HomeMy WebLinkAbout1999-011208 - entryway PERMIT
• CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 : :7: ;_;�:,u;:;
Cr stal Ba , Minnesota 55323 Permit Number: � _,. _
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Date Issued:
(612) 473-7357 t�a;��,�� � ,�=3°�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: m.. �,�,�,; ; ;r;,;�, _ :=,�- , ;_��,: .OWNER:
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APPLICANT,-PERMITEE SIGNAT � ISSUED BY:SIGNATURE ��-,
� Total Fee: � J�� ;� r; `= Date Received: � -,� - c� c�
Entered By: ,,�f,. Permit#: ;'.h���`'�
CITY OF ORONO - BUII.DING PERMIT APPLICATION
All information must be submitted in full before plan review w-ill be started.
(please print all information)
------------------------------------- -----�------------------------------------------------=--
THE APPLICANT IS: (circle one) �OWNER OR CONTRACTOR
JOB SITE ADDRESS: 3 yv L�.�r s i.e�� i ZIP: �S 3 S`�
NA1�TE OF Otiifi'ER: �`1o�r�t•� s � ���.�y PHONE: (home) ��� '�'���
� (work) %�� -S�S�
1�1AII.,ING ADDP�ESS: �yo �e.t F 5'� CTTY: c�2on o ZIP: �535 6
CONT'RACTOR: ��,Q.�y_ �s'u, /T PHONE: �7 6 -S'�s"�
COivTACT PERSO�': ,�o� �i��'y MOBILE/PAGER: .+" 3g� �6�z 5�
MAII�I�i'G ADDRESS: �?� .n � CITY: ZIP:
STATE LICENSE: # ��"i�
ARCHIT'ECTlEI\'GItii TEER; �,r,e,e �� ,�a
h'� �l�s�� PHONE: �
IZAILPi tG ADDRESS: 'CITY: ZIP:
��ME; REGISTRATION#
TYPE OF Z�ORK: New Addition ,� Accessory Structure
Move Remodel/Alteration Land Alteration
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PROPOSED WORK(describe in detai�: �i�T.�y G•�i� � ('� �e�o �
I is��C/.�n�� /4�f'.��e a� Fa�- �' �P� � � . vC�/ _
,
STORIES: f SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GAR.AGE STALLS: ATT. DET.
ESTII�i iATED CONSTRUCTION VALUATION (excluding land): $ �� �-` � �
I hereby apply for a buildin�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 Buildin� 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 ap�roved plan.
_ -- ,:
APPLICA��'T'S SIGNATURE: , .f��,s.� ���_�-� _ DATE: � - _,? - �S
. �
NOTE! Parade of Homes events require separate perlirit"approval by Police Departntent and
City Counci160 days prior to the event. Non permitted events will not be allowed.
. Sec.13.04 RIGHTS OF S[JB,TECTS OF DAT.+, '
Subd. 1. Tppe o[data. The righrs Of individuai on whom rhe data is stoced or to be srured shall be u sec fo�sh in this secdon.
Subd.2. Informallon nquired to be givw Individual. An individuaI uked to supply privatt or confidearial dan conceraing himselt shall
be inforused of: (a)the pucpose and iatended use of the tequested dan wichin the coUecaag State ageery.po6dcal subdivisioc.or sracewide rystem;
(b)whe�er he may ret�se ot is,legally tequired to supply the ctquesud daa:(e)aaY iaiown wauqueace uising fmm his supptyiag or re[using to suPP�Y
privace or confidendal dara;and(d)[he idendry of ocher pe�soas or earides auchorized by state ot fedenl law to cnceive the data. Thit cequitemenc s6a11
no�apply when an individual is uked w supply invesdgadve dan,pursuaac ro secdon 13.$2,subdivisioa S,ro a law enforcement officer.
The eorimissioner of rcvenue mav olac- che nodc- re�uired und-r dtis subdivision in the individual income rax o�orooem ax refund
jnscniedons inscead of on rhose Eorms.
Subd.3. Accas to data by iadivtdual. Uport request to a cespoasible authoriry,an individual shall be informed whether he is the subject
of stored daa on individuals.and whaher ic is etassified u public,private or confidendal. Upon his further requesc,an iadividuai who is che subjecc
of swred private or public dara on individuals shall be shown the dan wi[houc any charge to him and;if he desira,shall be informed of the contenc
and meaning of thu daa. Af�er an individual has been shown rhe private dara and iaforaud of ics meaaia8.the dara aeed noc be disclosed oo hua for
siz mondu checeatur unless a dispute or acdon pursuanc w dsis secdon is pending or addiaooal dan on the iadividual has beea collected or cma�ed.
'Ihe«sponsible authaciry shall pcovide copies of the private or public dara upon cequest by the individual subject of ehe data. 'Ihe responsible authoriry
may tequire dte cequesdng person W pay the actual coscs of makin$,cettifying,and compiling the copia.
The responsible auehoriry shall comply immediacely,iP possible,wich any requesc made pursuant w�his subdivision,or wichin five days of
the dam of che requesc,ezctuding Sacurdays.Sundays and legal holidays,if immediace compliance is not possible. If he cannoc compty with the requesc
wirhirt that dme,he shall so infotm the individual,and may have an addidonal five days withia wluch ro comply wi[h the requesc,ezcluding Satuidays,
Sundays a�kgal holidays.
Subd.4. Ptoeedure when data ts not accurate or complete. Aa individual may contesc the accuracy or eompleteaeu of public or private
daca eonceming himsNf. To exercise chis righG zn individual shall nadfy in wridng the responsible aurhoriry describing the eacure of the disagreement
The responsible authoriry shall wiehin 30 days either. (a)correct rhe da[a faund to be inaccurate or incomplete and atcempc W nodfy past recipiencs of
inaccunte or incomptete dara,inetuding recipieats named by ehe individuai;or(b)noafy the individual thac he believes the data to be correcc. Dara
in dispuce shall be diutosed only if the individual's statemenc o[disagreement is included wi[h the disclosed data.
The decerminadon of the responsible au[horiry may be appealed pursuant to the provisions of the adminisaadve procedure act reladng to
contesad cases. •
DATA PRIVACY ADYISORY
In accordance with M.S. 13.04, Subd.2, "RiQhts of subjects of data",we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or
confidential information.
You aze notified thar.
1. The infocmation you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply daca, but refusal may require that the City deny the permit or license.
3. The inforcnation may be shazed with ocher 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 informatioa 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 applicatioa or permic.
�— �—
F'u �fiddle �I
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Address
�.E�o�r� ��1 s-S 35-� y��� s..�:s�
Ciry Stace Zip Ptione
I understand my righcs as stated above. '
�_ _.__
���
Sigttamro �
� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �Gi� _ �oL�
PID:
DESCRIPTION OF WORK:
ZO�TING REVIEW BY: ,� DATE APPROVED: 2-3•9�
BUII.DING REVIEW BY: DATE APPROVED; z• 3 •Sg
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,� No
PLAN REVIEW Yes � No SEWER CONNECI'ION
STATE SURCHARGE Yes � No WATERCONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION �
Number of SAC-Units OTHER (specify)
ZONING CH�CK LIST Zoning District: R R-1�
Fire Department: (�¢�v 6 lA� Post Office: N K•� School District: (7(2�o,sn
Lot Area: Sq.ft. Z�,�S3$ Acres •6 Z Width /5�• �� Depth 3(oC�•bZ.
Survey Submitted: Yes � No Date of Survey:
Proposed Setbacks:
Front(Lake): ZZ' Right Side: S � �
Rear(Street): N (� Left Side: N �-10�
Adjacent Structures: _ _��-ry�C la�� Wetland: /v 1 A�
Building Height: Def. Hgt. (9, {� Peal:Hgt. -
Lot Coverage: -]•b��
Grading: Staff Approval Date: n1 �/�- By: — Council Approval Date: —
Septic: Staff Approval Date: /�f (�4 By: —
Zoning File: # 24 2 Resolution: # Resolution Date: ocx 2� � `1 S
Shoreland District: /V O
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
BUII..DING REVIEW CHECK LIST
UBC: (Z•3 CONSTRUCTION TYPE: �f/'V
Sq Footage $Per Sq Ftg
Basement x —
lst Floor a —
2nd Floor a =
Gazage x =
a =
TOTAL
u
Estimated Construction Value: $ 5�(�00 `Z
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanieal . Water Connection
�_Footing ` Septic Sewer Connection
��Framing Fireplace Lawn Irrigation ,
Insulation (Masonry) Other
Wa11:Boazd (Mfg.) Well(State Permit),
_�Final Grading/Filling Elecuical(State Permit)
Other
REMARKS(IN HOUSE): . �
REV�W BY OTHERS: DATE:
. ,
Access: Ezisting New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMI�:
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BUiLDING P�{MIT N REVI�W
i�VSPECTOR s—� �
�ATE � 3-�'�1� PER�IT NO. I
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. in full c�mptiarce �r�;th 2r er.^i;c;�':!;; :,u:�din� un� zorffng code.
_ Requitements including iteme.rrt cp�;i',,,�;�;�,noteu in this re�caw.
E KEEP THIS r LAN StT�N SfTE Ai-ALL 71��(ES
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�RRYBUILT • TERRYBUILT • TERRYBUILT • TERRYBUILT • TERRYBUILT • TERRY�
DATE TIME
CITY OF ORONO CALLED IN �S��i'
INSPECTION NOTICE • scHE�u�Eo �l99 9 � 3 O
PERMIT NO. � �� COMPLETED _�_ �
ADDRESS__`1���� � •
OWNER CONTR. �
TELEPHONE NO. '�7(o -�-Z J-L
� DES�-.C TION � rr;'�i>.��,
� 1 FO 11 M�IANIC.'�L,,f�i 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 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
� 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
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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y COMMENTS:
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d M1IORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
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� O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN
O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next ins tion 24 hours in advance.473-7357
OwnerlContrac r site
Inspector. � �
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE .Zb� SCHEDULED
PERMIT NO. � COMPLETED
ADDRESS __ 3�� �lptc` �T
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION -�'`-�'�- �� s w^' N-'Q--�
� 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 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 COMPLA�NT
� 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
2 OWNERICONTRACTOR TO MEEf YOU:_YES_NO
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