HomeMy WebLinkAbout1998-010354 - tearoff/reroof PERMIT
� CITI( OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 =�i��E�%��'�<<
Crystal Bay, Minnesota 55323 Permit Number: i:;�i i w;',.�.
(612)473-7357 Date Issued:
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — ������ =c:�t�t. — °_� i".(. (._I{� .OWNER:
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` Total Fee: $ Date Received:
Entered By: (�l, Permit#: J0.3S
CITY OF ORONO - BUII.,DING PERNIIT A]PPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE A.PPLICANT IS: (circle one) OWNER OR CONTRACTOR
aos s1� annxEss: �3�5 N'c��. <S j�c r� ��i�� z�: S�3 i� u
NAME OF OWNER: ��-1�I-� 11�1��r(�P�� pxo�: (home)
(work)_
MAILINGADDRESS: �� 110��Sh�re �rW CITY: Md�,� v��( ZIP:��;3.�._
CO�T'TRA.CTOR: (`,'�1LLS-�"i�'+n S �nC,� PHO�TE: �7 C� ��� ��(? 1
CONTACT PER�S ON: MOBILE/PAGER:
MAILT�i 1G ADDRESS: I�-f�0 '�a r l�, [71 d CITY: �ll�c.ti h hc�n�S`�� ;� ZIP:�-1-�]
��
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO�IE:
MAILI�IG A.DDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF tiVOR�i: New Addition Accessory Structure
Move � Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detain: �'1 r(' (�}-�-�� ('� �- (\C`C� �-
STORIES: SQ. FEET OF EACH FI.00R: �
NO. OF BEDR00�1�IS: GARAGE STALLS: ATT. DET.
ESTII�i IA.TED CONSTRUCTION VALUATION (excluding land): $ � �� _
I hereby apply for a buildina 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 BuildinJ 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 SIGNAT`URE: r���i� ' ; , DA�: (p-- 1(�._�C�f�
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NOTE! Parade o Home events requ' e separate permit approval by Police Department and
City Counci160 days prior to the event. Non permilted events wi11 not be allowed.
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Szc.13.04 RIGHTS OF SUBJECTS OF DaTA
Subd. 1. Type of daca. "Ihe righes of individual on whom the data is stored or to be scord sha[i be as sec forth in this secdon. -
Subd.2. Information reqirired to be given individual. An individual azked to supply privace or confideaaal dara coacerning himsetf shall
be informed of: (a) the purpose and iarended use of the requcs•..�dam within the collecang"stare ageacy, polirical subdivision,or st3cewide rystem;
(b)whether he may rfuse or is legally required co suppiy the r_quested dac3;(c)any Irnown coasequence arising from his supptying or refusing to supply
private or conndendal daca;and(d)the idendry of o[her panoas or enddes auchorized by scace or federal law to receive rh=data. This requ'uement shall
no[appiy when an individual is asked to supply invesrieadve dara, pursuan�to secaon 13.82,subdivision 5, to a law enforcement ofricer. -
The commission-r of revenua mav place cha noac- rauir�+ und�r this subdivision in the individual ir.come tax or oropzm_tax reCund
inscrucrions instead of on chose forms.
Subd. 3. Access to data by indi�iduai. lipon request to a responsible au�horiry,an individual shall be informed whether he is the subject �
of scored dara on individuais,and wheche�it is classified bs public, priva:e or confidennal. Upon his further requesc,an individual who is the subjec�
of s�ored private or public dara on individuals shall be shown che daca wirhout any charge to him and;if he desires, shall be informed of the content
and meaning of chat dara. Afrer an individual h�s been shown[he privac�data and informed of ics meaning, the data need not be disclosed to him for
six monchs[hereaccer unless a dispu[e or acdon pursuan�co chis secdon is pznding or addirional data on the individual has been col[ece�d or creaced.
The responsibl�authoriry shall provide copies of the priva[e or public data upon reques�by che individual subjecc of chz data. The responsible auchoriry
may require the requesring person to pay the auual coscs of m�king,cerrifying,and compiling the copies.
The responsible auchoriry shall comply immedia�ely,if possiblz, with any request made pursuant to this subdivision, or wichin five days of
the da�e of[hz request,exciuding Sacurdays,Sundays and legal holidays,if immedia[e compliance is noc possible. If he cannoc comply with the requesc
wi[hin[hac cime,he shall so inform che individual,and may have an addidonal five days wichin which to comply wirh the requesc,ezctuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may concesc che accuracy or compieteness of public or pri�•ate
dara concerning himse(F. To exercise this ri¢hc,an individual shall noa"ry in wriang the responsible auchoriry describing the nature of the disagreemenc.
The responsibi�aucr.oriry shall within 30 days ei[her: (a)correct�he data found to be inaccurate or incompiete and actempc to nodfy past recipiena of
inaccurate or incomplz�e data, including recipiencs named by the ir.dividual; or(b)r.odfy the ir:dividual that he believes the data to be cocrect. Data
in dispute shall b�disclosed only if the individual's s[aczmenc of disagrcemenc is included wich che disclosed data.
The d:cerminadon of the responsible authoriry may be appzated pursuanc to [he provisions of[he admuusaadve procedure act relaang to
con�esced cases.
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Ri�cs of subjects of data", we would like to inform you that your request
for a permic or license from the Ciry of Orono or any of ics departments may require you to fumish 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 perm.ic or license.
3. The information may be shared with other local, state or federal a�encies 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 cenain ri;hts under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process [his application or permit.
�.����:-� ����,�I�� � � ���C�'�.C� ���1'.1_
First �Siddla Last
`���� �c ('� I S -
Address � _ ,
'�ti�C;l� 1 � �'l C�.��►/1 �� S�'��'► —
Ci�� Sta�e Zip Phone
I understand my ri;h�s as stated above.
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Signacure
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOe �������
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 581-9000 TEST RECORD
ADDRESS_ -` �9✓ ��� �� �/'�� CITY �! �/;a
OCCUPANT`� �✓%yl':' !� � OWNER
SOLD BY �- ! INSTALLED BY G✓l �
MAKE MODEL �`,v��UD ��(�G�
SERIAL NO. � /Y '��/� INPUT �" ��J r ���,�/ U `
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/ LJ ��
THERMOSTAT �G'� ���L'"�`�� VENT SIZE /'
VALVE �' TYPE OF LINER �` '�'3 (�! ��Z` ��
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LIMIT LINER SIZE
LIMIT SETTING ` lX✓ � FILTERS: SIZE NUMBER
FAN SETTING �`� WIRING
PILOT TYPE Ct�L✓ C:i / �G TEST TAG
IGNITION MODEL LIGHTING INST.
PILOT TIMING ` ��Q�,��`�
�� DATE TESTED ( U �
PRESSURE ��`J � '� PERCENT COz � G � �
�/ - _� -�
INPUT CFH ,��� PERCENT OZ 4� ��j COMPANY TESTING
'1,Z :YL • -
STACK TEMP. !l�� �� PERCENT CO NAME OF TESTER
FORM 235(REV.11/89) FORM DISTRIBUTION: WHITE COPY-JOB FILE VELLOW COPV-CITV
ATE TIME
CITY OF ORONO CALLED IN �-����
INSPECTION NOTICE � / SCHEDULED � / yY /, c%z%
PERMIT NO.,/�.��`—'�f COMPLETED T ,�_
ADDRESS ���-s�1/�-�2�+2c> A � ,
OWNER CONTR.-s�/G-2 ��,s
TELEPHONE NO. �7�-- :�CY�s /
�- DESCRIPTION /C��eTi-,�
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� 01 FOOTING 1}/�v1ECHANICAL 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
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q FIN 14 SEWER HOOK-UP 06 PROGRESS
� EMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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
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W� O WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑C RECT WORK&PROCEED f, ISSUE CERTIFICATE OF OCCUPANCY
� ORRECT 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
OwnerlContract�i i :
Inspector. �
White Copyllnspector's File Canary CopylSite Notice