HomeMy WebLinkAbout1991-004059 - tear-off / new asphalt I'ERMIT �
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1335 Brown Rd. South • P.O. Box 66 Permit Number: `"-r'�{'��=�
Crystal Bay, Minnesota 55323 Date Issued: � ���•�'�-'�
(612) 473-7357
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APPLI NT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� � CITY OF ORONO - BIIII,DING PERMIT APPLICATION
Total Fee: $ Date Received:
� �- � Date Approved:
Entered By:
Permit#:
AT•T• INFORMATION IKDST B$ SIIBMITTED IN FIILL BEFORE PLP,N REVIEW WILL BE STARTED -
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THE APpLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: ` 3� ��"�rl�f/�8�� "' • ZIP:
(work)
N�ME OF OWNER: PHONE: (home )
MAILING ADDRESS: �O �' �� CIT�= ZIP:
CONTRACTOR: �1��/L�l�K ��Pll/D�S �f2�- PHONE: q7q'-�9�0
AiAILING ADDRESS: (pBDD �,��L!/11I� CITY: � !O'! , ZIP: .1'�..�J /
R'�PE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
r / � �/�
PROPOSED WORR (describe in detail) : �..��I✓r-d � `�Si�'c„l�� llL�Gt/
G��
STORIES: SQ. FEET OF EACH FLOOR:
NO,. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ / lyari���
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
und�rstand this is not a Fermit and work is not to start without a �ermit; and
that the work will be in accordance with the aFFroved plan.
APPLICANT'S SIGNATURE: DATE: ��`����/
lPle e 11 out e reverse side of this form)
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Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
-- Y: '`+`:
� � � � On the North Shore of Lake Minnetorzka
t� ' �r_�. A
DATA__PR_IyACY ADVISOR__
In accordance with M.S. 15.165, "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 license 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
�a.cense.
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. 15.165 to review private
data on yourself.
6. Your ful� name, and date of birth are required to process
this application or permit.
.
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First
Midd e Last
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Address
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City State Zip
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Phone
I understand my rights as stated above.
gn ure
BUILIIIN & NING—473-735� • ADMINISTRATIOh&FINANCE—473-7358 • PUBLIC WORKS —473-7359
ASSE .'G
DATE TIME
CITY OF ORONO CALLED IN ��"�1 _ ���'''`
INSPECTION NOT E SCHEDULED �1— G11 !'m.r�-.
PERMIT NO. SQ COMPLETED G
ADDRESS �
OWNER CONTR. �l.11'�.�n ��C�'�"
TELEPHONE NO. �� / '"���D ,
� DESCRIPTION
� G 11 MECHANICAL RI 16 WELLTEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADINGIFILLING
y ON 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREMIETLANDS
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 PROCRESS
"� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
v 10 PLUMBING FINAL 2;i SEPTIC FINAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �WORKSATISFACTORY:PROCEED ❑ PRWECTCOMPLETE
W CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOYERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
O INSPECTIOPt REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 2�t hours�n advance.473-7357
OwnerlContra r site:
inspector:
White CopyAnspect Flk Canary Copy/Slb Notic�