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Home My WebLink About2000-P02058 - addn/remodel/repair ✓ ` ^ PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: .�� 0�,05� Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodei�tepair (612) 249-4600 Date Issued: i/Ig/oo SITE ADDRESS: 2soo siXtna�err LONG LAKE,MN 55356 PI D: zx_ils-2�-4i-0004 DESCRIPTION: Proposed Use: Residential UBC Occupancy: R3 Permit Class: Building Construction Type: � Pcrmit Type: Addition/Remodel/Repair Census Code: 434 Permit Sub-rype: Single Family DETAILS: Resohition#: N/A Separate permits required fo Electrical(state permit) NOTICES: FEE SUMMARY: permitFee: $ 321•2� Valuation: $ 20,000.00 Plan Review Fee: State Surcharge Fee: $ 10.00 SAC Fee: $ 0.00 Misc. Fees: $ 0.00 TOTAL FEE: $ 331.25 APPLICANT: L�w Erickson OWNER: Le«�A Erickson 718 129th Ave 2500 Sixth Ave N Blaine, N1N 5�434 Long Lalce, MN 55356 THE UNDERSIGNED HEREBYREQUESTS PERMISSION TO MAKE THG REAL 1MPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMI'LIANCE WITH ALL CITY OF ORONO ORDINANCES AND STAT�OI'MINNESOTA BIJILDING CODE REQUIR�MENTS. ..�./ PI,ICAN'1'PERMITET;SIGNATU SIJED BY SIGNATURE'/ /J, , /' �C� l/1C. Today's Date: 1/18/0o Page 1 Total Fee: $ Date Received: Entered By: Permit#: _� ,r, _, yC�C�1C c'`f CITY OF ORONO - BUII..DING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) --------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) �R CONTRACTOR JOB SITE ADDRESS: �.��G� !� ��/�G{' !�� ZIP: SS J S� • � � �i �/i G��SC/<v PHONE: (home)G� 1VAlV1E OF OWNER: / Il�o� ��'G-? (work) �"j r MAILING ADDRESS: �l� � � CITY: /A�G;iz.� ZIP: 5�y `1 ;f�-,� PHONE: CONTRACTOR: �- CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: �L�II.ING ADDRESS: CITY: ZIP: N��; REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration i� Land Alteration PROPOSED WORK(describe in detai�: �_�lt,� pAvc�e C�-�PA�2 STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. EST�IATED CONSTRUCTION VALUATION (excluding land): $ �� `'��U 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 pernut and work is not to start without a permit; and that the work will be in accor nc the approved plan. APPLICANT'S SIGNA . DATE: �' 7 - ��G NOTE! Parade o�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. Sec.13.04 RIGHTS OF SUBJECTS OF DaTa Subd. 1. Type of data. The righ�s of individual on whom the dara is stored or�o be stored shall be as set fonh in this secrion. Subd.2. Information reqirired to be�ven individual. �.n individual�sked ro supply private or confidenrial dara coocerning himself shall be informed of: (a)the purpose and inrended use of the requested data within the collecang'state agency, polirical subdivision,or sratewide rystem; �b)whecher he may refuse oY is legally mquimd to suppty the requested data;(c)any frnown consequence arising from his supplying or refusing to supply priva[e or conndenoal data;and(d)the idenrity o[o�er persoas or enddes au[horized by scace or federal law to receive the data. This requirement shall not apply when an individual is asked ro supp�y u:�'zsnearive data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enu mav pfa-� the rocce rauired under this subdivision in the individual income tax or propertv raz refund inscrucdons ins[zad of on[hose forms. Subd. 3. Access to data bc individuaI. Upon requesc to a responsibfe authoriry,an individual shall be informed whether he is the subject of scored data on individuals,and whether it is classified as public, private or confidendal. lipon his further request,an individual who is the subjec[ of stored private or public dan on individuals shall be shown the data wi[hout 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 hun for six months thereafrer unless a dispute or acdon pursuanc to �his secaon is pending or addiaooal dara on the individuai has been collected or created. The responsibie authoriry shall provide copies of che private or public data upon request by the individual subject of the dara. The responsible au[horiry may require[he requesring person to pay the acnial costs of making. cerrifying,and compiling the copies. The responsible authoriry shall comply immediatety, if possible, with any request madt pursuant to[his subdivision,or within ftve days of the date of the request,exciuding Sanirdays.Sundays and lezal holidays,if immediate compliance is noc possible. If he cannot comply with the request wichin chat time,he shall so inform the individual,and may have an addidonal five days wichin 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 pri�•ate data conceming himself. To exercise[his rieht,an individual shall nodfy in wriring�he responsible authoriry describing the na[ure of the disagreement. The responsible authoriry shall wichin 30 days eid:er: (a)correct che data found eo be inaccurar�or incomplete and attempc to noafy past recipients of inaccurace or incomplete data, including recipien�s named by che individual; or(b)noafy [he individual that he believes rhe data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed data. The decerminanon of the responsible au[horiry may be appealed punuanc ro the provisions of the administrarive procedure act relaring ro contested cases. D:�Ta PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�ts of subjects of data", we would like to inform you that your request for a permit or license from the Ciry of Orono or any of its departments may require you to furnish cenain private or confidential information. You are notified that: 1, The information you furnish wiil be used to determine your qualification for the permit or license requested. ?. 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 a�encies 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. �, You have certain rights under :�i.S. 13.04 (available upon request) to review private data on yourself. (, Your full name is required to process this application or perm.it. ` �� , ,"�lt j�io�l, �� tiddle Last First �� G�� / ��,�j iS�/3 <� �� %� Addre , �iJ !�/ /L-� Ciry State Zip Phone I understand my ��hts as staced abov _ / L� �� Signatur CHECK OFF LIST FOR ISSUANCE OF PERII�IITS _ FOR OFFICE USE ONLY • ADDRESS OR LEGAL: Z s�o s�x�,., �►..�e. N� . PID: DES CRIPTION OF WORK: �'�n�, n,q,,•ste�e R�'�A�2 ZO�G REY��V BY: � c�,�rrr�f DATE�iPPROVED: � � BUII.�D�tG REVIEW BY: � DATE APPROVED.; / . �Y�- c�v FEES TO BE CHARGED: Misc. Fees Calculated By: PERNIIT Yes �/ No pL�,rT REVIEW Yes No � SEWER COrfNECTION STATE SURCHARGE Yes �/ No WATERCONNECTTON INV�ESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECITON Number of SAC-Units OTHER (specify) ___________ _______---- ---------- ZO`Z�'G CH�CK LIST Zoning Districr. N� C tt�-n�Ge 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: � . Rear(Street): Left Side: Adjacent Structures: Wed Building Height: Def. Hgt. Peak t. Lot Coverage: ' Gradir.�: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # esoludon Date: Shoreland District: Avg. Setback: Bluff Setback: LotCoverage: . Ezisting Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes No Date of Council Approval: REMARKS ('in house): 7 . BUII..DING REVIEW CHECK LIST �C� � � 3 . � CONSTRUCTTON TYPE: �/`� Sq Footage $Per Sq Ftg � Basement . . . x . _ lst Floor _ a _ 2nd Floor x _ �- . . Garage z = z = TOTAL Fstimated Construction Value: $ 7�c�,c�oc�� Inspections Require@: tiYork Requiring Separate Permits: Site � Plumbing Fire Hazdcover Removal Mechanical Water Connection F��g Septic Sewer Connection � � o� Framing . Fireplace Lawn Irrigation Ol Iasulation (Masonry) Other �Wall Boazd (Mgg.) Well (State Permit) F�� Grading/Filling c� Electrical(State Permit) Other REitiZARKS(IN HOUSE): , . REVIEti'V BY OTHERS: DATE: M ---- Access: Existing New . Access Approval: Date gy; � REI�IARKS (TO BE NO'I'ED ON PERA�IIT): �~~ N 8