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Home My WebLink About2002-P04769 - addn/remodel/repair � � CITY OF ORONO PERMIT 2fi50 Kelley Parkway- PO Box 66 Permit Number: Po4�69 Crystal Bay, Minnesota 55323 P@�CTllt Typ@: Addition/RemodeURepair (952) 249-4600 Date Issued: i�si2oo2 SITE ADDRESS: 1525 Sixth Avenue N. L.ong Lake,MN 55356 P ID: 26-118-23-33-0033 DESCRIPTION: UBc occupancy R3 Construction Type VN Proposed Use: Residential Permit Class: Building Census Code 434 Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: Eiecnicai(sraie� NOTICES/REMARKS: FEE SUMMARY: PermitFee: $ 181.25 Valuation: $ 10,000.00 State Surcharge Fee: $ 5.00 TOTAL FEE: $ 186.25 APPLICANT: Owner/Self OWNER: S&S Morrison MN 1525-Sixth Avenue N. Long Lake,MN 55356 l THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND A� O ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BU ` REQUIREMENTS. �'�,� 0�� C�� , APPLICANT PERMITEE SIGNATURE ISSUEDBY SIGNATURE Coqies: 1-File(SiQnitures Required). 1-Analicant 1-Monthlv Reaorts, 1-Assessing, 1-Finance Page 1 . � �g� �S Total Fee: $ Date Received: �� {��,g . Entered By: n Permit#: / -��! -�/ CI7 � � _ '7 —C I C:�OF ORON.O — BUII.,DING PERNIIT APPLICATION All information must be submitted in full before plan review will 6e started. (please print all inforncation) --------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: 2 s ��ve �I � ZIP: S S �� NAME OF OtiVNER: ��'� � ��R 1 S 8� PHONE: ome 1��2 ��q (��O� (h ) l�Z � Gj� ` , (work) �l� Sr,� 9517.� MAILING ADDRESS: �'�/e �l � CITY: �o GQ�� ZIP: j`�3s 6 CONTRACTOR: ��P 1 C7�S PHONE: 9�z �S�I d�� CONTACT PERSON: S�� M e rr�5 B� MOBILE/PAGER: 6/Z ;�g 9 f��(� MAILING ADDRESS: -�>'49'�%`r�' ,�s ��V� CITY: ZIP: STATE LICENSE: � ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition / Accessory Structure Move Remodel/Alteration (/ Land Alteration PROPOS D WORK describe in detui�: f �� fteP:� OC;C i'/) ��"�' � d�/2 ct �Q U � `''_' ' r G STORIES: � SQ.FEET OF EACH FLOOR: �dU �ja�" � S��rurs�rh NO. OF BEDROOMS: �_ GARAGE STALI.S: ATT. DET. ESTIMATED CONSTRUCTION VALUATION(excluding land): $ l� �D� 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 Ciry 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 d ith the�approved plan. , APPLICANT'S SIGNA DATE: � , C�� NOTE! Parade of Homes events require separate permit approval by Police Deparlment and City Council 60 days prior to the event. Non permitted events will not be allowed. � . . � Sec.13.04 RIGIiTS OF SUB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom[he dara is stored or to be stored shall be as set forrh in this secrion. Subd.2. InFormation reqirired to be given individual. .�n individual asked to supply private or confidendal dara conceiniag himself s6a11 be informed of: (a)the purpose and incended use of the requesred dara wi[hin the collecting state agency,poliacal subdivision,or stauwide sysum; (b)whe[her he may refuse oY is legally required to supply ehe requesud data;(c)any Irnown consequence arising from his supplying or refusing to supply priva�e or confidendal data;and(d)the idenary of o[her persoas or entines au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav place the noace rewired under this subdivision in the individuat income tax or orooertv taz refund inst�ucaons inscead of on ehose 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 class�ed as public,priva[e or confidenaal. Upon his further request,an individual who is the subjecc of stored private or pubiic data on individuals shall be shown the daa wichout 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 dara and informed of iu meaning,the data need not be disclosed ro him for six months thereaher unless a dispute or action pursuanc to rhis secrion is pending or addiaonal data on the individual has been collected or creared. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesang person to pay the actual costs of making,cerufying,and compiling the copies. The responsible au[hority shall comply immediately,if possible,with any request made pursuant to this subdivision,or wichin five days of the date of the request,excluding Saturdays,Sundays and tegal holidays,if immediau compliance is not possible. If he cannot comply with the requesc wirhin that time,he shali so inform[he individual,and may have an addirional five days within which to compiy wich 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 pri�•ate data concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing che nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct rhe data found m be inaccurate or incomplete and attempt to nodfy Qast recipienc�of inaccurate or incompiete data, including recipients named by[he individual;or(b)nodfy the individual thac he believes the data to be correct. Data " in dispuce shall be disclosed only if the individual's sratemenc of disagreemenc is included wirh the disclosed data. The decerminarion of the responsibte auchoriry may be appeated pursuant to the provisions of the administradve procedure act relaring to contesced 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 fumish certain private or confidential information. You are notified thar. 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 ocher 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 . Ciry State Zip Phone , I understand s ted above. naaro CHECK OFF LIST FOR ISSUANCE OF PERMITS . ` FOR OFFICE USE ONLY ADDRESS OR LEGAL: (SZS S� �T� ,4v-e N • PID: DESCRIPTION OF WORK: �3��y�►�-' ��,•��si� ZO�YG REVIEW BY: DATE APPROVED: BUII.DING REV�W BY: DATE APPRUVED; r- ?-o z, w_ �_t_____�- -- FEES TO BE CHARGED: Misc. Fees Calculated By: PERNIIT Yes ✓ No PLAN REVIEW Yes . No �/ SEWER CONNE�TTON STATE SURCHARGE Yes ,/ No WATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTION Number of SAC�Units OTHER (specify) ZONING CH�CK LIST Zoning District: �/a c�-r��C Fire Department: Post Office: School District: � Lot Area: Sq�.ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front(Lake): Right Side: Reaz(Sueet): Left Side: Adjacent Structures: W tland: Building Height: Def. Hgt. P •Hgt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # Resolution Date: Shoreland Disuict: Avg. Setback: Bluff Setb k: Lot Coverage: Existing Proposed Hazdcover: 0-75' 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes N Date of Council Approval: REMARKS(in house): I � 7 Y BUII,DING REVIEW CHECS LIST �C� �" 3 CONSTRUCTION TYPE: _V�`�' Sq Footage $Per Sq Ftg Basement x _ 1st Floor x _ .�� 2nd F1oor x = Garage x = x = � TOTAL Fstimated Construction Value: $_ � O��o o °'�-- Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical Water Connection . F��g � Septic Sewer Connection �Framing Fireplace Lawn Irrigation Insulation (Masonry) Other _OS Wall Boazd (Mfg.) Well(State Permit) �``F�� Grading/Filling �p _Electrical(State Permit) Other REMARI�.S(IN HOUSE): . ------------------------------------------- --- REVIEW BY OTHERS: DATE: Access: Ezisting New Access Approval: Date By; -------------------------------------------------------- REMARI�S (TO BE NOTED ON PERNIII�: 8