HomeMy WebLinkAbout1997-009073 - shed � � � PERMIT
t CITY OF ORONO
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE: ,: ;;.;: :,.
Permit Number: ��;`;�,j�;:.;_;'��'"'
Crystal Bay, Minnesota 55323 _ � �
(612)473-7357 Date Issued: ;; ;; f ��_��
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - ��_��= � - --���� -
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APPUCANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
f ��
, Total Fee: $ / `'�s• ,�� Date Recei�d:
Entered By: , Permit#: �C' �,3
CITY OF ORONO - BUILDING PERMIT 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) �OWNERJOR CONTRACTOR
JOB SITE ADDRESS: �'�6 ,�C'. ��� :J� h� ZIP: r s" 3 � </
NAME OF OWNER: J���,d� <J c�� `/ �.41�i � f� �. PHONE: (home) <j `r� - S-3/ rj
(work) �� i - S� ��3 �
MAII.ING ADDRESS: �S`��' /ri�' /�,�hz /� t� CITY: /�I r���,c.�» ZIP: S�s�- � < <�
CONTRACTOR: � ��- ,� c' h PHONE: `� � � � s- .3l c
CONTAC�'-F�RSQl�I:___._ MOBILE/PAGER:
MAILING ADI�RESS: _ _ __ _ --___ CITY: ZIP:
__ ..__-__
STATE LICENSE: #
ARCHITECT�/ENGINEER: PHONE:
MAILING ADDRESS: - CITY; ZIP:
NAIVIE: REGISTRATYON#
TYPE OF WORK: New Addition Accessory Structure �
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: /E��c/.� � ('��f�k� �= ,� .�/� c= i�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /�r li� C�%
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.
APPLICANT'S SIGNATURE: ��° ���� �� �� ���.������ DATE: C� � �'"
NOTE! Parade of Homes event require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
5
.� �
Sea 13.04 RIGHTS OF SUBJECTS 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.
Subd.2. Information required to be given individual. An individual asked ro supply private or conf'idential data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political 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 confiden[ial dara;and(d)the idendty of other persons or entities authorized by state or federal law to receive the data.
This requirement sha(1 not apply when an individual is asked to supply investigative da[a, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or oronertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,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 has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafrer 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 shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant[o 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 additional 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients 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 disdosed only if the individual's sta[ement of disagreement is included with the disclosed data.
�'he deternunation of ihe responsible authority may be appealed pursuant[o 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 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 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 permit.
��� (j,j—f� ��/i�' �!�Uf 5 S d�f l
First Middle Last
5�.� U /� ���
Address
�'����,v/� /�i�' �S�s,3�y ��� -S..3/y'
C�ty State Zip Phone
I understand my rights as stated above. ,
l
C /. ��.
Si atu �
�
6
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: BC�O N o2TH i4-2�rv� (�R���;
PID:
DESCRIPTION OF WORK: t 2� �cA c9 F�2w�N �rt�.�
---------------------------------------------------
------------------------------------------:-----'j--:---------
ZOi�TI1�tG REVIEW BY: � DATE APPROVED. G ( 57
BUII�DING REVIT�W BY: DAT'E APPROVED: �-((-q�
FEES TO BE CHARGED: , Misc. Fees Calculated By:
PERMIT Yes ✓' No ,
PLAN REVIEW Yes v� No SEWER CONNECTION
STATE SUR`HARC� Yes v-- No WATER CONNECTION
INVESTIGA'I'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: LR-I/3
Fire Department: {/1^,0��� Post Office: y►n�u nrrL School District: t�J�'ST�N K�
Lot Area: Sq.ft. / ' Acres Width Depth
Survey Submitted: Yes_� No Date of Survey: on► t�rc�; /( �/(,7 7
Proposed Setbacks: �
Front (Lake): . c/5 � Right Side: (6�b
Rear (Street): 7�� Left Side: 3 g�
Adjacent Structures: Z 5� Wetland: N<<4
Building Height: Def. Hgt. � . K- Peak Hgt. p, �e.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland Dist:ict: .
(� � Avg. Setback: Bluff Setback: L.ot Coverage:
�� Existing Proposed
Hardcover: 0-75'
75-250'
250`500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
• 26
BUII.,DING REVIEW CHECK LIST
UBC: �- ( CONSTRUCTION TYPE: �/N
' �- Sq Foota�e $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x _
Garage /b X ZO = 3� x_� !o.ea = �, Z o 0
x =
TOTAL
Estimated Construction Value: $ 3�-��o=
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
x- Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Perm.it)
_� Final Grading/Filling Electrical (State Pemut)
Other
------------------------------
REMARKS (IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
------------------------------------------------------------------------------------------------------------------------
REMARKS(TO BE NOTED ON PERivIIT):
27
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S � �c S1TE PLAN — :
'� � �APPROVED-sH�b ;
'Q ❑ AFPROUED�W1TH REVISIONS
Q `. . , . ❑ DISAPP ' � 1
x9 59
,�q7s; \ BY _q
O Denotes Iron Monument �
� Denotes Wood Stake '
X000.0 Denotes Existing Elevation Proposed Top of Foundation Elevation= 9�0.0
(000.0) Denotes Proposed Elevation Proposed Garage Floor Elevation= 9 79 S
-[-- Denotes Directipn of Surface Drainage Proposed Lowest Fioor Elevation= 9�Z.D
I hereby certify that this is a tr�e and correct representation of a survey of the boundaries of:
Lot 2 , Block 1 , PIRATES COUE, Hennepin County , Piinnesota
And of the location of all buildings, if any, thereon, and a(I visible encroachments, if any, from or
on said land. It also shows the locaton of the stakes as set for�a proposed building. As surveyed
;. �-..- �-
by me this 1 6 th day of Novembe r 19—�-• f � , �
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%�/'7i%.'��/ � �. �/��'l•i���.-! '�%�
Thomas S . . Bergquist ��
Land Surveyor, Minn. Reg. No. 7725
;•`•Eso, CERT(FICATE OF SURVEY
B�x P��E . for
, McCOMBS-KNUTSON ASSOCIATES, INC. /0,3 7/
%^� CONSUITING IHGIHEERS A lANO SURVEYORS i SIiE ItAHNfAS
; '>>>��.`��: `"E"�. Q �C`tLUND S 1NE'DLUND
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DATE TIME
CITY OF ORONO CALLED IN �"��
INSPECTION NOTICE SCHEDULED �O - �1� � �3a
PERMfT N0. ��I,.3 COMPLETED rl. ' ✓L
ADDRESS ��C� �D�, QJ�t.vv+ �/2,J'
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� DESCRIPTION ��-��1CC..4 ���
� FOOTINO 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� INd 13 MECHANICAL FINAL 19 LAi�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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= 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
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W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL Z8 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNEfi/CONTRACTOR TO MEET YOU:_YES_NO
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❑STOP ORDER POSTED.CALL INSPECTOR - CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance.473-7357
OwnerlContrac r n i :
Inspector.
White Copyllnspector's Fil Canary CopylSite Notice
D TE c TIME
CiTY OF ORONO CALLED IN � ��8/(7
INSPECTION NOTICE SCHEDULED /9 �7 �
PERMIT NO. �7 O 7 � COMPLETED
ADDRESS � • � G� �
OWNER CONTR. ��2�L�
TELEPHONE NO. �7.Z - J 3/S
� DESCRIPTION �,,,�I � �;��_�C�
� 01 FOOTING 11 CNANICAL RI 18 IXCAV/GRADINd/FIWN(i
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FlREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER NOOK-UP 17 SITE INSPECTION
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= 05 FI 14 SEWER HOOK-UP 06 PROGRESS
�` 07 DEMO—SITE 27 SEPTiC MAiNT. 21 COMPLAINT
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W 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
2 09 PLUMBINf3 RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v INQ FINAL 28 CED R SH LES 36 FOUNDATION REMOVAL
OWNER ONTRACTOR TO MEET YOU1�NO
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� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. r- pHOTO TAKEN
INSPECTOR WILL REfURN
O STOP ORDER POSTED.CALL INSPECTOR = CITATION ISSUED
0 INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73rJ7
OwnedContract it :
Inspector. �
White Copyllnspector's File Canary Copy/Site Notice