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�i5 Brown Rd.South•P.O.BOX 66 Permit Number: '-.'''i� `-=�:`.`-.-
�ystal Bay, Minnesota 55323 Date Issued: `}�r� _.' ' :_. }
'^', 473-7357
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INSPEC:'1'lUN ll�;(:UK1� �,�_���_3��,�.����
CITY OF ORONO PERMIT TYPE: �;�f�;;_;;;
1335 Brown Rd.South•P.O.BOX 66 Permit Number: ;:;�;�t:;;�;�;_��
Crystal Bay, Minnesota 55323 Date Issued:
(612)473-7357
SITE ADDRESS: APPLICANT:
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CZTY OF OROAO - BIIII�DIA'fG PERMIT APPI.IC�TION
Total Fes: $ ��. �� Date Receined:
�� �� Date Approved:
Entered By: -� ���
Pe_rmit�:
�L I3JFORMATION �IIST B8 SIIHMITTED IlY FOZZ Bffi�ORE PLAR 1tEVIEW WILL BE STARTED
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T� Ap�LIC�IAT IS: (circle one) OWNER or ONTRACTO
�JOH SITB ADDRESS: `�'`� �� +v��l f 5��� � • ZIP:
(work)
NAME OF 03�iN$R: �(�.��`��c\�, ���.���►S o� PHONE: (home)
MnTZING ADDRSSS: u�{ S�'s� fnb;2TN�v rt�' �.�°Z CITY: Q2�o 1'V c� ZIP:
CONTRACTOR: �N�i�• �V'`� ���} �e��-�`N+� pHorrE:�1 a-b�"3�l-
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MAILING ADDRES S:�� 7� Li N��'.� ���� CITY: . u�,iv{� ZIP: ����•��� "
TYPE OF WORR: New Addition Acc�ss�X� Structure Move
Demo Remodel/Alteration Reaovat Land Alteration
PROPOSED WORR (describe in detail) :���� -������m��
��� CSF� �F�15�(N� Z. C,P'`(��.� dr- �.�;S� � t�/� � �
STORIESs � SQ. FEET OF EACS FLOOR:
N0. OF B�ROOMS: GARAG$ STAIZS: ATT. DET.
ESTIMATEn coasTxuc'rlo8 4Azu1�lTIOR (eaclnainq laaa) i $ �3�� o °•�
I hereby apply for a building permit and I acknowledge that the informatic
above is complete aad accurate; that the work will be in conformance with tt
ordinances and codes of the City and wi�h the State Buildiag Code; that
understand this is not a Fermit and work is not to start without a permit; ar_
that the wosk will be in accordance with the approved plan.
; �\ n \ - -�
�iPPLICANT's sIGPIATORU: vv DATE: � � U �
(Please fill out the reverse side of this form)
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(��'�'�o� ���1�T�
A1 Post Office Box 66�Crystal Bay.Minnesota 5�323•Mnnicipal Offices
•
� _ � �. On the North Shore of Lake Minrcetonka
DATA PRIVACY AD��ORY
In accordance with M.S. I5.165, "Rights of subjects of data", we
wvuld Iike to inform you that your request for a permit or Zicense
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� ra1 a enciestto the extenthnecessary to processcthe permit or
fede g
3.icense.
4. If your requested permit or license requires Council action
�b approve, some information may become publ.ic.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permi.t.
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Address
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City State Zlp
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Phone �...
I understand my rights as stated above.
Siqnature
BUII.DING�ZONIIYG-473 7357 • ADMIIv1STRATION�FiNANCE-473-7358 � PUBLiC wORKS-473-7359
pSSFSSING
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� ATE TIME
TY OF ORONO CALLED IN ' v /
NSPECTION NOTICE SCHEDULED � — �.
PERMIT NO. 1 ��`" COMPLETED
ADDRESS y SS /C�� . � �
O W N E R �---�'- CO NTR. ��-
TELEPHONE NO. --�'-�7a-- S�e
�FOOTING O PLUMBING RI ❑ SITE INSPECTION
FRAMING � � O PLUMBING FINAL ❑ EXCAV./GRADING/FILLING
� ❑ INSULATION �❑ MECHANICAL ❑ LAKESHORE/WETLANDS
� ❑ WALL BD. O WATER HOOKUP ❑ LICENSING
W ❑ FINAL ❑ METER SET/TURN ON ❑ COMPLAINT
� O PROGFESS ❑ SEWER HOOKUP O FOILOW-UP
� ❑ OEMOL. ❑ SEPTIC INSTALL. O SEPTIC FINAL
Q ❑ FIRE PREV. ❑ SEPTIC MAINT. � FIREPLACE/WOOD BURNER
Z ❑ WELL TEST PUMP ❑
Q COMMENTS: v L-��L � .r��L`� :�`i� -- _ �,.._ :, �.; t"'��
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'ORK SATISFACTORY:PROCEED ❑ PHOTO TAKEN
`RRECT WORK&PROCEED
7RECT WORK.CALL FOR REINSPECTION BEFORE COVERING
'�ECT UNSAFE CONDITION WITHIN HOURS INSPECTOR WILL RETURN.
ORDER POSTED.CALL I�SPECTOR.
'TION REQUIRED.CALL TO ARRANGE ACCESS.
�next inspection 24 hours in advance.
-. on site
���<-�.. ' 473-7357
�.ector's File Canary/Site Notice
DA/TE TIME
�TY OF ORONO CALLED IN � CO� Z' ��2�'1
INSPECTION NOTICF�;,� SCHEDULED � 7� �
PERMIT NO. � COMPLETED � � ��OG
ADDRESS S D�— �1 �S O/'"G i�"
OWNER �6/'Q.l��/h�SZ�%1 CONTR. � �o��^
TELEPHONE NO.��-" �P S3 �
Cl FOOTING � PLUMBING RI ❑ FIRE PREV.
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� C FRAMING �: PLUMBING FINAL ❑ FIRE SUPRESSION SYS.
� :-! INSULATION C MECHANICAL RI ❑ EXCAVIGRADINGIFILLING
y ❑ WALL 60. G MECHANICAL FINAL ❑ LAKESHOREM/ETLANDS
� �7 FINAL �7 FIREPLACEIWOOD BURNER ❑TREE REMOVAL
Q �C DEMO—SITE ❑WATER HOOK-UP ❑ KENNEL LICENSE
� C DEMO—FINAL �= METER SETITURN ON ❑ SITE INSPECTION
v _.� SEWER HOOK-UP ❑ PROGRESS
W ❑SEPTIC MAINT. ❑COMPLAINT
= G SEPTIC INSTALL ❑ FOLLOW-UP
J
� C SEPTIC FINAL
O ❑SITE WELL
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� ❑WELLTESTPUMP
� COMMENTS: �
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W ORKSATISFACTORY:PP.00EED C PHOTOTAKEN
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G CORRECT WORK&PROCEED ❑ CITATION ISSUED
� ❑ CORRECT WORK,CALL FOR REINSPECTION C ISSUE CERTIFICATE OF OCCUPANCY
O
V BEFORE COVERING TEMPORARY
C CORRECT UNSAFE CON'�ITION WITHIN HOURS. PERMANENT
INSPECTOR WILL R'�TURN
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRE0.CALLTO ARRANGE ACCESS.
Call for the r�ext inspection 24 hours in advance.473�7357
OwnerlContractor�qn .
Inspector. �/` �
Whit pyllnspector's File Canary CopylSite Notice