HomeMy WebLinkAbout1997-009379 - new residence � _; . PERMIT
CI�Y�L�F ORONO PERMIT TYPE:
27�0 'rCelley Parkway- P.O. Box 66 _ _
Crystai Bay, Minnesota 55323 Permit Number:
(612) 473-7357 Date Issued: -
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: _ - - OWNER:
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APPLICANT-PERMITEE SIGNATURE ISSUED BY SIGNATURE
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� Total'Fee: $ � l L' �- � � Date Received: :.fi�� �—� �
Entered By: Permit#: ���;��y
CI OF ORONO - BUILDING PERNIIT 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) OWNER OR CONTRACTOR
���ll���.—
JOB SITE ADDRESS: 3i l� �C''/��I�l`j��` Z�: ���� �I �
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NAME OF OWNER: - � / � ! C/(J�� PHONE: (home) `��7`~ l��`�
,�; / (work) �t �� '��O
MAILING ADDRESS: � �� ���� ���IL�ITY: �� ZIP:��
,�> �iU��
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colvrr�cTox: r'�D�� / �/ /��/��` PHONE: �' �.� ��'���
CONTACT PERSON: ,��" l 1`+�IOB �/��PAGER: G GS� �`� ��'�'`
MAILING ADDRESS: IOC��v ��l,�rYC�h'�( l���[TY: L�/�C%�Z�� ZIP:
STATE LICENSE: # f�l/
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New � ' Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�: O�/��G(/ _~,r��./'J/�'�1�.__
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STORIES: �-- SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: . ' GARAGE STALLS: ATT. �; DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �L�`-'�� G=��='
I hereby apply for a building pernut 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.
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APPLICANT'S SIGNATURE =���r`-�?�/�`-�"%'-���ATE: �`���`� � �� I�`��
NOTE! Parade Qf Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
; `
Sec.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 shatl be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential 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 confidendal data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund
instructions instead of on those 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 stored data on individuals, and whether it is classified as public, private or confidential. Upon his fur[her 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 individuai has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is pending or additional data oo the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
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 to this subdivision,or within five days of
the date of[he reques[,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possib(e. 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 conceming hunself. 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 disclosed only if the individual's statement of disagreement is included 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 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 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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First Middle Last
IUD� l�/�tii�'iSlC��r� �/l��'�-
Address
�/'�iJ/�'i'Gj i��/=%'='� � �� l����
C��y State Zip Phone
I understand my rights as stated above.
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Signature
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' " CHECK OFF LIST FOR ISSUANCE OF PERNIITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �115_ I�O RT1�1 Sl�EO(I� pR��C
PID: O�- 11-1 - Z3 �Z (�o► �
DESCR�TION OF WORK: IU C W (2.�5.
ZONING REV�W BY: DATE APPROVED: �-Z• 5 7
BUII..DING RE`VIEW BY: DATE APPROVED: g -2• �i 7
FEFS TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ✓ No
PLAN REVIEW Yes ✓ No SEWER CONNECI'ION
STATE SUR`HAI�C� Yes � No WATER CONNECTION
INVESTIGAZ'ION-FEE Yes No PARK FEE
SAC Yes No STfEINSPECITON
Number of SAC Units OTHER (specify)
ZONlNG CHECB LIST Zoning Districr. c..�t-�(3
Fire Department: Post Office: (�,�(�,� School District: c�(2.ont0
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Lot Area: Sq.ft. t°I„1�{O Acres •y 3°I Width `C30� Depth
Survey Submitted: Yes_�, No Date of Survey: �'ZZ' ��
Proposed Setbacks: � ,
Front (Lake): S y Right Side: �
Rear(Street): 23"J� Left Side: lo • 3Z-�
Adjacent Structures: N l�- Wetland: �1(Ar
Building Height: Def. Hgt. 2,'?� Peak Hgt. 3y`
Lot Coverage: ��ti,,A,,�,�c_
Grading: Staff Approval Date: 9•2-�i'1 By: � Council Approval Date: s- 2,'7-�i7
Septic: Staff Approval Date: N 11'� BY: �-
Zoning File: #_�_Z2>ZI Resolution:# 3�03 Resolution Date: 5-Z?-�t7 '
Shoreland Dis�-ict: V(�5
Avg. Setback: �1 ARi ar�C�. Bluff Setback: .�/�f� Lot Coverage: JAC1.l�Arrw'
• Existing Proposed
Hazdcover: 0-75' 33.y 2 Z g•b
75-Z50' . .
ZSO-500' • .
500-1000'
Hardcover Variaace Required: Yes L No Date of Council Approval: -��
REMARKS('m house):
26
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BUII.DING REY�W CHECK LIST '
�C: _ R•3 CONSTRUCTION TYPE: �/IU
' Sq Footage $ Per Sq Ftg
Basement x =
. . lst Floor � . /5�43 . x ��t�. 3l _ �a .00 . .
� 2nd Floor �_a b 9;3( — t i��'1S�-lo`t � .
G�Be `I� x �$�( _ _ 8+78�.�30 �
x —
TOTAL
Estimated Construction Value: $_ 235�, Z.Z`'(.5 7 • �
Inspections Requlred: • Work Requiring Separate Permits: _
Site ,�_Plumbing Fire
Hazdcover Removal F Mechanical _�Wazer Connection -
_Q�Footing Septic _�Sewer Connection
_�Framing Fireplace _�Lawn Irrigation
_p�Insulation (Masonry) Other
�o Wall Board (Mfg.) _�Well (State Permit)
—�.F� Grading/Filling �Electrical (State Permit)
Other
RE1�24RI�.S (IN HOUSE): � � �
REVIEW BY OTHERS: DATE: �
Access: F.xisting New
Access�Approval: Date gy; �
REMARSS(TO BE NOTED ON PERII�IIT�: �
- . 27 _ � _ ��:
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ac� . 1�, �997
A�t:rt: Rober� Wade
�rom: Berrii�e 5�roh� P.E,
Re: Ae��y 'Vagt Res�dence �" �. 5
(North SFia�re Driv�) $� DETAIL 1
1�''dlt REX�t�I�'.
Memo: I� is my unders�anding _,
�k�ez due �o �lood plain ''
�equiremetlCs, the grade � �J►
beam fqoCin�s may nn� "'"`""'—"�
have th� minimum 42" .
Q� fr08� dep�h cov�r � � ' +
ti��ma}.�.y required. since
�h��e s�i1,g are noG 12". (�
�apec�ally frast su�ceptib�p , , . �
3.t would b� accep�able �:o r
�xcavat� 3C�� d�ep �1ong the ; t �� ` ..�.�„��
grade beam� ax�d pro^vida a 2" : ?• I�. --�,
���ul.a�ion bo�rd as ahvwn on ' '
the det��1 ar xighr. � �_
do • • •
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DAT/E TIME
CITY OF ORONO CALLED IN �1Z1��
INSPECTION NO�I�� SCHEDULED :r r'J �:� •'�'��'
PERMIT NO. / . �` COMPLETED
ADDRESS �//,`�_ ��: ._1<..�_ �. L� ;.
OWNER —i/� �, �'._� CONTR.
TELEPHONENO. ��:� --�- .�`�-.����c ! �� 71 _ fC�_:.��,
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
y 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
Q �b9�iR5�C�i�1J;`- 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
2 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PIUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 28 CEDAR SHING�ES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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- PROJECTCOMPLETE
W L CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
O C CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN NOURS. -, pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for t xt ins ction 24 hours in advance.473-7357
OwnerlContrac�' it .
Inspector.
White Copyllnspector's File Canary CopylSite Notice
pATE TIME
CITY OF ORONO cn��E�iN i-'..'�/"=�'
INSPECTION NOT�CE�7 SCHEDULED j/.,<.n.',/'�_X :�7 � C'
PERMIT NO. `7� / � COMPLETED
ADDRESS --.��/7 ��I. �f,'�� �� .
OWNEFi�---��._�� CONTR_ ����_-•
TELEPHONE NO. ���: ��i'/� _fr.�/�� ' 7�
� DESCRIPTION
� Ot FOOTIN 11 MECHANICAL RI 18 EXCAV/GRADING/FIWNG
�Q FRAMINCa 13 MECHANICAL FIIJAL 19 LAKESHORE/WETLANDS
Q LATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 VUALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
= OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
v
� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W�� - PROJECTCOMPLETE
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O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. r- pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR . CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance.473-7357
OwnerlContract r o si
Inspector.
Whiie Copy/lnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE �G� SCHEDULED 3�L'�� �l
PERMIT NO. COMPLETED j� � Z'��/
ADDRESS ���� � ti°�� �'��� �•
OWNER �°� ll�y'�'� CONTR.
TELEPHONE NO.
� DESCRIPTION C 1N Arl �-o/t. C�G
� 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 �FINAL 14 SEWER HOOK-UP O6 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 FINAI 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W AyVVORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
Wl❑CORRECT WORK 8 PROCEED �iSSUE ERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION �TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
C: CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73rJ7
OwnerlContra n
Inspector.
Wh'e opy/lnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLEO IN �—
INSPECTION NOTICE SCHEDULED '7•23-SY� I"�
PERMIT NO. COMPLETED
ADDRESS 3 t�S N0�'TI'I Sff06L� iO�
OWNER CONTR.
TELEPHONE NO.
�
� 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
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q �FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTAIL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W❑CORRECT WORK 8 PROCEED y�ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION � TEMPORARY
V BEFORECOVERING �pERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance.473-73�J7
OwnedContracto n site:
Inspector. '� ���-
White Copyllnspector's File Canary CopylSite Notice