HomeMy WebLinkAbout1994-005922 - remodel/remove wall PERMIT �
. L;ITY OF ORONO PERMIT TYPE: .,
2750 Kelley Parkway • P.O. Box 815 Permit Number:
�;��I��Ih��;
Orono, Minnesota55356-0815 Datelssued: `�'�'��'�`'`
(612) 473-7357 t;=./�,�,;'=:}
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE •r1L
Z 1 �
CITY OF ORONO - BDIZDING PERMIT APPZICATION
Total Fee: $ Date Received:_
Date Approved:
Entered By: ',�'t/ permit�:_j 7�,
� ALL INFORMATION MIIST BE SIIBMIZT� IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
T� APPLICANT IS: (circle one) OWNER or CONTRACT
JOB SITE ADDRSSS: 3�� ��T�i ! ��)2C �/e. ZIP: �53 �/
(work) 3`�'�3-D y/ ,�
NAP� OF OWNER: Sr�vav� JpNN� �iv.vg ,✓ paor�: (home)�]I-77.S�a--
MAILING ADDR.ESS: 358'7 Nax�-,v ��r 1�TY s ��6�G ZIP: .5�.3 �l
coN�c�roR: ���YyI�' /1 E�L.�'zr7anl�, .�N c , p$ox$: �73 ' S%7.3
IKAILING ADDRESS: /3�a �iwi�.l.ips l�'�te. ci�r: L..on��--�.��" ziP: SS`3S�
STATB LICENSE: � O�9/3 3 .
ARCHITECT/SNGINEER: PHONE:
MASLING ADDRESS: CITY: ZIP:
N�: RSGISTRATIOA �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration_� Renovate Land Alteration
PROPOSED WORR (describe in detail) : /��14Vi4L O� 5T�1/�C14SE Wf1'LL- 7� �z- LN/4"LL
�Jl cA�P . !?�rif a rA�c. �t- �,rPP�2 cA�f3s AD� ��.� s�rn E N�r.� a�l��N�ne-�/
A01� B�E�I'J=G�S7 F.3/�1�.° , NEvt! �<.c��e✓NG- CC�'2f'�T'f vil�f�(1..�,N£vd W/��NG-• /N z�ooM.S
STORISS: SQ. FEST OF EACS FI�OOR:
NO. OF B�ROOMS: GARAG$ STALZS: ATT. DET.
- � �1�0� �� ,
ESTIMATED CONSTRIICTION VALIIATION (ezclnding la.ad) : $ �
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 wil 1 be in accordance with the approved plan. .
APPLIC�NT'S SIGNATQRE DATE: Z l.S�
r s �
�
CITY of ORONO
Post Office Box 66•Crystal Bay,Minneeota 55323•Municipal Officea
•
� • � � 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 like to inform you 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 will 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 3icense requires Council. action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Yaur fu11 name is required to process this applicatian or
permit.
���/�- �i� �� ��/���
First Middle Last
13�b �������vs �-�.
Address
�N� �,�E M�J Ss=�5�
City State Zip
�/73 -.S/?3
Phone
I understand my rights as stated above.
�
Signature .
BUILDING 8c ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 � PUBLIC WORKS—473-7359
ASSESSING -
s r �
513.04 RIGflTS OF SIIBJECTS �F DATA � �
gubdivision L Type of data- The rights of individuels on whom the data is
stored or to be stored shall be as set forth in this section.
Subd. 2. Intormatioa r�
to be given individ��a1- An.individuel asked to
� ' su 1 private or confidentisl data concernin�BmWithin� collecting state agencye
PP Y
purpose and intended use of the requested
olitical subdivision, or statewide system; (b) whether he may refuse or is legally
p known consequence arising from his
required to supply the requested date; (�) anY �d (d) the identity of
supplying or refusing to supply private or confidentiel data;
other persons or entities authorized by state or federal law to receive the data. This.
1 when an individual is asked to supply investigative data,
requirement shall not app y
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue ma oleTt t8X re°und�truct�onsuinsteadhos
subdivision in the individuel income tax �r r
on those orms. . � --- - " .
Subd. 3. Access to data bY
����. Upon request to e responsible
authority, an indinduel shall be informed whether h��ateeor eonfidentiaLe Upon his
individuels; and whether it is classified as public, p ublic data on
further request, an indi�►iduel who is the subject of e to himriand, if he desires, shall
individuels shall be shown the data witho of�hat da a. After an individual hes been
�e informed of the centent and meaning the data need not be �isclosed to
shown the private date and informed of its u��oT�BC�on pursuant to this section is
him for six months thereafter unless a d�SP
� ending or additional data on Lhe individu e h� 8te or public datarupon8request by
' P require the
responsible authority shaIl provide coples The res nsible aut�rg y maY �� the
the individuel subject of the data• p° ��rtif n , and comp g
requesting person to pay the actual costs of makinB,
copies. ' immediatelY, ii Possible, with any request
The responsibls authority she]l comQly of the date of the request,
made pursuant to this subdivision, or within five ��immediete compliance is not
excluding Saturdays, SundaYs and legal holidays,
ossible. If he cannot comply with the request �thin that time, he sha]1 so inforth the
p within which to comply
individual, and may have an additional fve y5
request, excluding Saturdays, Sundays ead legal holidays-
Subd. 4. Proced�ae when data is not acc�ate or complete. An indi�id� mgy
- rivate data concerning himSelf• To
eontest the accuracy or completeness of public or p the respensible authority
exercise this right, an individuel shall notify �n ���e authority shall within 30 -
describing the neture of the disagreemenL The respe
days either: (e? correct the ciata f ound to be inae��e���ng Qeec pients namedt by
notify past recipients of inaccurate or incomple �
the individual; or (b) notify the individuel that he believes the data to �ement is
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the disclosed data. � BpPe�ed pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
� �- 1 CHECR OFF LIST FOR ISSIIANCE OF PERMITS
. FQR ,OFFICE USE ONLY
. � ,
ADDRESS OR LEGAL: pID'
� � � �' �
DESCRIPTION OF WORR:
-------------------- -
ZONING REVIEW BY: DATE AP OV$D:
BIIILDING REVISW BY: .. DATE APPROVED: � Q
�S � Bg �RGg,p: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARR FEE
SAC Yes No SITE INSPECTION
Number of SAC IInits OTHER (specify)
----------------------------------------------- ;
ZONING CHECK LIST Zoning District: '
Fire Department: Post Office: School District:
Lot Area: � Widthz Depth:
Survey Submitted: es No Date of Survey:
Proposed Setbacks:
Front (Lake) : Right Side:
Rear (Street) : Left Side:
Adjacent Structures: Wetland:
Bui]�ding Height: Def. Hgt. Peak Hgt.
Avg. Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75 '
75-250 '
250-500 '
500-1000 '
Hardcover Variance Required: Yes Date of Council Approval:
Grading: Staff Approval Date: B : Council Approva7. Date:
Septi c: Staf f Approva]. Date: BY�
Zoning File:# Resolution �: Resolution Date:
RffiKARRS (in honse) :
BIIII.DING REVIRW CHECK LIST L _. �
IIBC:
�--3 g g CUNSTRIICTION TYP$: R
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X - •
.'
2nd Floor x -
Garage X -
x =
TOTAL
8stimated Construction Value:. $ ! � v
Inspections Required: Work Reqnirinq Separate Permits:
Site ` P�umbing Grading/Filling
Footing Mechanica]. Fire
�Framing Septic Water Connection
Insulation Firep�ace Sewer Connection
all Board (Masonry) Lawn Irrigation
�j F�inal (Mfg.) Other
Other Wel 1 (State Permit)
�Electrical (State Permit)
--------------------------------------------
REMARKS (IN HOIISE) :
--------------------------------------------------------
REVIEW BY OTSffitS: DATS:
Access: Existing New
Access Approval: Date BY=
-----------------------------------------------------
RF.L�lARRS (TO BS NOTSD ON PSRMIT) :
DATE TIME
CIYY OF ORONO CALLED IN �9 �/� ���'� �
INSPECTION NOTICE SCHEDULED =�,// '//%''� � -��o d
PERMIT NO. �`� ��� COMPLETED K ti
ADDRESS �"�''� � �� ` ���'" , ��-, .
OWNER��ry�'�� CONTR. � M �� 1--���
TELEPHONE NO. � �� '�' ' `� � `� ��
� DESCRIPTION , ��,�����:-��
� 01 FOOTIPd6� 11 MECHANICAL RI 16 WELL TEST PUMP
02 FRAMING:� 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS
O
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SETITURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED �� PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
C STOP ORDER POSTED.CALL INSPECTOR '�- CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for next'n pection 24 hours in advance.473-73�J7
OwnerlCont r on si :
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO � CALLED IN ' a' i3�
INSPECTION NOTICE �j�I� SCHEDULED -a � r �
PERMIT NO. " COMPLETED ' Z — � ��
ADDRESS �� �
OWNE � CONTRA��e �� / -�--.
TELEPHONE NO. �7c3 ' �/ � J'
�
� DESCRIPTION ,
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
O
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q FINA 13 METER SETlfURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE CONERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
C CITATION ISSUED
❑,STOP ORDER POSTED.CALL INSPECTOR
�'�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance.473-7357
Owner/Contractor on si
Inspector. ��'
White Copyllnspector's File Canary CopylSite Notice
D'� TIME
CITY OF ORONO CALLED IN �'
INSPECTION NOTICE ���,'Y SCHEDULED 9 � �
PERMIT NO. 5 COMPLEfED -2S�
ADDRESS � 7 � '
OWNER CONTR
TELEPHONE NO. '��3-5� �3
�
� DESCRIPTIO
� 01 FOOTING 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADING/FILLING
y 031NSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORFJWETLANDS
Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q FINA 13 METER SETITURN ON 17 SITE INSPECTION
{� EMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
v 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEEf YOU:_YES_NO
y COMMENTS:
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WORK SATISFACTORY:PROCEED �PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CO�/ERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONHEQUIRED.CALLTOARRANGEACCESS.
Ca11 for the next inspection 2a hours in advance.473-7357
OwnerlContra
inspector.
White Copyllnspector's Flle Canary CopylSite Notice