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Home My WebLink About1995-007407 - addition/remodel � _ ,* PERMIT CITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 Permit Number: �.�s.��}��`u;� Crystal Bay, Minnesota 55323 �:i:f i�.:_:; Date Issued: (612)473-7357 t;�-y f t�;�:.;'�=;;_: SITE ADDRESS: .. •.�'' . . _. .,��`! . . .. . . .'__. _•�"� . _. . . . . ... _.i i,�-- _._. :i.dl,—'lJ`_%. DESCRIPTION: . ...:`�:� f v'i_i. .. . ._?d�t_SL`�Y� ��(,�7 � ;j;"7;7 . _. iii's _ I r� . _ "'F;��.{:�i�i"'t��'�:_��i�l_ . • � _:; .... . �. . ,, �.i{J. _' s_?..ii`� 4�+_�� '.. �y��..- �-'�'3r'T� i,I^EFJ '.. �� ftf?ft :��5: I�{s=Cf_(�_.�j�s"` �— — i.•i'..e`� _ :�iFvir� �'{"_ � _ .'�.._; ! .Ll�Y.'"!tt.:L! ..!1 1L•L i,��•?3:a{ ;'i3i;', >,��c."i. � rt:�c= �{,: Y: — u't iJ v.i��,�`Ifr� !_!'�=.1� i�.flr'�L'YL-�t�5.'L� _ !T - ° :A: i}!S :ui .�v�i.vv i�'i r;"�r:'e': ?i 1�1s'l'll.'t"Vi�L' Tl � �:}� Ai. VL:�T JV! n IJJ i ��ifti� eS !� .L t��iG i..V V 5.'�L�V 1► ��:! rf! _... iJLlt •a!1 1�'t1L!'A' � � L:!lLL�lt J.�.J�F�.�yS+J ��'t��*'L . _'e. 1.ifri +t�4..i..:1'�. :.iiiiel :t�t' �r� •1��ff :�:.'.': `:'�'> �� : �w ifT4J1V I.:L%+..�J. r\t�t i.l.V�t..�+.� _ .-}L..•�� S 1�i��!J! REMARKS: _._._ _ r �'.t._.L��L..:'•. ( . � i...i.:�i'(F 3'' 1'"c� i�:j I"�.`f.e r � �,: f. ` � ' ' :.-. . � • � �i � ��_��' . . . . .r. . ._! :� . , r . •_. .. . ._.� . : ' • " . : . . ... . . , .. . . . . .... . � FEE SUMMARY: � ��:�_�_��°; , .. �<<s`•. :��i= _;_�,.�� .•�.� F�-F� �'7�_1 . i::�:i !�'?��{�'� ��!=_l��t�:�f�: ::.:=;t_.�' , r�L, ��tt��'�'��.�'°_-i= ----- '��__'�„ q,�F:..�:L `':__ i={s` _ , _ s� _ , : CONTRACTOR: — .;Y�;:-I �c_.r;t. — . . . _....�:�: . OWNER: ._ - _; -. ;,-:.::.-. - - - i - . - � _ � . . _. . . _ _ _ i.: .__ _ ._. ._ =r:.�. .._.�.,_! �R_!�_`:_'�= _. _ . .... .. ._ .- _ ._. .� . ._. — -�3.d;`• F i.it:i,__.�: .. . —'t - _�«� ` .. , . ' -� — — — - - f��,��i,.,_ i ._.�»7:,.�j �:��'_ -•— �:'•_i[i 4 �- 1—i-•�??"} `i�� ___.--,—: ��..._ , —+——::—.: L;" J..�r..,,,} t �.�2._v..� 3 ii'7C.,.3� !�'i1� 4^, � � i�i'ii�I�'v� {'-:' �:r,'' . ... .. _... . ."..l,�-Y.�� . ._ ... . _ .�. ._. ._ �—._F. . .. . ... ... , . 1S.�;— " � a T�� iL��r'�i at��fJ ti�:-C.~«�` �.��.��,t�`�T'` �F' : r I# s t ,r-, �;�� :.,, �: . � � , : �,� r `�r t� . , a ' _`,i � ,r , . . �..�_� � f�:'t �� i�f _ . ._�. . ... . _ t��._� . _ . . _ i; _ �� a } # .r: .a., � . . .�.. _ _ . 1;�: ��5 , _ _ _ _ , . :. .,. - .. .{C' � t "t t T k ,_ . , . .:;. _ L . . . . . . _ ;. - , '� � _ . . _ _ �__.� . .. . .. . . . __ ._ . . _ _.._i._ �� ,s. �� >!��-_, ( --! APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE ' � � '� CITY OF ORONO - BUILDING PERM.IT APPLICATION Tota.I Fee• $i� '' 1c ! � Date Received: %� ,��5 Date Approved: Entered By: � �'� Permit�: ';'��-� AT,7• INFORMATION MIIST B$ SIIBMITTSD IN FIILL BEFORE PLAN REVIEW WII.L B$ STARTED (See Check-off List Enclosed} -------------------------------------------------- THE APPLICANT IS: (circle one) OWNER or CONTRACTOR } �i� \ JOB SITE ADDR.BSS:��(,� h �_1 �f�-� ��"\t�N�,� �� ZIP: � (work) �� -��' I � , ,� t N�ME OF OWNER: �`�� 11v� PHONE: (horae) j - `zC,Z MAIZ,ING ADDRESS: CITY: ZIP: r�{�.C�� /`�'1�� C� .�-�r.�,�; cora�c�rox: ��1�T N�� j(�: PHorr$: `�� -Z2.`Z-� MAILING ADDRESS: �� OG �'I� ��-II D. CITY: '��l�� ki �� ZIP:�/)j�"l�V'"�(�C`0 STATS LICENSE: � `2��;'L z� �'��,k �cHz�c�/��irr�Ex: �'��- ,SS� �"" PHorrE: MATI�ING ADDRSSS: ) �� 7� �r'1 • 4"-/�C��-��C�� CITY: ZIP: Z,J�: RSGISTRATIOA $ TYPE OF WORR: New Addition� ' Accessory Structure Mone Demo Remodel/Alteration�_ Renovate Land Alteration r.. , �'", �c�,.� r�1�. \� -y�� r� ' PROPOSED WORR (describe in detail) : �;` "� l�-� ��,11��v l`�� Y✓� -'��'`��'�) �' �� -,�� `�`��-�C��v�� '�i�C�� . STORIES:_�, SQ. FEBT OF EACH FI,OOR: NO. OF B$DROOMS:�;_ GARAGS ST�LS: ATT. �% DET. - (�� `� �'�;'�'. �sT�� coxs�.zQcrzox v�uATzox (eacluainq Iana) : $ �� ' �� L��` I hereby appl.y for a building permit and I acknowl.edge 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 i accordance with the ",pproved plan. � R R / /) [/� I ` r i � � ' �.� J '� ; i � �,�,� �'� � ` _ � '2�- APPLICI�NT'S SIGNATURE: . J ,�-j �'w�, DATE: \J �r t �"� ,,{',. �i � it�� "i� n,�� p � h � �� $� C ITY of ORON(� y T' �-- "' Si t sY �r� d� �; a � _ � ,�z�! ��-y�< ba+� � t� �°. �'��,_� Post Office Box 66•Crystal Bay, Minnesota 55323�Municipal Offices , Y,: _; yk<:: �: , i � . � ,";�;� -�! 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 yau 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 confidential information. You are notified that: 1. The information you furnish wiZl 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 Iicense. 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 Zicense requires Councii action to approve, some information may become pub.Zic. 5. You have certain rights under M.S. 13.04 Lo review pri�a�� data on yourself. E. Your full namP is required to process this apFlicatian or permit. �� -� � �'�c �� S�'-'r��. --� First Middle Last r �� . �7> ��' ' � � � Address `�.'�'� � f�� t,� , - Cit State �zP �� - Z2z-f Phone I understand my rights as •�stated above. \ �� ' � i v� � !� ��--�. � � Si na ure , BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 ASSESSIN G � — �_ * �_� �Gg� pg gpgJgCTS OF DATA � . Subdivision 1. Type of da�a- The rights ctio�viduels on whom the data is stored or to be stored shall be as set forth in th�s Se An.individuel asked to Subd, 2. Information required to be given individuel. � � 1 rivate or confidentiel data concerning himwitlhin the collecti g state agency, supp y p uested data purpose and intended use of the req tem; (b) whether he may refuse or is legally political subdivision, or statewide sys �own consequence arising from his required to supply the requested date; (�) �Y in or refusing to supply private or confideae��gw to receive he data.1tThis- supply g state or fe investi ative data, other persons or entities authorized by requirement shall not epQly when an individual is esked to supply g pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue ms lace the notice re uired under this subdivision in the individuel income tax or ro ert tax re und instructions instead o on those orms. - - --- - . t� �� . Upon request to a responsible Subd. 3. A�� authorit , an individusl shall be informed wh blic h r vate or eonfident al.e Upon his y ublic data on individusls, and whether it is clessified as p � P data without any charge to him and, if he desires, shall further request, an inaividual who is the subject of stored private or��u� � been individuels shall be shown th of that data• After an indi �e informed of the content snd meaning the data need not be �isclosed io shown the private data snd informed of its u��BcUon p�rs�t to this section is him for six months thereafter unless a �P n request by ' din or additienal data on the individuel h�8 e or publie dataruQoeated. The � pen g rovide copies of the pr uire the responsible authority sha]1 p The responsible authority may req the individual subject of the �t8• certif and compiling the requesting person to pay the actual costs of making, Y�g' copies. immediately, if possible, with any request The responsible authority shall comply S of the date of the request, made pursuant to this subdivision, or within five day xcludin Saturdays, Sundays and legal holid�eys�ni�ham�m 8he shall so�info m the e g with the request with the possible. If he eannot comply within which to comply individual, and may have er► additio� i��o deys. request, excluding Saturdays, SundaYs g te or complete. An individuel maY Subd. 4. Proced�e when data fs not accura �mself. To . shall notify in writing the respcnsible authority contest the accuracy or completeness�of public or private data concerning� Wlthin 30 exercLse this right, an individuel �ible authority sh describing the nature of the disagreement. The respo da either: (a) correct the data found te be in�e a�ae�°�udingPee�ipi��namedtby � notify past recipients of inaccurate or incomple � the individusl; or (b) notify the individuel t��dual'sistatementof dis8�'eement is if the mdi Data in dispute shall be disclosed only ' • ineluded with the �isclosed data• � appealed pursueT►t to the ' The determination of the responsible authority may provisions of the administrative procedure act relating to contested cases• . � CHECR OFF LIST FOR ISSIIANCE OF PERMITS FOR OFFICE USE ONLY ADD22ES5 OR LEGAI,: �� /�� C�'�Z/l, ?-e.�ti�� PID: � �-O�c�'� -� �!'� 000`J --� TJESCRIPTION OF WORK:� ��c'3'�- ��' -- � �--------------- ' -------------------� ---------- ZONING REVIEW BY: � CQ/W�ow DATE APPROVED: g- Zg -5 S BIII7�DING REVIEW BY: DATS APPROVED: �I-24 -S S' -------------- ----------- FEES TO BE CHARGF.D: Misc. Fees Ca1cul.ated By: PERMIT Yes ✓� No PLAN REVIEW Yes r/- No 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: L.2• /� ' Po Off � S Y�ool District: Fire Department: �� _- � � Lot Area: Wid � eP Survey Submitted: Yes /� No Date of Survey: ON lr�� Proposed Setbacks: � Front (Lake) : ''.� '�' Right Side: 3�� Rear (Street) : (SL' � '�- Left Side: ��/� Adjacent Structures: �?77'9GCf�'� Wetland: /VL1�- Building Height: Def . Hgt. /�///� Peak Hgt. —` Avg. Setback: O • l�-� Lot Coverage: ��/� Existing Proposed Hardcover: 0-75 ' 75-250 ' - p. l� 250-500 ' 500-1000 ' - Hardcover Variance Required: Yes No o� Date of Council Approva�.: � Grading: Staff Approval. Date: — By: � Council Approval Date: Septic: Staff Approva� Date: � BY� Zoning Fil.e:# -- Resolution # : ------ Resolution Date: REMARKS (in house) : BIIILDING REVIEW CHECR LIST - � pgC: I�''3 CONSTRIICTION TYPE: �✓� Sq Footage $ Per Sq Ftg Basement X - lst Fl.00r X - 2nd Floor X - Garage X - x = TOTAL Estimated Construction Value: $ 4�3�0 o a`� Inspections Required: Work Requiring Separate Permits: Site P�umbing Grading/Fil.�ing �'Footing Mechanical Fire � Framing Septic Water Connection �_Insulation �p _Fireplace Sewer Connection Wa�l. Board (Masonr ) Lawn Irrigation �- Y «,Fina� �(Mf g.) Other Other Well (State Permit) �Electrica� (State Permit) -------------------------------------------- REMARRS (IN HOIISE) : ------------------------------------------------ REVIEW BY OTHERS: DATE: Access : Existing New Access Approval: Date BY= ------------------------------------------ REMARRS (TO BE NOTED ON PERMIT) : �}, -y" � �` }�`�Q�� t�..,:�. '�/. "r�'i 4r' 'Y�� ..r� Lf . J �' . 'Y~ . 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A ..._. ._ ._. ..�._ iT..��i� �`��-JJ � CT/Si►�/659 3 . . � _ . _ -r� i_Ff ��1 F'..!.1�.�'-:`;T[".i II_' " P,...`:! 1'�, r �' 2�,rr.s±roo,Foscnr.Anderli�and As;ociatns Inc.i�an Afhrmabvn qctbn!Equai Oop�rtwrlry Einpl�yer I Bonestrot� <,rto G 9oncztroo Pf Ho�vnrd A Senfnrd PE Michaa C r yncn PE grFzn K Gr�fr,P.F. "^b�rc W' Ruiene,Y E" Keith,q uerden V E James R Mni4nd P.E. F.Todd Foz[er PF Ro�ene '�sCpn C /�nde:lik P.E Rober`R.f"ct`crlm f.0 Jerr� 'J Fertzscn P,E Y:[Ith R Yap� P E. � N.arv�n I Snrt�ald P F Ri�lvard 1V Fnit..� P F 'teert� Ar7an.k �E Oo+!;la� i grne.i. P c Ander�ik & �'�r<r�yc Tu��cr ?E Di idO LOskG[d °E Kenntchi' Aneerien RF ShawnO Guctatso� �F L,�enn a Ccc� P E F.nbrrt C.RUSSPY. A.l.P. Mark R.P.Alfs PF frNfi�nl+virr PF � n }� TnCm�s E.Noy'es.P.E. JC�ry A,BoUrdor. P E. M3rk A SeIU.�'� Kent J Wagn�r.F.E, ` 1 \,�SQC��4�s ^��•�c G Sc�+un�cnt 'E. nRark n N�n<on P,F Gdfy W..L7oripn PF F..u!G Neu.r Fp \ _.., �r,� Ch�.:�n 'P A' Mirhasi T R.�u•mann a.F ?avl 1 �annon A I A 1nMn P Garder G F ' ^_er�.:;�Consv�:n�e 7ed K Ae'o.v.E Dar,le.J EtlgertOn.PE. G3n O Bayum.P.�. Engineers � Architects thr.,m,-r.k �r�rc-�r °i-, P, Ri:k Srhmn�f P F ��.`t,.� ! fF+iq.tn,a... F F Irm�S F' R'n n � C F !13'.f �1 �.,•yP o F :<� t '.� tir;�'n � Dona',d: R�.�rl.ir�-�,,..c V!�q��/.i.eSWFl1 FF ler^M �ninn P�c T�1nTtf!A (�ifN� �E� A�Tf1'(7 �YJ::I�{� P F fh��rir. q Fr�rY•n.. l frede _J StmGiu: .P c. 'o7�la�F Jrnc«n F E i rn M.P �I Ssptcmher �1. 199� ^ � � S�.Y <r �a. . . �� j ,.,, � �: �,,,.,.,..., .�., °AI•-n."•P '3u P.E Y:a�:. . '.l';a�mrN c p .1,)nr=.R1 :;•ir.��•, i1�Uti�e` ✓�v �rt�r-,nn :� t;3rv i+ Rr'.�rnlir: P.F �R.Y�Pi i Fn7rl/t��i! �1��i'. 1.1"�a' (_i?ll�ill. , i,ui;:litt_' C)(]i- i_�i ('it� �;i � �r;�t�� F�:�ct ()tti�c• Ei��,� t,h �.fti'�i�l� 1Yc11�. i�llliil.`��l(,i .? .��l.i k.. :c�t:;i �;,�r�h I .:�;,� �5:.. I�il_. i�� 1.:•:-<.�rc;i {)c:ir I �'ir ��%e havr re��ic=t1•ed the prc�p�7ti�; t-� install a �:e�ond <<ulvert tindr:r 1.1�}n�= L.��kP K��acl anel ��xc�avr�tc� thc ditcl� al4m�� Count�� Ko<�ct h �,> pr��ic�t 3n adequate n��t[�=t fc�r rhe exicti»� a�ctl:�nci nn �,c�t �. �31ock 1. Thc Farm it [ �_7tt.� Z_;��e, 7`he initial c:a.l�ii::ari�ns cit�ne. h�� l�ir ��.fc F '�r�l�c�n �SAkk �n�ineering c:;t�m}�ar1y an�l the reeent lcttcr b`� SteCshen M. J,�hnst�n. [_�inrlfc�rm En��nec:rin�� e��,mpa�1�� 2�p�:a� acce�,tarte fr,�m ar. en��necnr�fr ct:3nci�sc�int. The hc,use w�lk��ur eie.�atior� <it�>ulCi he �et nc� ��rr tt�a;7 cie��ati«n y'��,�, a� detcrmined i�� C.�ir.�f<�rn� F.n�inc�c�rin� Cc�nlpam� : `;��tll pro��idt .�p�r��:i:tl:ttciv ,�nc ic>��t of frerhi��rd ah,��'e thc �';�lc��latc��j 7�1i1-vear floo� rle�<i:;�_�tr. Tt�c hor��o�re�� i�c�utd F>c dc��•iscci that �}ne f�>�-�t �,f frc�eh�„�r�i ma�� n�t hr adcyuaic pr,_�te�:tian tr,�rn fl;,c�d�r�� ctiir�rn�= �� I<�r�rc�r f�rr.��tiencv ct,,rm �,cnt Silt tcnc;= •;h:>uld �>e itlstatl:,c� at rhe ��>ti��nstream limit� of the �rc}n�,�ed t�radtnn, �ri{�r rc� �OIIliTiill:':It� «ii�l tti� �l'i>pii. 1..�-�Tt:y l.�}�t' b!:)U�E'�'r1C� �flil4t ��i, t'l C>%�trf'i�{ tt") It� t�i"lfrlliRl �r��;�-c<•;•t;c�n ��r tn a r111111tI:tltil �>t six inct�es c�f <_:i�� a��rc�atc bas�� rd �1.� ir�;:he� c;f hit�,minc>>>ti n-,ixture. {Ttrpe �11) «�hi,:}�ci�c�~ �� ,rc�rter_ �itarn;n��u� miYttzr��s mu�r. hF� pJac-ec� �n l�ft� n�>t <-�ceeilin� rhr�� nc�te� in th�c.�:ncss. .�li h<iLk2ill hrie;�� t��e (_'iass � a�Ure�atC n��t he �>rantrlar ht�rrc�u� n7;ate1;��1 mectin� �tnUU7 -5pe�tiiratit�n ti�_�, ��l�l� ACcesc ��Ic�n�� ! s;n�� I .akc kc,ule.��ard mi��t he maint��inei� ��I ali tit:7c��. kc:��2n� ��n�: i:lne ,:,t tr•att�c• c��c=•r� 1'r:3tt�� cc,ntr��l muct hc� in�rallc,�f anci maintaine�; ir ��ceor:lar.�r: with the '�i'�t["I'C:'T� Thc� C'ir� :hc>ulcj t•�, I1otified tc+r ins�eeticm at ��tti[ =�� f1�.'Ur� �1rIC1r TC' rEIlli`r�"Ilti�y' r�lf' �UCt�3�i. .)1 �.S,T�'., �.:i�:i' FiC111�F['."11'�� 'P Vl'(ltl�C'� 1'('1�i1T11Tlll'Tl<j �� 1��.r,t_��i 1<-tt�r ot cre�iit b�. pro��i,1t<1 t�; the Cit�� !>> in�urr� th��t th�� +�rk i� d��ne ,cati�f�crr�ril�� YleaSe cc-�nIaCt �11e �t t111s �tTic�:: ti ��r�u h:��e anv �tit:titinn� r�:��ar�lin�Y thi� m.itter � .,;, ,-, �. ;.,; $O.ti��l'Kt�IU. RC)t,F-:�}-:. Ati;i7F�tZi .IFti is� .>'��i)C'I:�T�t=.�. i�(". ; . �. �`"_J�C.i�.:7- ��'. :. .r't,:,;`_�'..r�.-;:.; �fitt��(i I 1 l_I.I4r�1(�.i-��i1 1''.L:� ..._-.�.�_.:._.._..,_._ .____�...............__. .._.:_._. .. ' . _ __....__._........._..v..._.s,.._�._.�.�.�.�_..__.�.�..r__.._....�."'_'..._ .. ._ _.__.____..._._._"'__ .._..__�____....._____ 23�5 Wesi Hiyhw�y 3G ■ St f�a�ul, f�fN S5T13 R l�17-f,3l,-4(,f}(3 . . _ • _ _ � �,� i,. /� NQ55+�� A'Cfl�t�+�f+.:r� ��:? �r.r",-. ,�,[G';,'� f x�. , ,, , . .. , _ _ _. __.. . __. _�_._. .._.......__._..�,.-.....�...�_...,.,..._.._...,_ ... ._ .... _..___ � F��M?s,� t�A^��!"�,;�r�7A:, n�.°L��g Sff.E�T 'v'�_i:._ . . _. _� . .. . � . T:- F', ,..a1.. . - . _ �_i'.u'�_.�. . .� .� .. � . .. . . ��Y.�!'�?� . ".f La �. -.. . .. .i... .. SuBJE�T u� "�-,�-' f�•; , ''� =r- : _ ;- _ .- "_}�_ ;r .�1�— . . -;�;.`:-',__�(r'a�+"l�� , -`'�' , �r',:'M��f' .. °'�r1�� i..;t-.�,, r', -_ . i a: � �„ r y.� . . . . : a .•' - �;, ,'F.R � '. - . ' -• f.�- } r.. � .__ r� � . c ��71... , .. . . ^ . i!� - � -- ' ' . , � � .. . ., . � ;_..a : ��. �T� k "j��..a � r . h"� -. " �i� ' � � F r•-. , � . . . . -. , . . ... . . ' ... ,. �. . _ . ± . � .F. - . .. � - + . f , �� .. L-� � � > , � p: 1 w� � � Sec.13.04 RIGHTS OF SiJBJECTS OF DATA Subd. 1. Type of data. The rigLcs of individual on whom the dara is sWced or to 6e stored shall be as set fonh in this secaoa S�bd.2. Information c�eqmred to be givm indioidual. An individuai asked to suPP1Y Private or confidendai data concerning himself shall be informed of: (a)[he purpose and inoended use of the�equesud data wichin the collecting§tate agency,poGdcal subdivision,or saoewide sysoem; (b)whether he may cefuse or is legally required to sa4P1Y��n9u�data;(c)any known consequence azising from his supplying or refusing to supply privau or confidendal data:and(d)ehe idendry of other pecsoas or enddes authorized by stau or federal law to receive the data. This iequusme�shall not apply when an individual is asked to supply invesdgadve data,punuant to secdon 13.82,subdivision 5, to a law enforcement officer. 'Ihe commissioner of reveaue mav alace the noace required under this subdivision in the individual income rez or aropem taz refund instrucrions 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 whecher it is classified as public,private or co�dential. Upon his further request,an iadividual who is the subject of stored privare or public data on individuals shall be shown[he dara wi[houc aay charge to him and;if he desires,shall be informed of the conrent and meaning of that data. Afur an individual has been shown the private data and informed of itc meaning,the data need not be disclosed w him for six months thereafttt unless a disputt or acdon pursuant to this section is pending or addidonal dara on the individual has been collected or enated. The respoasible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsibie authoriry may require[he requesring peaon to pay the acmal costs of making,certifying, and compiling the copies. The responsible au[hority shall compiy immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Sanirdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the request within thac time,he shall so inform che individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal 6olidays. 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 ezercise this right,an individual shall notify in writing the responsibie authority describiag the nature of the disagreemeat. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and atumpt to notify pasc recipiencs of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data W be correct. Data in dispuu shall be disclosed only if ti�e individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant w the provisions of the adminisnadve procedure act relating to contesud 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: i, 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 permit or license requires Council action to approve, some information may become public. g, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. f"l,K�-1� W;��F�t••� �►s'--� F�� Middle �� S� �`'►�It�1.�'1zx�'.� �31.��(J � 2--E�4 aaanss �l�v 2�i MIJ SS��t� �c2— ��3 -2�—� � C� S�� ZIp Phone I understand my righu as stated above. Si mre . r� �� Total Fee: � DateReceived:��.Zi/9,� Date Approved: Entered By: Permit#: CITY OF ORONO - BUII..DING PERMIT APPLICATION ALL INFORMATION il�1UST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WII.L BE STARTED _ -------------------- THE APPLICAI�IT IS: (circle one) OWNER OR ONTRACTOR JOB SITE �iDDRESS: t��°� I�ro� fir� �� z�: ��z� NAi�OF OW�TER: {Z�1i�'� w- ��►JS PHONE: (home) `-��3 -��8 (work) �t�-3•�3c.�- VIAILINGADDRESS: '�'�0 �� t�-.�i'- CITY: �'�A�t�k- ZIP: 5��1�_ CONTRACTOR: ��Z�� t.�S PHONE: �-}�?,- �� vIOBILE PHONE/PAGER: MAILINGADDRESS: 18�U MM`� ��-� CITY: W'u�zh1'� ZIP. M,N� STATE LICENSE: # 2oo3•-P53� '�2Og � PHONE: ARCHITECT/ENGINEER: MAILING ADDRESS: CITY: ZIP' N��: REGISTRATION # TYPE OF WORK: New Addition '?C Accessory Structure Move Remodel/Alteration Land Alt,erarion PROPOSEDWORK(describeindetail): 1�'� ot= � ��2 c�L �.h��'c�,t'� �_ r� 2� STORIES: I SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. � DET. w ESTLVIATEDCONSTRUCTIONVAI.UATION(excludingland): $ �ZI QC� " — 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 Ciry and with the State Building Code; that I understand this is not a permit and work is not to start without a pemut; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: 3I'L� �� NOTE! Parade of 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. , � � . ., r O�'/ _ , I � � �` / � 'Zj Q �" n �... � `• �� , 1 \` ` ' o �� I \� ' \ `` � 4' � ' .- . . , � �.� f� . ' E,�,�,�`� M .�� \ . � i _ . . i��._ � � � . - � f�� 1 �� . ' � �. , � j � .� , � I . � , j� � 1 �I , _- �:� , '�,\ � l �. � , �, � � �� - � / � � � :\ i � -��. � � ♦ . I 1 `' � / /C \ � � � �° � 'S� '� , 1'- � �, g� � � •,\` �' /�`.�\ l � �� /, � �� T� / / •., �� ,Y, � , � `�,�,,,� c� .� / � � �� ', , . ' i / � c� , ,N �..\ �, ,, � `.' . � � / � � / �� , ` �� . � 3 � �4 t \\ ` ; r � / � • � �� / • ��. � .\.Y ,�yr �\ . `�. � '/ � / / `.y ' � � I ' / ,� 1� `�, � ��, �ix � .--_-�� / , _ � ,., , ; �-- � / � . � f 9 ,r � j l . / � � / .`,.. ` — � / �/ // , - ; . , .� / --�--- � `�-�- � Jq ' �� , i l �� . � , ;_� � � �� / / � , �,. ' ��`. `�`, �. � / / ��.�.— q. L9'.�� / `� ��=.^ ..,:_. `r` _— � �— y_�.�. ----- --- --C� / r— � � r- � d7 4/ 4) � �`�, / !f h ---- � Q, Ll.1 . �.. r �--� �,�a� ``� � � co ..----- `�-" r �1 � ,� �� -� l �� .y--- L � �---- b/ 1��` . �. ..F � - / _ "— ;�� __ ,� 'ii ��H�-I H:-��IH I�'=,=,�fa �,iiiiih'b;',T'=� T �iaT '_;�-,�=,T "_��;'�=,it DATE TIIv�E CITY OF ORONO CALLED IN I -a �-� S��S INSPECTION NOTICE SCHEDULED /� 3% °� PERMIT NO. � y� � COMPLETED �1 �C�C; ADDRESS jG �/9 7�� tiv1'�'1 �d - OWNER ,r-�•'r1�e�¢i CONTR. � ��o��. TELEPHONE NO. � 7 6 - � � � � DESCRIPTION � 01 F( OpTINr 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 0 F2 RA �NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMB�NG RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO Z y COMMENTS: a C'� � �Ct,v� Gt S ` SS� � J O � � O � W � Q � 2 W � W � � d ❑WQRK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ja'�CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN ►NSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Ca11 for the next inspection 24 hours in advance.473-7357 OwnerlContract site� Inspector. � U White Copyllnspector's File Canary Copy/SNe Notice DATE TIME CITY OF ORONO CALLED IN i�'� ! INSPECTION NOTICE SCHEDULED � � "- < %! � � PERMIT NO. � j �/ �f COMPLETED � , ADDRESS /�� - � �� '' i� � r OWNER � �: �� -� CONTR.�=_%��. /,<< - . � TELEPHONE N0. '`�%`! � �' �' %� � DESCRIPTION — � 01 FOOTINO 11 MECHANICAL RI 18 EXCAV/GRADINO/FIWNO y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORENVETLANDS Q 03 INSULATION , , . �.. /24/25 W�OD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK•UP 17 SITE INSPECTION Q Z OS FINAL 14 SEWER HOOK-UO 06 PROGRESS � 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT J Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBINCi RI 23 SEPTIC FINAL 35 HARD COVER FiEMOVAL v 10 PLUMBINO FINAL 36 FOUNDATION REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � 0. � `t � D � S 0 '� s p.r' � 0 � W R Q � Z W � W � � d WORK SATISFACTORY:PROCEED - PROJECT COMPLETE W � CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY C CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ` pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR =CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO A RANGE ACCESS. Call f e nex in ction 24 hours in advance.473-7357 OwnerlContra n site: Inspector. White Copyllnspector's File Canary CopylSite Notice DATE TIME CITY OF ORONO CALLED IN /��' lJ `��`% ��'� INSPECTION NOTICE scHE�u�E� �'=� � �-�'�= // '��'-' �= �� , ._ PERMIT NO. Y � - � � COMPLETED i, � �_ r ADDRESS� i CO � `l �,J t�)_�?� ��, f-;; �;i,-,- � �1��_ OWNER �� 5-,� � :':.- CONTR.-��a-��2�-.1�.'t��i�� TELEPHONE NO. `�'� ��`-'�� ' =' 7 � DESCRIPTION ,��z �� ' -�.`' � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 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 J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � � . a j �i r � � � 0 � � O � � �, � � U� Q � z W � W � � d � WORK SATISFACTORY:PROCEED C PROJECT COMPLETE W CORRECT V��ORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. o pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ` CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for t�e e t i spection 24 hours in advance.473-73�J7 OwnerlContr r on�it - Inspector. White Copyllnspector's File Canary CopylSite Notice �� DATE � � T7 1 CITY OF ORONO CALLED IN -�� / `�� Z' INSPECTION NOTICE scHEou�Eo � % �� -� �3�� PERMIT N0. cOy11PLETED � � �ADDRESS , � ,` � l� / �� r",s-, OWNER �I,e- �.��,c,�� CONTR. n�' �-�:,:�� . �c-��,��,� // ; : TELEPHONE NO. `� � <-� ` ,T� :� :� I � DESCRIPTION /L�-Yv��-t�' fi � Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLINCa � 02 FRAMING 13 MECHANICAL FINAL 19 IAI�SHORE/WETLANDS Q 031NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. /' 12 WATER HOOK-UP 17 SITE INSPECTION ��"'b��5 NIF AL�.`�+�/ 14 SEWER HOOK-UP 06 PROGRESS k' 07 DEM4-§ITE 27 SEPTIC MAINT. 21 COMPLAINT J W 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL v 10 PLUMBINCa FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: W '�� <. _ � �. 0 ��`_7 ��/ � 7�=��'�'�. O /12��'L��/'��f. � 7L S �. Q z %G's`7 -� „'.l ` W ��-�;�a � � ��c-� ��, � �d WORK SATISFACTORY:PROCEED �ROJ ECT COM PLETE W C CORRECT WORK&PROCEED - ISSUE CERTIFICATE OF OCCUPANCY O ❑ 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 ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance.473-7357 OwnedContractor on s • Inspector. White Copyllnspeclor's File Canary CopylSite Notice