HomeMy WebLinkAbout2006-P09864 - addn/remodel/repair = PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09864
Crystai Bay, Minnesota 55323 Pel'mlt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
6/15/2006
SITE ADDRESS: 1300 Sixth Ave N Unit#
Long Lake,MN 55356
PID: 26-118-23-31-0004
DESCRIPTION: UBC Occupancy U1
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit T e: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair
YP
D ETAI LS:
Approved perresolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
Addition to existing outbuilding
FEE SUMMARY: Pernut Fee: $ 251.25 valuation: $ 15,000.00
Plan Review Fee: $ 163.31
State Surcharge Fee: $ 7.50
TOTAL FEE: $ 422.06
APPLICANT: Terry Built OWNER: 7ohn Sheehan
340 Leaf Street 1300 Sixth Ave N
Long Lake,MN 55356 Long Lake MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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CANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesReg ired), 1-Applicant, l-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
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Total Fee: $ Date Received:
Entered By: � Permit#: ���J
CITY OF ORONO - BUILDING PERMIT APPLICATrON
All information must be submitted in full before plan review will be started.
(please print a[l information)
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THE APPLICANT IS: (circle one) OWNER O ONTRACTOR
JOB SITE ADDRESS: f 3 00 � T�— 1�Je /✓ ZIP: S S3 S�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ No If yes, a special event perinit is r�egui��ed with Police Depai�tment and City Counci/approva!
60 da��s prior to the event. Shzrttle bars service tivill be regi�ired unless applicant cternonstr•ates
suff cient on-site par�king is available. Non-pe��initted events�vill not be allowed.
NAMEOFOWNER: Vc� Lt c� �l-�eP��} il� PHONE: (home) 9S�- y73 - 5 SS3
(work) 9S�- 9.2 Y � y 9'`/
MAILING ADDRESS: �30 0 6 �� ���- rV. ciTY: 020�� ziP: �
CONTRACTOR: �2� �� /T- PHONE: Sr3 S�
�s� - y76 - S-7�z
CONTACT PERSON: i(o.-vr Tci'✓' MOBILE/PAGER: //� — g.So• o�9'f�
MAILING ADDRESS: 3 yp ,(r �� ST, CITY: �Con�y <�4,FP ZIP: SS3S�
STATE LICENSE: # 7g/S' EXPIRATION DATE: %tl�y ,�p� 7
ARCHITECT/ENGINEER: � p� � PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition �_ Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detai�: AOD� T�o� o �'3<� S T. � 5
��. � .3k . /� �. �
STORIES: � SQ.FEET OF EACH FLOOR: yyc� �
NO. OF BEDROOMS: ?� GARAGE STALLS: ATTACHED DETACHED�
ESTIMATED CONSTRUCTION VALUATION(excluding land): � � S c�v c� ��
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate;
that the work will be in confonnance with the ordinances and codes ofthe 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 �vith the approved plan.
APPLICANT'S SIGNATURE: TE: � 7"' (��
31
Sec.13.04 RfGHTS OF SUBJECTS OF DATA
Subd.l. 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 dataconceming himselfshall 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 legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identiry of other persons or entities 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 o�cer.
The commissioner of revenue ma+�place the notice reguired under this subdivision in the individua(income tax or Zro. er y tax refund
instructions 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 data without any charge to him and,if he desires,shal I be informed of the content and
meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six
months thereafter unless a dispute or action pursuant to thissection 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 costs of making,certifying,and compiling the copies.
The responsible authority shal I 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 hol idays,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 to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may con[est the accuracy or completeness of public or private data
concerning himsel£ To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature ofthe disagreement. The
responsible'authoiity shall within 30 days either. (a)coRect the data found to be inaccurate or incomplete and attempt to notify past recipients 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.
Tfie detertnination of the responsible authority may be'appealed pursuant to the pvovisions ofthe administrative procedure act relating to
contested cases.
� ' ' DATA PRIVA�Y ADVISORY �
. In accordance with M.S.1�3.04,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
, puqlic.
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 understa�n¢-myrtgbts as stated above.
� F
%
Signature
Reset Form 32
�
CHECK OFF LIST FOR ISSUANCE OF PER1ti.tITS
z �OR OFF�CE �SE ON Y
ADDRESS OR LEGAL: � � � ���'� �`��' , � ��"'`�
PID: .
DESCRIPTIO:V OF YVORK: � `� � �`�" '� '�- '�`'� � ��" ��� ��
,
-------- - --------=-------------------------------------------------------------------
------------------------------- -
ZONItYGREVIEIVBY: <l/ ?�_ DATEAPPROVED: .S � �
BUILDXNG REYIEW BY: DATEAPPROI'ED: s -Zs -o co
--------------------------------------- ' -----------------------------------------------------------------------------
FEES TO BE CHARGED: lLtisc. Fees Calculated By:
PERItilIT Yes � 1Vo
PLAN RE VIE LV Yes—� �Vo SE tiVER CONNECTION
STATE SURCH.4RGE Yes—� 1Vo yVATER CO�WECTIO�V
I�VVESTIGATION FEE Yes No _� PARK FEE
SAC Yes IVo � SITE NSPECTIO�V
NLcmber of SAC Units OTHER (specify)
-------------------------------
------------------------ ---------------------------------------------------------------
ZO�V.IIYG CHECh'LIST Zar�i�tg District: � I�
Fire Depa1•hner:t: Post Offcce: SclGoof District: ___..
Got.�(rea: Sq.f't. Acr•es �,G 7 YYidtlt ���� Depth �•��7� �'�C�� '
S�v-vey Submitted: Yes ✓ No �ate of Scuvey: `t
Proposed Setbacl.s: �-5�" '
Frortc(-{,-cr/�Zs): � l��" �(.�/ &i.gl�t Side: �� +
r w� � �.C/, �
Rear EStre�t): � �U � G-c�t Side:
Adjncent Su�c�ctcu•es: � , GG'etictnd: v� !f
?� : ,-
Buildi„g Height: Def. Hgt. ��.� Peak Hgt. � Z
Lot Coverage: l��
G+'ading: Stc�ff,4pp�'ovctl Date: N��� By: Cot��tci!Ap���ova(DRte:
Septic: Staff,4pproval Date: � BY� W(.�
Zorting File: �� Resolc�tion: # Resolectio�a Da£e:
Sltoreland Dish•ict: �/'f
Avg. Setback: Blc�ff Setback: Lot Coverrge:
Etiisti�ig Pr•apased
Hardcover: 0-7�'
7.5-2�0'
250-500'
500-!000'
Hardcover Vnria�ice Reqccired: Yes No Date of Council�Ippraval:
.REItiIARKS(i�i lzouse):
3i
r
B UILDIiVG RE VIE yV CHECh'LIST
UBC: V � � CONSTRUCTIO�V TYPE: �I✓u
Sq Foata,�e ,�Pei•Sg Ft�
Basenier�� � _
!st Floor x =
���d Floa• x =
Gar•�ge � _
� _
TOT.4L
Estiniated Constructioic L'afue: ,S l5 vo o `'^�
Irispectioi:s Reqc�ired: GYork Requir•irt;Separ•ate Per�r�its:
Sr.'te Plcunbrng Fire
Hardcover Reinoval Nlechanicnl Y�ater Coiuzection
_ � Footutg Septic SetiveJ•Co�vtectio�l
' F,�a»ti��g Fir•eplace Lativra!!•rigatiori
Inscclation (�tifasonnJ) Other
6Y"ct11 Board (Nlfg.) 6Ye11(State Permit)
_�Final Grading/Filli�t,; °< Efech•ical(State Per-ntit)
Oth er
REttiIARli S(IN HO USE):
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REVIEW SY OTHERS: DATE:
.4ccess: Existin,� rVew
,4ccess�(pp�•oval: Date B�:
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RE�tiIARIiS (TO BE NOTED O�V PER[tiIIT):
32
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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
v 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
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Q�5 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 PLUMBtNG RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL �1
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Call for the next inspection 24 hours in advance. �952� 249-460�
OwnerlContractor on site:
Inspector. ��� ��/��
White Copyllnspector's File Canary CopylSite Notice