HomeMy WebLinkAbout1999-011333 - skylite/reroof PERMIT
CITY OF ORONO PERMIT TYPE:
_ 275� Kelley Parkway- P.O. Box 66 - _
Cr stal Ba , Minnesota 55323 Permit Number: �� .-=,�_.:. --
y y Date Issued: `-'� ' �� � -�
(612)473-7357 _;.�;�s -. _. -
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ r;�:�,; 1�;.:;;;�. _ OWNER:
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APPL CANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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, Total Fee: $ ��J"'7 3. 3`7 Date Received:
Entered By: �('� Permit#: �� ,�3-3
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will6e started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
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JOB SITE ADDRESS: ,�D � �����'�/^ �JZIP:
NAME OF OWNER: t�0'r� PHONE: (home) �7�� �-�i3
(work) �/�1�-'39 S/9
MAILING ADDRESS: CITY: ZIP:
COl�'TRACTOR: :...L,w�, (�B 1�J 5�- PHONE: �'�1 G'//`� �/
CONTACT PERSON: MOBILE/PAGER: � - v '
MAILING ADDItESS: � CITY: IP: ""�9
STATE LICENSE: #
�` S� �/Z
ARCHITECT/ENGINEER: j� ��'���S , PHONE: 3 Z o �� PG �1-
MAILING ADDRESS: '1 S- I I .�,I- �" CITY: �.�.�.ntoc `i�w✓ ZIP: S'S 3 3 �1
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration_� Land Alteration
PROPOSED WORK(describe in detai�: � U�J�' �C�/4 ���
,
STORIES: � SQ. FEET OF EACH FLOOR: �`/ ��'�- - 14�0 ✓,��
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $�B;�►, �,_
I hereby apply for a building pernnit 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 approved plan.
APPLICANT'S SIGNATURE: DATE: `9�``� � /
NOTE! Parade of Homes events re uire separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGIiTS OF SUBTECTS 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.
S�bd.2. InformaHon required to be given Lndivldual. An individual asked ro supply private or confidential data co�erning himself
shall be informed of: (a)die purpose and'uuended use of the requested data within the collecting state agency,polirical subdivision,or statewide
system;(b)whether he may refuse or is legally nquired to supply the requested data;(c)any Imown consequence arising from his supplying or
refusing ro supply private or confidential data;and(d)the identiry of other persons or enrities authorized by state or federal law to receive the data.
This requirement shall not apply when an uidividual is asked to supply invesdgative data, pursuant to secrion 13.82, subdivision 5, w a law
enforcement officer.
The c�mmissioner of reveme rt�v nlace the notice rea�ired�nder d+is c��bdivi�ion in the individual income tax or nmoertv taz refund
in�tr�ctio�t instPad of on thoss forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the
subject of swred data on individuals,and whether it is class�ed as public,private or confidential. Upon his further request,an i�ividual who
is dx subject of srored private or public data on individuals shall be shown the data without azry charge to him and,if he desires,shall be informed
of the content and meaning of that data. Afur an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafoer unless a dispute or ac6on pursuant to this secfion is pending or addidonal data on the individual has been
collected or cnated. The responsibie aud�ority shall provide copies of the private or public dara upon request by the irnlividual subject of the data.
T'he rosponsible authority may requiro the requesang person to pay the acmal cosu of making,certifying,a�ttl compiling the copies.
The responsible authoriry shatl comply imme�iately,if possble,with any request made pursvant to 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 cazmot comply with
the request within that time,he shall so inform the individual,and may have an additionai five days within which to comply with the request,
excluding Sadudays,Sundays affi legal holidays.
Subd.4. Procedure when data Lc not accurate or complete. An individual may contest the accuracy or compleuness of public or
private data concerning himself. To ezercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the
disagree��u. The responsble sudwriry shall within 30 days either: (a)correct tl�e data found to be inaccurate or incomplete and attempt to notify
past r�ipients of inaccurate or incomplete data,including r�ipients named by the individual;or(b)notify the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is i�luded with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating
to contested cases.
DATA PILNACY AI�VISORY
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 Giry of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze notified that:
1. The information you fumish 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 Ciry 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.
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.
First Middle 1.ast
Address
C�ty State Zip Phone
I understand my rights as stated above.
Signaare
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� , � � CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ 3t�Z o hr o(�.�� s��v�, p,2
PID:
DESCRIPTION OF WORK: �Ky Cr� t� -t ►Zc Ezn o c=
----------------
ZONING REV�W BY: �� DATE APPROVED:
BUILDING REVIEW BY: DATE APPROVED: y-!�-�i9
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,/' No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST zoning District: �p c �,�`o
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Street): Left Side:
Adjacent Structures: We and:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: Council Approval Date:
Septic: Staff Approval Date: B :
Zoning File: �/ Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Vaziance Required: Yes No Date of Council Approval:
REMARKS(in house):
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BUILDING REVIEW CHECK LIST
UBC: IZ-3 � CONSTRUCTION TYPE: VN
Sq Footage $Per Sq Ftg :
Basem�nt, `. . x =
lst Floor z =
2nd Floor x =
Gazage x =
x =
TOTAL
Estimated Construction Value: $ SprOaOvO
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal . Mechanical Water Connection
Footing Septic Sewer Connection
C Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well (State Permit)
�Final Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMII�:
8
Rpr 09 99 02: OOp Tibtits En6ineerin� � 320-864-5672 p• 2
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TIBBITS ENGINEERING gHEETNO. v__ �_�__ ____
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735 11TH STREET EAST c�u.cu��rEoev� o,�Te_._�__L�1./
GLENCOE, MINNESOTA 55336
(320) 664-5642 FAX (320) 864•5672 cr+tcKeo ev DATE___._
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I�STe.Uc.T��n15. CITY OF ORONO
BUILD(NG P,C MI PLAN REVIEW
IN,�?ECTOR �� � !►n,i._
DniE_4 •( - rERMlTNO.
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CITY OF ORONO CALLED IN / DA�—G� TIM��
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INSPECTION NOTICE SCHEDULED — .,91 �`.3
PERMIT NO. // 3 3 3 COMPLETED li '�
ADDRESS �Z-o b�i �/t,t-we�
OWNER ONTR. � OlJ C
TELEPHO NO. � �S�� g � 3 �f
� DESCRIPTION
ly 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
O03"T LATION 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
h 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
v�, COMMENTS:
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� IVORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W�O CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contract n
inspector.
White opyllnspector's File Canary CopylSite Notice
AT TIME
CITY OF ORONO CALLED IN 6 'a�D avn
INSPECTION NOTICE SCHEDULED b PM
PERMIT NO. 3 COMPLETED << �
ADDRESS ��r'� �S'ho�'`e Drc�
OWNER CONTR.� (.���� •
TELEPHONE NO. 4q'S- /�7 � S�?��5�1"
�
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z � • 12 WATER HOOK-UP 17 SITE iNSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK 8�PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑ CITATION ISSUED
❑ INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContractor ite-
Inspector. -
White Copyll pector's File Canary CopylSNe Notice