HomeMy WebLinkAbout2005-P08557 - addn/remodel/repair PERMIT .
Cl�Y �F ORONO permit Number:
275Q Kelley Parkway- PO Box 66 Posss�
Crystal Bay, Minnesota 55323 P@I'll'llt Typ@: Addirion/RemodeURepair
(952) 249-4600 Date Issued: a�4�2oos
SITE ADDRESS: 1980 Sixth Avenue N
Long Lake,MN 55356
P I D: 27-118-23-42-0004
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/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate permits required: Eiecmcai(siaie�
NOTICES/REMARKS:
r'--�-�- r-- �i�'--�_c..__.�_�����.t--'`r-----'`
FEE SUMMARY: Pernut Fee: $ 492.25
Valuation: $ 35,000.00
Plan Review Fee: $ 319.98
State Surcharge Fee: $ 18.00
Misc.Fee: $ 492.25
TOTAL FEE: $ 1,322.48
APPLICANT: Brian Stephenson Construction Inc. OWNER: 7udy Pierpont
2025 Pawnee Rd. 1980 Sixth Avenue N
Medina,MN 55340 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.
��
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Revorts, 1-Assessin¢, 1-Finance Page 1
c.� �-�..��
. Total Fee: $ �`32 2' �� ��8� Date Received: '�J_30�U�
Entered By: ,�}e12- ���/T Permit#: ;� (; ��S'7
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pYint all i�ifor»iatio�a)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTO�c
JOB SITE ADDRESS: / �Y� L' � r�` ��� C :1;t�lZ� ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ No If yes, a special event permit is required with Police Depart�nent and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NA1�TE �FOWNER: �mc5 1�►er�r�or�� PHONE: (home)`i����-`�7�-f/`13
(work)
MAILING ADDRESS: ���' ('�'�,> �� ��'f��� �. CITY: ZIP:
--� .
CONTRACTOR: ��R4�� ,���'��eh��:,� Con��� �►1�.� PHONE: (� 1�- 'k"$) ' "�1 7
CONTACT PERSON: MOBILE/PAGER: ` ` ` ' ' '
MAILING ADDRESS:r_�G.�LS� �'A-wa�� 21 CITY: j'1`��%ti i;U k ZIP: 1'��
STATE LICENSE: # ��,���yS 1 3 3 i �'i�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration � Land Alteration
PROPOSFD WORK(describe iiz detai�: �.5 i dr►.�-�. o�'er� h�-ntis; k�r,<���r- �, ,
�rt�n C�� �--2a r��} �►n}�e-f
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. r/�DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��, On0
,
I hereby apply for a building pernut and I aclrnowledge 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.
APPLICANT'S SIGNATURE: • DATE: ���,�q-�S
. ,
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type of data. The rights of indivldual on whom the data is stored or to be atored shsll 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 h(mself shall be
intormed 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 identity 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 Iaw enforcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or orooertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by indlvidual. 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 classitied 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,shall be tnformed 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 this section is pending or additional data on the individual has been collected or created. The
responsible suthority 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 shall comply immediately,if possible,with any request made pursuant to this subdivision,or withln tive days of the
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot compty 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 tegal ho(idays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or prtvate data
concerning himself. To exercise this right,an individual shall notify in writing the responsible suthority descrtbing the nature of the disagreement. The
responsible authority shall with(n 30 days eit6er: (a)correct the data found to be inaccurate or incomplete and attempt to nottfy past recipients of
(naccurate or inrnmplete data,including recipients named by the individual;or(b)notify the indiv(dual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement oi dtsagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administraHve 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 permit.
First Middle Last
Address
City State Zip Phone
I understand my rights a ted abov
�— `
Slgnature
.
CHECK OFF LIST FOR ISSUANCE OF PE�ti,fITS
FOR OFFICE USE ONL Y
ADDRESS OR LEGAL: 1�'�� 5�y-�-� Av� N�
PID:
DESCRIPTIO.�OF Y�ORK: s i��N c�, i�o o r��G �A N�w r��^r�' �'"r��---
------------------------------------
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ZOtYI1VGREVIEti�BY: D.A�'EAPPROVED: ti-�f-o .�' �
B LiILDING RE V.(E W B Y: D.�TE AP.PRO 6'ED: y- �Y-6 S
-------------------------------------
FEES TO BE CHARGED: IL'Iisc. Fees Calcctlated By:
PERII�IIT Yes � No
PLAN RE I�IE GV Yes r� t�Io SE tiYER CONNECTIO�V
STATE SURCH.4RGE Yes � tVo tiVATER CONNECTIOtV
�VVESTIG.4TIOIV FBE Yes ✓ t�Io PARK FEE
SAC .Yes No SITE NSPECTIO�V
Ncu�l6er of SAC Units OTHER (specify)
---------------------------------------------------------------------
Z'OtYI1YG CHE CK LIST Zor�ing Disd•ict:
Fire Departrrie�rl: Post Off ce: Sclxoo(District: _..
Lot.�Iren: 5 �. Aa•es GVidth Depth
4�f
Siuvey Subrni[ted: Yes_� Na Date of Suiveti�: �r (=��-�% �"�3"S�
Proposed Setbacks: �
Frorit(Lake): Zly �- Right Side: I 15 �
Rear(Sh�eet): I�S� '-� Left 5ide: �3Z- �
Adjacent Str•c�ct�u•es: fFrr+'�u+e�9 GUetlnnd: /Jl�'
Buildi�rg H�ight: Def. Ngt. CJ•�'C Peak Kgt. —
Lot Coverage: � —
Grading: Staff.4ppraval Date: — By: Cozencil Approval Date:
Septic: Stnff.�lpprova(Date: —' BY�
Zoning File: # -- Resolutia�t: # Resol«tiai Dnte:
Shoreland Disd•ict: N d
Avg. Setbnck: Blceff Setback: Lat Coverage:
Existin,; Pr•oposed
Hc��•dcove�•: 0-75'
75-2.i0'
250-500' �
500-1000' '
ffarcfcover Vm•iafice Rec�uirecf: Yes No Date of CoEuaci!Approval:
REIlTA.RKS(iit house):�- ��R-'1� 5—, ►41��� � o �-�w�.A i
31
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B UILDI�VG RE VIE tY CHECh'LIST �
UBC: f2-3 � COIVSTRUCIYOiY TYPE: �!�
Sq Foatag� .�Per Sq Ft�
Basenienr x =
l st Floor x =
?nd Floo,- s =
Gara�e .r
x
TOTAG
Estirnaced Col�structio�i Valc�e: S �5,O 00 �
Lispections Required: if'ork Reqcei�•i�tg Sepa1•ate Pern�its:
Site Plurnbing � Fi1•e
Hardcovei•R�moval Nlechanica! bYater Cainection
X Footing Septic Sewer Connection
v� F�•aming Fireplace Law�i h•r•igatioiz
lnsulation • (rl�lason�}.) Oclter
iY'all Boar•cf (h�tfg.) G(/e!l(Stnte Per�►iit)
�Fina[ Gr�di�tg/Fillinu �_Elecd•ical(State Permit)
Other• '
REt1�lA.R1'iS(INHOUSE): �
REVIE W B Y OThCERS: DATE:
Access; Existing iVerv
Access Approval: Date By:
RE11�itiRh'S(TO BE NOTED O�V PEIt�YIIT):
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�/' CITY OF ORONO CALLED IN � ���
INSPECTION NOTICE SCHEDULED �����1�1-r-� �l.1�.�
PERMIT NO. ,� S��COMPLETED
ADDRESS ,����� r i� �
OWNER CONTR.�G�/�
TELEPHONE NO. ��`YY�(.�J `�l� ' �f�� ' ���25
� DESCRIPTION T Ci�T�/V� �C�TiT�l1 ��,
�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING �jr
Q 02 FRAMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS 9
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL /,
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION L _`-L
Z �
Q 05 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 PLUMBING RI 23 SEPTIC FIN 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU: ES_NO
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� � WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑ CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTfOtJ REQUIRED.CALLTO ARRANGE ACCESS.
Call for th ext inspection 24 hours in advance. (J52� 249-46��
OwnerlCo n site:
Inspector.
White Copyllnspector File Canary Copy/Site Notice
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Cer_tificate of Survey : � '�-, � +
for Daniel A . Berger_on �t`��"� ��� �����
. ., ;,
ii� th� NW 1 /4 of the SW 1 /4 o.E Scc . 27- 118-23 � u,
Hennepin Courlty, h9innesota
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oFJcc. z7-i�8-13 ,Ud�°/G"�2"C.�
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APPP�Pc���_ N vP R�CiHT Op
co�.ntv Ro - WA'� ��N6
+d No. ) �__ `
6� i[irS __
NIGHWA7 N0. 6 �
L.oUNT7 S'fA7E A 1 P r'
Coun��'Y ('Iud Ao(di :on -
---�- � CP�r Lony LakC o
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Leqal Description
Tlzat part of t1�e Nortlzwest Quarter of tt�c Soutl��ast Qu�rter, Secti_on 27, Townshi�� 1 1�3, Range 23, dcscril�ecl
as beginning at t1�e Northwest corner of_ said Northwest Quarter of the Soutlzezst Quarter; thence L:ast along
the North line thereof 257 feet; thence South paral]_el with the West _line of said Northwest Qu�rter of the
Southeast Quar_ter, to the center ]_ine of County Ro�d No. 6, �s said center 1�_ne is stlown o�i the plat oL
Long 'I�ke Country Cluh Ac]dition; thence Westerly along szid center line to the West line of said Nortlzwest
Quarter of the Southeast Quarter_ ; tlzence North along szid West _lin� to the point oL- i�git�ning, accordii�g
to the Goverrunen t Sui�vey thereof. .
This survey shows the location of an existing house in relztion §:;
to the north and west lines of the above descr_ibecl prolxrty. It '
does not purport to show any other improver�x�nts or encroacl�ments.
,��
I hereby certify that this survey was prepared by rr� or w�der my
direct supervision and tnat I am a duly registered L�-�nd Surveyor
under the laws of the State of Mi�lnesota.
COP'FIN & GRONBrsRG, INC. Date : 6-13-90
Scal�: 1" = 50'
`�� �?_i�� � �.i, _.__ o : Iron m�irker
��Mark S. Gro rq Mi1. Li . No. 1275; ( �i;._—��= ��� ,--;�' `) L3e�rings show�l are to
►�� ,�_�:- . , ._,��1 zn assumed d�tum.
�gineers, Land Surveyors, Planners --
Long L�ke, Miiu7esota
J l!�V 2 7 �.990