HomeMy WebLinkAbout2000-P02551 - addn/remodel/repair , PERMIT
CI�Y OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2ssi
Crystal Bay, Minnesota 55323 Pel'�711t Typ2: Addition/Remodel/Repair
(612) 249-4600 Date Issued: 6i2�ioo
SITE ADDRESS: 2060 Sixth Ave N
LONG LAKE, MN 55356
P ID: 27-118-23-31-0002
DESCRIPTION:
Proposed Use:
Permit Class: Building Census Code 319
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): church
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 181.25 Valuation: $ 10,000.00
Plan Review Fee: $ 117.78
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 304.03
APPLICANT: AL HIRSCH& SONS OWNER: TRINITY ENG EVAN LUTH CH INC
PO BOX 633 2060 SIXTH AVE N
DELANO, MN 55328 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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A PLICANT MITEE SIGNATURE ISSLTED BY SIGNATURE
Copies: City,Applicant,Assessor, Finance Page 1
,
Total Fee: $, �,, �:c�_3 Date Received: !o f/.3� O6
Entered By: �y,' Permit#: p 3�Ss J
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 O CONTRACTOR
JOB SITE ADDRESS: ���,•� �T-� (�' � �� ,�� ZIP:
Co. ��a �' ow� r�
NAME OF OWNER: 'fir�h,� �, ,, ��,,.��( PHONE: (home)
T�
. (work)
MAILING ADDRESS: 0�6�e o Si X�'Y�r,cr� CITY: ZIP:
CONTRACTOR: �� ��r s ��, � S o n S PHONE: �7„? -- �/(P
CONTACT PERSON: � � MOBILE/PAGER:
MAILING ADDRESS: �?,o� (P 3 � CITY: '� e.., h,�, ZIP: y���
STATE LICENSE: #
ARCHITECT/ENGINEER: p+ �,�, �n 5 C a ,�,� PHONE: Q�'�-, 3 Q D p
MAILING ADDRESS: CITY: ZIP:
NAME: S ct �„ � � r� ?�� REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�^ Land Alteration
PROPOSED WORK(describe in detai�: r E•n o d e t,s a�� �a Y,��i n� � /�'-�,h G�-.,�'
I�1' � u� S ti �-c'�v�a�l�7`a C a v c.- r✓r--.a� �� p�- a����S �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /D, DDO, `�
I hereby apply for a building pernut 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 be in accordance with the approved plan.
APPLICANT'S SIGNATURE: � � �� DATE: LQ-- /�3 - o O
NOTE! Parade o�Homes events require separate perrnit 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 RIGHTS OF SUBJECTS OF DATA
Subd. 1. 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. Intormation required to be given individual. An individual asked ro supply private or conf'idential data conceming himself
shall be informed of: (a)the purpose and inte�ed use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is IegaUy required to supply the requested data;(c)any lmown consequence arising from his supplying or
refusing ro supply private or confidendal data;and(d)the identiry of other persons or entides authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply invesdgadve data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revernie mav olace the notice reauired u�er this subdivision in the individual income tax or nrooertv tax refu�
insc,vctic�ns'n.tead of on those forms.
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 i�ividuals,and whether it is class�ed as public,private or confidendal. Upon his further request,an individual who
is the subject of stored private or�blic data on individaals shall be shown the data without 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 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 secdon is pending or addidonal data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the iraiividuai 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 authoriry shall 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 a�legal holidays,if itnmediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the individual,and may have an addidonal 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 the accuracy or completeness of public or
private data conceming himcelf. To exercise this right,an i�ividual shall nodfy in writing the responsible authoriry describing the t�ature of the
disagreement. The responsible authocity shall within 30 days either: (a)correct the data founl to be inaccurate or i�omplete and attempt to notify
past recipienis of inaccurate or ittcomplete data,i�luding 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.
The dererminadon of the responsible authoriry may be appealed pursuant to the provisions of the administra6ve prceedure act relating
to contested cases.
DATA PRNACY 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 confidential information. �
You aze notified that:
1. The information you fiirnish 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 Ciry 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 pennit 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 �s�
Address
C��y State Zip Phone
I understand my rights as stated above.
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Signature
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' � CHECK OFF LIST FOR ISSUANCE OF PERi�IITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Zp G p �� �c�-r{ tarttP ND•
PID:
DESCRIP'I'ION OF WORK: �'�,�p Q n `
ZO�i'G REVIE`� BY: � � DATE APPROVED:
BUII.DPIG REVIE`V BY: „^ DATE APPROVED; (,- Zt --o v
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERIVIIT Yes ✓' No
PLAN REVIEW Yes ✓' No SEWER CONNECTION
STATE SURCHARGE Yes _� No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZOYL`�iG CH�CK LIST zoning Districr. (�V o G(..��tip _ .
�l`
Fire Department: Post O�ce: School Disuict:
Lot Area: Sq.ft. Acres dth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Righ[Side:
Rear (Street): Left Side:
Adjacent Structures: Wetl d: .
Building Height: Def. H;t. Peal: gt.
Lot Covera�e:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zouing File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Covera�e:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REviARKS (in house):
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BUII.DING REVIEW CHECK LIST
�C� CONSTRUCTION TYPE:
Sq Footage $Per Sq Ftg
Basement x =
lst Floor z =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ �U, (�c�c��
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hazdcover Removal Nlechanical Water Connection
Footing ' Septic Sewer Connection -
�Framing Fireplace Lawn Irrigation
��s (Masonry) Other
�` Wall Board (Mfg.) Well(State Permit)
�F�� Grading/Filling Electrical (Sta[e Permit)
Other
REI�IARKS(IN HOUSE): .
REV�`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
RE�IARKS (TO BE NOTED ON PERivII�:
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CITY OF ORONO CALLED IN l^IAZ �/`J �'W
INSPECTION N TICE SCHEDULED ��3 ��,, Q
PERMIT NO. �S COMPLETED � �'�, G%�
ADDRESS a� �� `�
OWNER CONTR. 1 �'�h C�3-S�'•
TELEPHONE NO. YI�a`a�f �
� DESCRIPTION I L�"?"t 0�
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q 5 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� COMMENTS:
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O ❑ CORRECT WOFK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. - pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cali for the next inspection 24 hours in advance. 249-46�0
OwnerlContrac or on site:
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Inspector. / Cf��- ��
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION TICE SCHEDULED ��/a D �
PERMIT NO. � COMPLETED � Zr
ADDRESS o�u�0� SiX''I'�'1 �� N •
OWNER CONTR. ���✓�SC�I
TELEPHONENO. GI'7a-' a�l I lO
� DESCRIPTION on K.tr��t�-f-�G✓�
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMIN 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�• 03 INSUtATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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 FO�LOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� ' ❑CORRECT WORK&PROCEED r_: ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. �, PHOTO TAKEN
INSPECTOR WILL RETURN
C] STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContractor on site:
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Inspecto . �,��� �i ��; !
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White Copyllnspector's File Canary CopylSite Notice