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Call for the next inspection 24 hours in advance.473-7357
OwnerlContr tor or�site:
Inspector. L U
White Copyllnspector's File Canary CopylSite Notice