HomeMy WebLinkAbout1999-011465 - pool PERMIT
C�TY OF ORONO PERMIT TYPE: -
2750 Kelley Parkway- P.O. Box 66 -�•'��-�-��'��=
Crystal Bay, Minnesota 55323 Permit Number: ;�:,���,�;_,_ _
(612) 473-7357 Date Issued: ;:��.,i-�7 f�__�_
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — ����� �i����t� — OWNER:
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APPL�CANT/PERMtTEE SIGNATURE ISSUED BY:SIGNATURE , +�[ �
- Total Fee: $ 3/'�. '�1� Date Received: `�' �'- ��`
Entered By: ,G/L Permit#: �! ���
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CITY OF ORONO - BUILDING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: r,� 7�S /Qtf��5�9� r �t�. ZIP: _5 5".�SS'/
�
NAME OF OWNER: �r�E� J o i�.rvs To�v' PHONE: (home) �I.�' '�l'1%-�!S'S�
(work)
MAILING ADDRESS: ��2 7vs' �if�i4-�e4iv� /`'v CITY: � ZIP:,s�-3,3/
f xCC-tS�e�P'.�
CONTRACTOR: /���. f oo,��51 D� �,E�e�✓���s: � ..�-.J� PHONE: (�S!-�:�'3-jw G� ��
CONTACT PERSON:�)�,�, �: �;,,���,/ MOBILE/PAGER:
MAILIl�IG ADDRESS:�/ �, C�. I�� G CITY: �, �T�-��,����P: �s�s-r i�
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK (describe in detai�: ,�,,,s� ;,4��.,g r�o,� ,�r ��t� `x u�} { �,�y��o�,,�,�
.S �.ci..��r� _> f'cr�c�< W/s T"r-="r,C l.ti°/��L �s � 1�/iv V i �:r✓:�,�c'_ �✓�f��/a�..0�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �2,0(�`p
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 the approved plan.
'` i
DATE: �'}� . c,
APPLICANT'S SIGNATURE:��u ` ,s,.�,
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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 confidential data concerning hunself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legatly required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidential dara;and(d)the idenary of other persons or enaues 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 orooerri tax refund
insiructions instead 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 confidential. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the dara 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 iu meaning,the data need not be
disdosed to him for six months thereafter unless a dispute or acaon pursuant ro this section is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require the requesting person to pay the actual cosu 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 time, he shall so inform the individual,and may have an additional five days within which ro 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 authority describing the nature of the
disagreement. The responsible authoriry shall within 30 days either. (a)conect the data found to be inaccurate or incomplete and attempt to notify
past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinarion of the responsible authoriry may be appealed pursuant ro the provisions of the administrative 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 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 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 permiL
,L ���s �. /��OG�/Zs�.✓
First Middle Last
`3�? ,�f'�/� � � �y � ��=
Address ,
�,�t � w�o r� r1� ss 1� � �5 i-�T�- ���y
City State Zip Phone
I understand my rights as stated above.
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Signamre
6
- � CHECK OFF LI5T FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z Z�� P 1�1�'X1srA�v� (lAiq�
PID:
DESCRIPTION OF WORK: o ot
ZONING REV�W BY: DATE APPROVED: 5`- 27-r^f'
BUII�DING REVIEW BY: DATE APPROVED: S • Z�• S 5
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,�/ No
pLAN REVIEW Yes �" No SEWER CONNF,CTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: L.�L-��
Fire Department: r►iw�N✓> Post Office: w�y-tq-t� School District: l�.i,P_g`rt�ul�'•4
Lot Area: Sq.ft. 3 5�3 Acres . 7 2- Width I 3 Z- Depth 2 343.6�
Survey Submitted: Yes c No Date of Survey: S-�7- �g
Proposed Setbacks: ,
Front(La#e): t$S� `-' Right Side: 3�$ �
Rear(S�eet): �a '� L.eft Side: 3� t
Adjacent Structures: �p ` Wetland: �1 �/�F
Building Height: Def. Hgt. �V�14- Peak Hgt.
Lot Coverage: D.��-
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland Disuict: �y�25
Avg. Setback: r///+ Bluff Setback: i✓�/s Lot Coverage: �+///o�
Existing Proposed
Hardcover: 0-75'
75-250'
250-500' 1`{•Z �
500-1000'
Hardcover Vaziance Required: Yes No_� Date of Council Approval:
REMARKS(in house):
7
BUILDING REVIEW CHECK LIST � '
UBC: '� CONSTRUCTION TYPE: '"'
� - Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gazage x =
x =
TOTAL
Estimated Construction Value: $��Ooo� _
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical.. Water Connection
_�Footing Septic Sewer Connection
F.zaming . Fireplace , Lawn Irrigation
Insulation (Masonry) Other
.Wall Boazd (Mfg.) Well(State Permit)
_�Final Grading/FIlling �Electrical(State Permit)
Other
REMARKS(IN HOUSE): -
REVIEW BY OTIiERS: DATE:
Access: Ezisting New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMI�:
8
DATE TIME
CITY OF ORONO CALLED IN �� �'� �
INSPECTION NOTICE./ scHE�u�Eo G//—� I� PN(
PERMIT NO. %l{y(C� COMPLETED �t �
ADDRESS �7G� Q,/?�<<.,�Z;-�f" I<=-�
OWNER <.��`�ZYt 5�, CONTR. �� ��'`��1�� �C�-�.'Z��
TELEPHONE NO. ��� ��_� — ��`�/ ��`�.��
� DESCRIPTION �7/�i� � -c-�
L� 01 FOOTING 11 MECHA AL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
Z
fl COMMENTS:
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� ORK SATISFACTORY:PROCEED �:, PROJECT COMPLETE
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❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
f7 INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contractor o ' e•
Inspector.
White Copylinspector's File Canary Copy/Site Notice
� DATE �IME
CITY OF ORONO CALLED IN �O-v2+� (9 � � U
INSPECTION NO SCHEDULED ,-= 3 ` � � o r'
PERMIT NO. �� �OMPLETED
ADDRESS�� 7 0� ��"�-r�:1f%� ,�l.���.E--- �'"l�'
01A���� _,� , � �
i� % ��2'-a�i����c��Z CONTR._ �t�t - d.,%c�'�, ��¢/
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TELEPHOf�E NO. �� ��- 7 77 7 � C'S�
� DESCRIPTION G�� �'� �=Z.E=�- l� ����(,.�i ;--�.. � �-�-�'
� 01 FOOTING 11 MECHANiCAL RI % 8 EXCAV/ RADING/FILLING
,Q 02 FRAMING 13 MECHANICAL F�NAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 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
� COMMENTS:
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W� �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. rPHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR '�- CITATION ISSUED
❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-73�J7
OwnerlContra r on '
Inspector. �`
White Copyllnspector's File Canary CopylSite Notice
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t�t bounJanef of �ht�bOve d�scriDed I�nd and o1 the Ip��hon of sil p��ldinqs, �Z��
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LAND SUitVEYORB,INC. B°°k - Pd�
' As wrvey• Ov rrH thi ' �� ds �Sf 19�
�0�0 M�rbOr��n�NO � Z'�- '° GREG JOHNSTON
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