HomeMy WebLinkAbout2002-P04964 - addn/remodel/repair CITY � ORONO '' PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: Po4964
Crystal Bay, N�innesota 55323 P@ffTllt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 3i2ai2oo2
SITE ADDRESS: 2soo shadywood d
Fxcelsiar,MN55331
PID: 20-117-23-11-0034 II
DESCRIPTION: I uac occupan�y B
Construcrion Type VN
Proposed Use: Institutional ,
Permit Class: Building Census Code 437
Permit Type: Addition/RemodeURepair''� Permit Sub-type(s): Addn/RemodeURepair
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DETAILS: I
Approved per resolution#: ,
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Separate pernuts required: Eiecmcai�sraie�
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 237.25 Valuation• $ 14,000.00
State Surcharge Fee: $ 7.00
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TOTAL FEE: $ 244.25
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APPLICANT: Freshwater Society OWNER: Freshwater Foundation
2500 Shadywood Road 2500 Shaydwood Rd
Orono,MN 55331 Excelsior MN 55331
THE UNDERSIGNED HEREBY REQUESTS P SSION TO MAKE THE REAL IMPROVEMENT'S SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT CO IANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS
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APPLICANT�FRMITE IGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Avnlicant, 1-M nthlv Reports, 1-Assessin¢, 1-Finance Page 1
Tot�'i Fee: $ �� �,� `�, Date Received: �.. /�/-�h Z.
Entered By: r ti'�— Permit#: /�-D �yl �
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR �C�s�-�_
JOB SITE ADDRESS: Z��� S NAD��t,t�oo p R D, 1V A,J��R,e� ZIP: �S 33 i
NAME OF OWNER: �i2t 5��-��,�,�raT�2 ��c ,�T—� PHONE: (home)
(work) � S�z-< �t� � � `� 7� 3
MAILING ADDRESS: z5cx� �H�+�y�wp T�.o . CITY: N aJ a,�2 E e ZIP: s 5�3�
CONTRACTOR: � i'��2-C� � c�L PHONE: �{5 Z- 7 y Z . 3 Q 1�
CONTACT PERSON: ��>��,.; t-��,� i ��� MOBILE/PAGER: �/Z: �3£�: L(o z .�
MAILING ADDRESS: ��c� S�ja„��wo u D t2� . CITY: �A��,,�.,�� ZIP: 5 S' � 1
STATE LICENSE: # � A � ;,� ��� �s� L i C c-�-=� 5`-,��
>� S JL3 c-�� -�-,����z�25
ARCHITECT/ENGINEER: �/�,2 c�j L.� PHONE: ��� - �1�Z� 3 G�CP
MAILING ADDRESS: z sv a ,r�:�,�,,� y v,,��,� R p CITY: ►„�p,v�.,2�e� ZIP: � � 3�i
NAME: �� ��,�, �-� �a ti� ��rt-o � REGISTRATION# �►��
� h-tl�s ]"�Ly c c> � r--t�'��-, �c� s �T cz �=cZ--t.: 2 a�,�.., U 2 �-1�c�r��., �c ���
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detai�: ��c►�C��� �-- '�1""'Uvo G"����i C� S �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ S c�o.vo
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 e in accor nce with the approved plan.
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APPLICAl�TT'S SIGNAT �-�� DATE:, tG1� i j ���'� -
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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.
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Sec.13.04 RIGATS OF SLTBJECTS OF DATA �
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Subd. 1. Type of data. The rights of i�ividual on whom the data is stored or to be sWred shall be as set forth in this section.
S�bd.2. Information req�rired to be givm imdividual. An individual asked to supply private or confidential data concerning himself
shall be n�formed of: (a)the purpose and inte�ed use of the requested data within the collecting state agency,political svbdivision,or statewide
system;(b)whether he may refuse or is legaUy required to supply the requested data;(c)any]mown conseque�e arising from his supplying or
refusing to supply private or confidential data;and(�the identity of other persons or entiaes authorized by state or federal law to receive the data.
This requirement shall not apply when an i�ividual is asked to supply invesrigadve data,pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revernie mav olace the notice reauired under this subdivision in the individual income taz or nrooertv taz refund
instructions instead of on those fortns.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the
subject of stored data on individaals,and whether it is classified as public,private or confidentiat. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without azry charge to him and,if he desires,shall be informed
of the content a�meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed ro him for six months thereafter unless a dispute or acdon pursvant to this section is pe�ing or additional data on the individual has been
coliected 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 d�e roquesting person to pay the.acwal cosu of maldng,certifying,and compiling the copies.
The responsible audiority shall comply immediately,if possible,with any request roade pucsuazu to this subdivision,or within five days
of the date of the roquest,excluding Sadudays,Sundays and legal holidays,if unmediate 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 to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest�e accuracy or completeness of public or
private dara co�eming himself. To exercise dris right,an individual shall noafy in writing the responsible authority describing tha�nature of the
disagreement. The responsible authoriry shall widrin 30 days either: (a)correct the data fou�to be i�M�Mte or i�omplete and attempt to nodfy
past recipients of inaccurate or i�omplete data,u�ciuding recipienu named by the individual;or(b)notify the individual that he believes the data
to be correct. Data in dispute s6a11 be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating
to contested cases. f'
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 conf'idential 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 permit.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
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Si
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, ' CHECK O LIST FOR ISSUANCE OF PERMITS
� � FOR OFFICE USE ONLY
.. ADDRESS OR LEGAL: z 5 . a S�A p v�oo� Za, IvP,V�4Yt,2c..� M N S�3� ) -
PID:
DESCRIPTION OF WORK: TZ�i�t0 D�-� -ti,vo G ,c� _
--------- --�------------------____------------------------------------------------
ZONING REVIEW BY: (� DATE APPROVED:
BUII.,DING REVIEW BY: DATE APPROVED: �2S-o z
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Y�s �/ No
PLAN REVIEW Yas No �/ SEWER CONNF.CITON
STATE SURCHARGE Ye� �/' No WATERCOrf1VECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
------*-------------- ----------------------------------------------------------
ZONING CHECK LIST Zoning District: N C� G H'�N��, -L
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acre�s Width Depth
Survey Submitted: Yes �io Date of Survey:
Proposed Setbacks:
Front(Lake): Right Si .
Rear(Street): Left Sid :
Adjacent Structures: j etland:
Building Height: Def. Hgt. _�_ Peak Hgt.
Lot Coverage: ''
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Reso ution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Se ack: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
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BUII.DING REVIEW CHECK LIST y
UBC: 6 CONSTRUCTION TYPE: �/`�
Sq Footage $Per Sq Ftg
Basement . z =
1st Floor x =
2nd Floor x =
Garage a =
R =
TOTAL
Estim$ted Construction Value: $ 1 y-, 0�8
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
_,�Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well(State Permit)
oC Final Grading/Filling _�Electrical(State Permit)
Other
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REMARI�S(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REI�ZARI�S (TO BE NOTED ON PERNIII�:
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MAR 07 '02 07�40 95� 742 5899 PAGE.02 " '