HomeMy WebLinkAbout1997-009492 - addn/remodel/re-roof _ PERMIT
CI�Y C1F ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��s�`v�-�
Crystal Bay, Minnesota 55323 Permit Number:
(612)473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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AP LICAN R TEE SIGNATURE ISSUED BY:SIGNATURE
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� Total'Fee: $ - Date Received: �
Entered By: r� Permit#: ��<�r �
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
------------------------------------------------------------------------- ----�-------------------------
THE APPLICANT IS: (circle one) OWNER O CONTRACTO
JOB SITE ADDRESS: 3�5 �'�' s�"'� �'� ZIP: ��'b'�
NAME OF OWNER: ���mA''�'E� '�TZ-- PHONE: (home) �--�I l- aZZ1--
(work) °I'�q'` �`�'+�
MAILING ADDRESS: �� CITY: ZIP:
CONTRACTOR: 1 NS�oE�,oNT �'MvP�l.o�C-5. PHONE: �?n-��-'S
CONTACT PERSON: �'YIA� 1�1J7.�t-t.-- MOBILE/PAGER: 4-l�j-23b O
MAILING ADDRESS: 5°�� ��6E� NJ• CITY: ��D�� �� ZIP: �'L-
STATE LICENSE: #� tJ-201
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NANIE: REGISTRATION#
TYPE OF WORK: New Addition ✓ Accessory Structure
ve Remod 1/Alter ' Land ' n
ht c7rv u{ �D�. NO W. ��'hcr�e� ►N-t��oR. o F �c►S�n Nc� �'►�► �O �,
PROPOSED WORK (describe in detai�:- -tq � ;L -�/rflDt�tvt-+ v�t/ Sovr�� t��!'�--
�'w�nve�.�+..� -f- tT-�'t�'b�'►� �'sN'f")�e�-� �"�yt'
STORIES: � SQ. FEET OF EACH FLOOR: 8�� �'�
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET.
�}}AyE �
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ a 5� o� # 2.� c�o
I hereby apply for a building pernut and I acknowledge that the information above is cornplete 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 acco dance with the approved plan.
APPLICANT'S SIGNATURE: DATE: 4�L'�'��1�
NOTE! Parade of Homes events require se ate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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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 shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data concerning himself
shall be informed of: (a)the purpose and intended use of the requested dara within the collecting state agency,polirical 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 confidential data;and(d)the idendry 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 officer.
The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or nronern 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 further request,an individual who
is the subject of siored 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 individual 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 dis�xrte or action pursuant to this secaon is pending or additional data on the individual has been
collected or created. 'I'�e responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry 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 the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with
the request within that dme,he shall so inform the individual, and may have an addidot�al 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 writing the responsible authoriry describing the nature of the
disagreement. T'he responsible authoriry shall within 30 days either: (a)wrrect the data found to be inaccurate or uicomplete and attempt w notify
past recipients of inaccurate or incomplete data,inctuding recipients named by the individual;or(b)noafy the i�ividual that he believes the dara
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
ro 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 shazed with other 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 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.
1'V��- �n/�LV�Mw� 8E1�►ZeLi�
First Middle Last
5�12o v+lat,�F��C LN�
Address
CSD�'1� V�Ii1.E'K ltiM�� ,S�j°h'��-- S L��-p6 L��"
Ciry State Zip Phone
derstand m ' ts as st above.
�
Signa re
6
� CHECK OFF LIST FOR ISSUANCE OF PERltiiITS
� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _��'y� ;�"-c 5-�:°� ���� f_.� ti,�..'
PID: •� -��?- <�� � 11F��' � p,..l
DFSCRIPTION OF WORK; � - �' ,�� ����G»���..�'. � t��e l
ZONING REV�W BY: � DATE APPROVED: (o-8- �r�
BUII..DING REVIEW BY: DATE APPROVED: � p -g-�,Z
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REV�W Yes � No SEWER CONNEC"TION
STATE SUR`HAKCr� Yes � No WATER CONNECITON
INVESTIGAT'ION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONIlVG CHECK LIST Zoning District: L.�-/C. _
��� Fire Department: Post Office: School District:
t Area: Sq.fr. Acres Width Depth
Survey Submitted: Yes� No Date of Survey: �- Z.°I- S�?
Proposed Setbacks:
Front (Lake): _ S�l� �" Right Side: �(�r '}
Rear(Street): ,3 v � �' Left Side: 7$ ' �'
Adjacent Structures: flr�t.(�� Wetland:
Building Height: Def. Hgt. Q.IL Peak Hgt.
Lot Coverage: ��1�
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
oning File: # Resolution: # Resolution Date:
Shoreland Dist:ict:
,,� \ �� Avg. Setback: Bluff Setback: I.otCoverage:
'\l Existing Proposed
Hardcover: 0-75'
75-250'
250-500' �
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
• 26
BUII.,DING REVIEW CHECK LIST �
�C� 2'3 CONSTRUCTION•TYPE: �(/�J
Sq Footage $ Per Sq Ftg
Basement z =
lst Floor R =
2nd Floor z =
Garage x =
z —
TOTAL
Estimated Construction Value: $ ��9��"
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_ D� Footing Septic Sewer Connection �
_� Framing Fireplace Lawn Irrigation
�_ Insulation (14asonry) Other . .
�_ Wall Boazd (Mfg.) Well (State Perm.it)
�, Fina1 Gradin�/Filling Electrical (State Permit)
Other
-----------------------------------------------------------
REMARKS (IN HOUSE):
--------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
-----------------------------------
REMARKS(TO BE NOTED ON PERil�1IT): �
27
5 E P-E 0-9 T T U E i t :2 n P_0 0 5 E P-3 0-9 T T U E 1 3 .2 3 p.0� 5 E P-3 0-9 T T U E 1 1 :2 6 P.0 6 S E P-3 0-9 T T U E 1 1 :2 T � , P.0 T
971152 U/l 1723 MS[DE&OUT REMODELERS
ADVANCE SURVEYING & ENGINEERING CO.
5J00 S.Hwy,No.I OI Atinnetonka,MN 55345 Phon<(617)474 7964 Faz(612)474 8267
suxvev Foa: I�YSIDE & OUT REMODELERS � i � ��� �`�.��� �: •i ? !
�
SURVEYED: Septcmber,I997 DRAFTED: Septanber 29,1997 I . ...�7�. - .� ' . � i.
SCALE: ONE INCH EQUALS 20 FEET � .
LEGAL DESCRIP770N: �
The east 238 feet of that part of Govemment Lot 2,S«tion 17,townshi 117,Ran e 213,Henne m O°°�Y' I
P a P t West
Minnaota,described ea beginning at e paint on the naAh line af said Qovemment Lot 2 distec�t 64J.50 ka right
..R
om t e mcander wmcr of seid nocth line;Ihence Wes[along said nocth line 5J623 ket;thcnce South,e �
angle,148.50 feet to�he point of beginning. � '�.
LIMITATIONS&NOTES: � ��
The scope of our aervices for this job is as followv � �!�`Y 0 E Q R��0
I. Showing the length and dircction of boundary lines of lhc Icgal description you fumished.
2. Showing Ihe location of exiscing improvemrnts we deemed importanL . �] {'� ' A
3. Setling new monumrnb or vcrifying old monuments to mark the tomm o(Nc property. � S 1�C i�l�!`1�V ._ G�'t�U I N G P V1 N r
4. While we show pmposed improvemcnts lo your property,we are not as(amiliar with your plans as you re nor . _ �
are we as familiar with Ihe requiremen�s of governmental agencies os Neir empioyees erc. We suggest ta�y�� i.�i.A[j�ji,}�}r[�i 1 �' � �'Vt= GJ'7'�'�[,j-{,)
nrntal �Y� P'ty i ti LsiJ
rcview lhe survry to conFirm lhet Ihe proposals ere what you intend end submit lhe survey to such goven .
agenciesasmayhavejurisdictionoveryourprojattogaintheirapprovalsifyouwa �w of � �ry��v�j��y a����N ❑ 1iIC1oA,C
. a u aling hard cover on the propcety both czisting end proposed for your review and Cor the ro
�" �.1 YK fl Y J 1\J
� govertunen�alagenci�swi�hjwisdiclion. ,I_..,� ,!.,��������v
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STANDARD SYMBOLS dc CONVENTlONS: 4�
•notes �j
'o"D<nate�IR"ID pipe with plastic plug bearing Slate Licenu Number 9235,sel,if"o"is fillcd in,thcn� �
found iron monumrnl ' C —
CERTIFICATION: . . DATC.. �Q ���
sioaal i tt�7, R.23
I hereby cenity tha��his survey wa�prepared by me ar under my dircct supervision and Ihat I am e Profe. 7HE NORhi LINE OF COVT LOT 2, SEC. 17, �,
Engineer end a Prof vional Surveyor under�he Laws of the Stete of Minnewta. � 613.50
es H.Perker P.E.& .S.No.9235 536.25 � S 86'33'11' W — �—
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. JOB N0. 97i 152
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NQTI�� SCHEDULED 1�7 �
PERMIT NO. y�� �-- �. ���ETE e �_ �.
ADDRESS � a4S � vf r�
OWNER CONTR.
TELEPHON E NO.__ ��b S��oZ
� DESCRIPTION �
� CpLr00TINCi 11 MECHANICAL RI 18 EXCAV/GRADIN�/FIWNO
� 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 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 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
� 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
2 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER HEMOVAL
v 10 PLUMBINO FlNAL 2$CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTFiACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d '�'�NORK SATISFACTORY:PROCEED - PROJECT COMPLETE
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ` pHOTOTAKEN
INSPECTOH 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
OwnerlCont on it :
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO ca,��Eo iN ' � " `i 1
INSPECTION NOTICE . scHE�u�Eo //- � �/ ' .: �
PERMIT N0. �:�i � COMPLETED �
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ADDRESS g 5��� %������<�t <�1��� i� ��:� °�
OWNER -f ..[f„ CONTR.��/1�c,C�- � � ; , -�
TELEPHONE N0. `> -`� -� � �'�.���
� DESCRIPTION -�ic.L( r. ..• ; /��: , j<<•�tc_(
� 01.FAQTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMI G� 13 MECHANICAL FINAL 19 LAKESHORE/WETIANDS
Z NSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Q 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
�Q 07 DEM�FINAL 15 SEPTIC INSTALL. 22 FOLLOW-i1P
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 28 CEDAR SHINGLES 36 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W PROJECT COMPLETE
W ; CORRECT WOFiK&PROCEED �-. ISSUE CERTIFICATE OF OCCUPANCY
� ;' CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN
❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the xt in�ection 24 hours in advance.473-7357
OwnedContra t n sit •
Inspector.
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN ��/! �%9 7 �—
INSPECTION NOTICE SCHEDULED �
PERMIT NO. ���tz. COMPLETED �_ �_
ADDRESS J��
OWNER .�� •CONTR.
TELEPHONE NO. _ •�.2G,,. SCo/2�
� DESCRIPTION /f.���-z�s.P�
� 64� 11 MECHANICAL RI 18 EXCAV/ORADINO/FIWNO
� 02 FRAMINO 13 MECHANICAL FINAL 19 LAI�SHORE/WETLANDS
Q 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�ITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBINQ RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBINO FINAL 28 CEDAR SHINGLES 38 FOUNDATION REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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��.tl�ORK SATISFACTORY:PROCEED - PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HOURS. L pH0T0 TAKEN
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
OwnerlContract it :
Inspector.
White Copyllnspector's File Canary Copy/Site Notice