HomeMy WebLinkAbout1999-011712 - remodel , PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -
Permit Number: ���_���--�'�t'��:
Crystal Bay, Minnesota 55323 Date Issued: `-'i � �` '-�
(612) 473-7357 _. P _ . .--
SITE ADDRESS:
_ ., ,=:f`;���°S f ����,,
}.-(2—:
... _ . . . . . _�L��..j .��.J "_�a.i { �".�i��I rj
DESCRIPTION:
�i-:i°�t_tf;�:.'—_
`��t11=��.1?°� =t't3f?T.• I ;+'r'� -. "tiE.�':'/�E;t=i1�'t=_!�.its��
h-<E17 ; •"�7 �i�_ ';:,{�_ii'�:; i �'C�r= l�,.f_�`,�l_I���j-s �`:t��F:F�tI_?�i��
� �` _ tS[i_j.4r�%,l�,f� �—i"'�
t,,.���2'i:T.i"t.�i fi.3 f�}-i ,r�;�„ �,;'•�.
�_?r'll':�i�tr _+ia:.S',�' +4�+�� f-��_t . �.`�=��'=_•'r����i:'—�••_
REMARKS:
FEE SUMMARY:
, .�`��i tr-j 1 �;-�'£� - =�)j :_i:_1:_
_-',;,'=}3_+ �`'t,-_s•�" ',T��:_'� . i_•'t
.���.���[�i�}'+�;i:? ...�..�..�...�._....� �i�ai
I i_.i i.i i ! �h' _ ��t_,'�� E"�
CONTRACTOR: - =;�.,��; ; ;.�;,1,. - :-;�- _ ;_�;: ,OWNER:
_.. .. .-'_,.-..",- '.f._": .- . .. .- . . I�f';�„F�..�.�, - - - - -i;t:; :�_... . �i�:,
.;'is�i;3i�� _.�d,i"�i T;��;_ i+:� �:;if_' t�E;;_i�i_l;'=`�`�1 �;�j
'�:i-`�f �.::�� i-'t-;i=i1.. ,� ,_;�,i �--,:� - i _- =�C,:=
_—_. _it '_i{;`I_I3.1E_i �'if'y _ _. � ._ �
t.i_ _.�,_. _t,%.1_.;.;;"����.::� ;'�.;?�"'(_}�:_�.�
T��. ��t����'•�:I��t��'C� ��:�:��'•� €`,`�t?�.��..��: �-`��:t�.�_�_._:�;,� ��_� �:.'3:.�=. �'��: �-:�:�.�_ ��{;��4,�,�_�3�-�,:�
�='�__t_`I'����! ��'�ii� ��,��—`�=�'`� "i i�t �°!,�'s �l i f��,°r; �rv •- �" ..,. . �—.—
,r; .�....... '�r _ ~� °i�,J�' t t�li`.. �_�'�r�rd+i�:�,, ti!j �'ry ;�} � �,Y :
"'."'_r:;i; - , ,,,, .°:`ix:� '� " i_. { .� - W r F t.t i#`,�,f� { E_S 1:�" t';£'�;y Y_��. =�i i ,_ -
: � . M.
� ;: t.,., . .. . _ •. ,� .�E�° . . . _ __. _ . ., . �
,
i; APPUCANT%PERMITEE SIG URE ISSUED BY:SIGNATURE �.
,
• Total Fee: $ l��• 2� Date Received:
Entered By: � Permit#: �� ��Z-'
,
CITY OF ORONO - BUILDING PERNIIT 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 CONTRAC R
JOB SITE ADDRESS: �� � d� �"d r� ZIP:
NAME OF OWNER: -��'� C�`t�'� PHONE: (home) `� �� -'S-z�SCP
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �-cr Ua����'�^Y � PHONE: Y�/-" dS 3 Z
CONTACT PERSON: �e ��� MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # O�z�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration_ C� Land Alteration
PROPOSED WORK(d scrib in detai�: �t;�e,�,,- , Cz�� �y''�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /O,�O d��
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 will be in accordance with e approved plan.
APPLICANT'S SIGNATURE: DAT'E:
NOTE! Parade of Homes events require separate pe it approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
5
w ,
J
•. ♦
Sec.13.04 RIGHTS OF S[JBdECTS OF DATA
Subd. 1. Type of data. The righu of individual on whom the data is sWred or to be stored shall be as set forth in this secdon.
S�bd.2. InformaHon required to be given indivtdual. An iniividaal asked oo supply private or confidenrial data co�eming himself
shall be informed of: (a)the purpose and intenled use of the requested data within the collecting stau agency,poliacal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or
refusing ro supply private or confidential data;and(d)the identiry of od�r persons or entities authorized by stau or federal law to receive the dara.
This requirement shall not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82, subdivision 5, to a.law
enforcement officer.
The commissio�r of reveraie mav nlace die notice rewired�der this subdivision in the individual income faz or nronertv taz refu�
instiuctions insuad of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the.
subject of stored data on individuals,and whether it is classified as public,private or confidendal. Upon his further request,an individual who
is the subject of stored private or public data on i�dividuals 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. Afur an individual has been shown the privau data and informed of its meaning,the data need not be
disclosed to him for six months thereafter unless a dispute or acuon pursuant oo this sxtion is pendic�g or addidonal data on the individual has been
collecoed 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 reqaes6ng person to pay the actual costs of maldng,certifying,and compiling the copies.
The rosponsible authoriry_shall wmply immediately,if possible,with any request made pursuant to dvs subdivision,or within five days
of the date of the request,excluding Sauudays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the individual,and may have an addidonal five days widiin which to comply with the request,
ezcluding Saturdays,S�ndays and legal holidays.
Slibd.4. Pracedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data co�erning himself. To exercise dris right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authority shall within 30 days eitt�r: (a)correct dre data fou�to be inaccucate or incomplete and aaempt to�tify
past rxipie�us of inaccuraoe or incomplete data,i�luding recipients named by the individual;or(b)noafy the individual that he believes the data
to be wrrect. Da�in dispute shall be disclosed only if the iidividual's statement of disagreement is included with the disclosed data.
The determination of die responsible authority may be appealed pursuant to the provisions of the administraUve 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�ity of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze 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 supplg.data, but refusal may require that the Ciry 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 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.
First Middle I-ast
Address
Ciry State Zip Phone
I understand my rights as stated ve. �
Signatur
6
, A
♦
� . ..
- CHECK OFF LIST FOR ISSUANCE OF PERMITS .
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: y0 d �k��'J �Lo�J -
PID:
DESCRIP'rION OF WORK: /�t�t2aQk_ -
ZONING REVIEW BY: /1/�/� DATE APPROVED:
BUII�DING REVIEW BY: DATE APPROVED: y-L-4�j
FEES TO BE CHARGED: Misc. Fees Calculated By: ;
PERMIT Yes ✓^ No i
PLAN REVIEW Yes No ✓ SEWER COrfNECTION
STATE SURCHARGE Yes �� No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION '
Number of SAC Units OTHER (specify)
---_--_____-�-�--_______���---------------------------------------------------------------------------------- �
ZONING CHECK LIST Zoning District: �/1, C C�r.�P '
�
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: ,
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: We and:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By: I
Zoning File: # Resolution: # Resolution Date: ',
Shoreland Disuict:
Avg. Setback: Bluff Set ack: Lot Coverage:
Existing Proposed '
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
w ,
` .
. , � .
BUILDING REVIEW CHECK LIST
UBC: /2"J' CONSTRUCTION TYPE: VN
Sq Footage $Per Sq Ftg
Basement x —
1 st Floor x =
2nd Floor z =
Garage z =
R =
TOTAL
w.
Estimated Construction Value: $ I � .C�o J �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
�Framing Fireplace Lawn Irrigation
�Insulation (Masonry) Other
�Wall Boazd (Mfg.) Well(State Permit)
Final Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): . .
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By:
REMARI�S (TO BE NOTED ON PERMI�:
8
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED -�' � 9% � �Z�
PERMIT NO. �/7/aZ� COMPLETED Z� � ����
ADDRESS '
OWNER CONTR. � �
TELEPHONE NO. �7/ � C� � �'�
� DESCRIPTION �� ��� �� ' ��'S �C/�- �J�"
� 01 FOOTING 11 MECHANICAL I 18 EXCAV/GRADING/FILLING
Q FRAMIN 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y SULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
w .,� S 7/n� �jr'c�.rtir�n� v�
� �U��
0
a
�
0
�
w
�
Q
�
z
W
�
W
�
j
d �VORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W
� ❑ CORRECT WORK R PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR c� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContractor on site:
Inspector.��.��- ��.�/1 S
White Copyllnspector's File Canary CopylSite Notice