HomeMy WebLinkAbout1996-007934 - entry replacement � PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �:t 1 T�,f;����
Crystal Bay, Minnesota 55323 Permit Number: �!�f�,,�__�
(612)473-7357 Date Issued: ;_3��t_},��,��,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
'=�EPf�FiATE F'!��l"i I T°: ��i;it!I t=t�� ��s� hfEC=H(�lwi I C:AI_ F�l�fl:� �LEGT�T C:Hi_ �::��E AT�? .
FEE SUMMARY:
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CONTRACTOR: OWNER: — �;���=1 ?c��y-�t. —
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PE MITEE SIGNATU��- ISSUED BY:SIGNATURE �
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� Total Fee: �,/��:Q��_ �• -� DateReceived:
DateApproved:
Entered By: �'1� .
Permit#: '7 �f-'`�
CITY OF ORONO - BUII.DING PERMIT APPLICATION
ALL INFORMATION viUST BE SUB�IITTED IN FULL BEFORE PLAN REVIEW WII.L
BE STARTED
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THE APPLIC��1T IS: (circle one) OWNER OR CONTRACTOR
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JOB SITE ADDRESS: ��.�("j l�.� '��� �� � ��-� ZIP: `��� '� l 1
NA.�y1E OF OWNER: '—���� � . ��.h,�N s��� PHOlV'E: (home) y 7 I- 8� 1`�
(work) �j7�;�-� �`i v `)
MAILINGADDRESS: -��.,-�z CITY: ZIP:
CONTRACTOR � � � PHONE: ��1 I - �3 I 3
MOBILE PHONE/PAGER `��"1 v 3 i H �'
MAILINGADDRESS: `� �--�. CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: -�j,,r ,� �- 1� r.�>��' PHONE: �-j 7 �, -L,}�,�
MAILTivGADDRESS: > >� �ti�_� �-, �,h,> ,�,-� s�� CITY: i.,,;�>-,�_ r t � ZIP: �� 3`i I
NAivIE: �>��� -� � ���-_�. �..o , �� � REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration �_ Land Alteration
PROPOSED WORK(describe indetail): ��� �� � �--� ����.� ��� � -,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(eYcludingland): $ ��:-4�.::�1,
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 a cordance with the approved plan.
� �
APPLICANT'S SIGNATURE: �`�, �. ` �-------- DATE: S 7 `,��
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
: �
Sec.13.04 RIGHTS OF SUB.TECTS 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 indiridual. An individual asked to supply private or confidenaal data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data wi[hin the collecring'state 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
pdvate or confidendal data;and(d)che idenriry of other persons or enrides authorized by state or federal law to ceceive the data. This requirement shall
not apply when an individual is asked to supply invesdgaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav piace the noace required under this subdivision in the individual income tax or propertv tax refund
instrucrions instead of on those forms.
3ubd. 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 confidenaal. Upon his fur[her request, an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the cootenc
and meaning of that data. After an individual has been shown the private data and informed of its meaning, the data oeed not be disclosed to him for
six months thereafrec unless a dispute or action pursuant to this secrion is pending or addirional data on the individual has been collec[ed or creaced.
The responsible authority shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesdng person to pay the actual costs of making, cerrifying, and compiling the copies.
The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the requesc
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 wricing 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 norify past recipients of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes the data to be correct. Data
in dispute shail be disclosed only if the individual's statement of disagreement is included with[he disclosed data.
The determina[ion 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 pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pemut 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.
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Address
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City State Zip Phone
I derstand my 'ghts as stated above.
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Sig ture
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� CHECK OFF LIST FOR ISSUAri CE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3c�Z� �N��T�� � �o��: �Ri c�P
PID:
DESCRIPTION OF WORK: Ln�rr"Z•�?,�-t/>�✓r�°-�� � � _
-------------- ---------
ZOi�tING REVIEW BY: DATE APPROVID: �- g-�
BUII.DING REVIEW BY: DATE APPROVED: S ~9- `�c•
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �No
PLAN REVIEW Yes � No SEWER CONNECITON
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No t/' PARK FEE
SAC Yes No � STTE INSPECITON
Number of SAC Units OTHER (specify)
-----------------------------
ZONING CHECK LIST Zoning District: �2'�� Shoreland District : ��GS
Fire Department: .v Gf-i� Post Office: ��r,� School District: p/Lc��t/�
Lot Area: Sq.ft. NU Acres G�-f'�'�'"��Width -- Depth —
Survey Submitted: Yes �_ No Date of Survey: O�v r=�� f -�-`l 'f
Proposed Setbacks:
�t (Lake): 2� � Right Side: N�'4
� (Street): �� Left Side: /�//3
Adjacent Structures: f}�r'�'I u�� Wetland: N(/�
�� Building Height: Def. Hgt. c9• k- Peak H;t. O.IG
Avg. Setback: N
��' Bluff Setback: N�� Lot Coverage: ���
Existing Prop��ed
Hardcover: 0-75 e'
75-250' �•l�- `n�`�`� ,L S`�o
250-500' /v�" z ���
500-1000' �j� ��
Hardcover Variance Required: Yes No o� Date of Council Approval:
Grading: Staff Approval Date: /✓/�' By: ''' Council Approval Date: —'
Septic: Staff Approval Date: ���" BY�
Zoning File: /# Resolution: # 'T Resolution Date: �
P�:MARKS (in house):
. � �
BUII.DING REVIEW CHECK LIST
UBC: %Z- 3 CONSTRUCTTON TYPE: ��
Sq Foota�e S Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 2������
Inspettions Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal r— Mechanical Water Connection
v�- Foo[ing Septic Sewer Connection
0\ Framing Fireplace Lawn Irrigation
K Insulation (Masonry) Other
( Wall Board (Mfg.) Well (State Permit)
o� Final Grading/Filling [ Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date BY�
RENIARKS(TO BE NOTED ON PERMIT):
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OATE TIME
CITY OF ORONO %-�-� CALLED IN -i ' �
INSPECTION NOTICE�!�j � SCHEDUI.ED ��� ,3 % �
PERMIT N0. � COMPLETED IU��S C� � � Z3
ADDRESS 1��� �% :01� i� /G�
OWNER;K.-[.-c.�.-y�a-�� CONTR. � ��� ��
TELEPHONE NO. � �� ��� �-->
� DESCRIPTION �'�-����--���
� O7 FOOTING 11 MECHANICALRI 18IXCAV/GRADINO/FIWN(3
� 02 FRAMING ___ 13 MECHANICAL FINAL 19 LAI�SHORE/WETIANDS
Q `03 INSULATIC3R�� 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z p4`apALCBD, 12 WATER HOOK-UP 17 SITE INSPECTION
Q
2 05 FINAL 14 SEWER HOOK-UO O6 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
iQ 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTiC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINQ FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTHACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. r pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP OROER POSTED.CALL INSPECTOR ' ' CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance.473-7357
OwnerlContrac r on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN d '�7 ' - ``'' '/1'
INSPECTION NOTICE SCHEDULED ���_c� ' ',�-c2,�
' u•��-
PERMIT NO. COMPLETED
ADDRESS � � � — 1�% f7�'.
OWNER � CONTR.��2
TELEPHONE NO._ � J / — �;l/�
� DESCRIPTION [��,����1 N�c.J
� 01 FOOTINO 11 MECHANICAL RI 18IXCAV/GRADIN(iJFIWNd
Q HAMIN 13 MECHANICAL FINAL 19 LAf�SHOREJWETLANDS
Q 03 INSULATION 24/25 WOOD BURNEFUFIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= p5 FlNAL 14 SEWER HOOK-UO O6 PR0C3RESS
�^ 07 DEM�SITE 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 PLUMBINO FINAL 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN `
�STOP ORDER POSTED.CALI INSPECTOR ='CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the e t nspection 24 hours in advance.473-7357
OwnerlContra o n 't :
Inspector. �
White Copyllnspeclor's File Canary CopylSite Notice
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DATE TIME
CITY OF ORONO CALLED IN = G /�-
INSPECTION NOTICE SCHEDULED � iG� //• C�d
PERMIT N0. �I�>.�'`� co PLETED �_ T
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ADDRESS�?�-.� C ��. - ' ���r�, �.r'L •
OWNER '—�_.���-✓ CONTR. ,-_<°���� �i
TELEPHONE N0. �'/� �,�-:�3
� DESCRIPTION �'����
�01 F TINQ_• 11 MECNANICAL RI 18IXCAV/ORADINO/FIWNO
�Q 02 FRAMINO 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
Q 03 INSULATION 24/25 WOOD BURNEFVFIREPLACE 34 TREE REMOVAI
Z 04 WALL BD. 12 WATER HOOK-UP 77 SITE INSPECTION
� OS FlNAL 14 SEIMER HOOK-UO O6 PROORESS
_
F` 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
�Q 07 DEMO--FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
Z 09 PLUMBINCi RI 23 SEPTiC FlNAL 35 HARD COVER REMOVAL
v 10 PLUMBINQ FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� BEFORECOVERING PERMANENT
0 CORRECT UNSAFE CONDITION WITHIN HOURS. C pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOPORDER POSTED.CALL INSPECTOR
C GTATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next i spection 24 hours in advance.473-7357
OwnerlContra si
Inspector. � �
White Copyllnspector's File Canary Copy/Site Notice