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CITY of ORONO <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br />I ICT:] <br />P <br />A <br />TMENT <br />POST OFFICE <br />VAR. DATE <br />COND. USE DATE <br />LOT AREA <br />WIDTH <br />DEPTH <br />PROPOSED <br />FRONT <br />ETBACKS: <br />R. SIDE <br />REAR <br />SIDE <br />LAKE <br />VETLANDS <br />ACCESS <br />NEW <br />AGENCY <br />XISTING <br />�,OV. DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />PERMIT NO. 6474 r <br />DATE ISSUED i) .AJ U 2- <br />SITE ADDRESS <br />PROPERTY <br />IDENTIFICATION NO <br />IP101 L .>>' / 7 <br />LOT <br />BLOCK <br />SUBDIVISION <br />OWNER <br />(Name) <br />(Address) <br />(Phone) <br />,rd ! <br />bel, J'v <br />� � rp <br />fhaevh, 11 r f rL <br />ARCHITE <br />/ENGIN ER - Must Certify ultl-Family. Commercial & Industrial Construction Plans <br />(Firm) <br />(Address) <br />hone) <br />5F_ rx <br />BUILDER <br />(Firm) <br />(Address) <br />(Phone <br />13 ��- <br />jj Gr<, <br />TYPE OF <br />ORK ew j <br />Addition Remodel <br />Reno to <br />�- ►� <br />Z - <br />I. `- �GiC't <br />CONST TYPE <br />BUILDING SIZE <br />/�L <br />Estimated Construction aluatlon <br />L W <br />^ r` Ht <br />r <br />CUPANCY <br />SSIFICATION _ <br />LL. STORIES B i 2_' 3 <br />TS <br />STALLS NUMBER OF BEDROOMS <br />SEPTIC <br />APP DATE <br />PROPOSED USE <br />iCOUNCIL <br />APP DATE <br />REMARKS: / �r f 1 �- C_z) <br />Ll C-'1�'�-- `_ J <br />INSPECTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PERMITS <br />.... FOOTING before pour <br />..... FRAMING rough .n <br />PLUMBING <br />.... INSULATION <br />MECHANICAL <br />...... WALLBOARD before taping <br />......FINAL before occupancy <br />WELL <br />❑ ...... SITE INSPECTION <br />SEPTIC <br />WORK BEYOND OR WITHOUT A RE. <br />SEWER <br />OUIRED INSPECTION WILL BE SUB- <br />JECT TO PENALTY <br />WATER <br />INSPECTIONS MUST BE CALLED -IN <br />... <br />GRADING A FILLING ... <br />24 HOURS IN ADVANCE <br />FIRE ..•.•..... .. <br />COPY WHITE -FILE GREEN -FINANCE <br />CANARY -INSPECTOR GOLD <br />RECEIPT <br />PINK -ASSESSOR <br />Moouyn ►rty •AW Co Inc 16121 661440 <br />PERMIT FEES <br />BLDG. PERMITSTATE <br />y( <br />FEE <br />FEE <br />PLAN REVIEW <br />SAC CHARGE <br />_ <br />SEWER UNIT <br />PARK FEE <br />PENALTY <br />OTHER <br />TOTAL DUE <br />ACKNOWLEDGEMENT <br />THL UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED AND DECLARES <br />UNDER PFNALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT <br />ANCL OF ALL INFORMATION CONDITIONS AND REQUIRE <br />MENTS REPRESENTED ON THIS DOCUMENT THE UNDER- <br />SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM <br />PLIANCL WITH ALL CITY OF ORONO ORDINANCES AND STATE <br />OF MINNESOTA BUILDING CODE REQUIREMENTS <br />l.!�-�� / <.! <br />Srynaturv' Uatr - it 47 <br />Approved dy nI Oro nc. <br />