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Home My WebLink About2009-00026 - addn/remodel/repair CITY OF ORONO PERMIT NO.: 2009-00026 , 2750 KELLEY PARKWAY � ORONO,MN 55356- DATE IssuEv: 02/23/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 2550 SIXTH AVE N PIN : 28-118-23-41-0005 LEGAL DESC : WILLOW RUN : LOT 004 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 40,000.00 NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) FINISH LOWER LEVEL APPLICANT pERMIT FEE SCHEDULE 574.25 PINEWSKI BUILDERS PLAN REVIEW 373.26 13750 CROSSTOWN DR-SUITE 203 ANDOVER,MN 55304 STATE SURCHARGE(VALUATION) 20.00 (763)753-5095 TOTAL 967.51 Minnesota State License#: 6859 OWNER RICE,EDWARD&TERESA 2550 SIXTH AVE N LONG LAKE,MN 55356 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and dces not grant permission for additional or related work which requires separate pertnits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issu if construction is suspended for a period of 180 days at an � e work has commenced. The applicant is responsib(e for ass ' g ired inspections are requested in conform ith S ding Code.This permit may be revoked at an J .:� C��;' "—�_'7t, �% � 23� O � � Ap �cant Permitee Signature Date Issued By 'gnature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED OVE. ��J�"`""' • ��o"°g Total Fee: $ �(p'7 S f Date Received: /`°�g 09 Entered By: Permit#: �00 9—ODOo� � CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: aS-S� ' E��h/�� /V� ZIP: SS 3 5� 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 Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed NAME OF OWNER: �D'�-T ESS �t C-� PHONE: (home) `j'SZ- N S Y- �.7 9n MAILING ADDRESS: oZS`'��,6�h,,��- (�'�'ork) CITY: O 12o N o ZIP: S 535� CONTRACTOR: �v��w�t; a� ry PHONE: 7�3 '7�3 "5 a q S� CONTACT PERSON: S1`t�►-c.- �,v�c w , MOBILE/PAGER: (o�2-2.oq�-�15f y MAILING ADDRESS: 13 7 So �'v'ozy�...�.� �+vc CITY: �Q r��'0 vri.. ZIP: S 5 3o y STATE LICENSE: # (�S15� EXPIRATION DATE: "3-31,0`� ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: --- REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Re de /Alteration (ie: Siding, Windows) Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detai�: �t �. �s t�L �--o w s-� t..�vL.� STORIES: �- SQ.FEET OF EACH FLOOR: /Soo -��o� NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED k DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �� G'r�O e`� 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 ardinances 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 wit�e�[p ;and that the work will be in accordance with the approved plan. -� APPLICANT'S SIGNATURE: DATE: �'ZF��9 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righu 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 data concerning himself shall 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 consequcnce 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 imestigative data,pursuant to section 13.82,subdivision 5,to a law enforcemenz officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property 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 infortned whether he is the subject of stored data on individuals,and whether i[is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individ�als 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 section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe 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 ofthe request,exduding Saturdays,Sundays and legal holidays,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 contest the accuracy or completeness of public or private data conceming himsel£ To exercise this right,an individual shal I notify in writing the responsible authority describing the nature of the disagreement. The . responsible authority shall within 30 days either. (a)correct 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 corzect. Data in dispute shall be disclosed only if the individuaPs statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealedpursuant to the provisions of the administrative procedure act relating to contested cases. � DATA PRIVACY ADVISOR�Y 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 reGuest)to review private data on yourself. 6. Your full name is required to process this application or permit. S�cA�i�,-, �vtc�rrw 7 i' �f tw'�. First Middle Last ��J � �I��SS 1�Y� ��l�V G._- Address �h��✓rr ✓!�N SS 30 �� b��75�3-Sd 9S`, City State Zip Phone I understand as st o Signature Reset�Forn� 32 . CHECg OFFLIST FOR ISSUANCE OFPERMITS � FOR OFFICE U,�ONLY ADDRESS OR LEGAL:��S a� PID: DESCRIPTIONOF WORg• L.�wE2 C.�vc:�. Fi�v��y ZONING REVIEW BY.• DATEAPPROVED: BUILDINGREVIEWBY.• DATEAPPROi�'ED: t •30 •d9 FEES TO BE CHARGED: � Misc. Fees Calculated By.• PERMIT Yes ✓. No P�N��E� Y�s ✓ No SEWER CONNECTION STATE SURCHARGE Yes� No WATER CONNECTION INVESTIGATION FEE Yes No PARK FEE `�C Yes No� SITEINSPECTION IVumber of SAC Units OTHER (spec�) ZONIIVG CHECg LIST Zoning District: N 4 G ff A/�.IC'a�, Fire Department: Post O�ce: School District: Lot Area: Sq.ft. • Acres Width Depth Survey Submitted.� Yes No Date of Survey.• Proposed Setbacks: Front(Lake): Right Si : _ .. ._ Rear(Street): Left Side. - . Adjacent Structures: We y�• _. Building Height: Def.Hgt. Pe H�, Lot Coverage: - Grading: StuffApprovcrl Date: By: CouncilApproval Date: � Septic: Sta�}"Approval Date: � " � �O� By. � �/� -��llL Zoning File: # Resolution: # Resolution Date: - Shoredand District: Avg. Setback.• MC�Permit. Bluf,}'Setback,• Lot Coverage: Fxisting Pro osed Hardcover: 0-75' p 75-250' 250-500' SDO-1000' � Hardcover Yariance Reguired.• Yes No Date of Council Approval: REMARKS(in house): 33 ' • B UILDING REVIEW CHECS LIST UBC: R'3 CONSTRUCTION TYPE: �lN Sq Footage $Per Sg Ftg Basement x = ' Ist Floor z = � ' 2nd Floor x = . Garage x = X — TOTAL Estimated Consduction Value: $ `IO.OfX� � fnspec�ions Required: Work Requiring Separate Permitr: Site �_Plumbing Fire Hardcover Removal _�C Mechanical� Water Con»ection Foo#ng Septic Sewer Con»ection �Framing _Q�Fireplace Lcrwn Irrigation �Insulation (Masonry) Other -_ Wall Board _�(Mfg.) Well(State Perrni�) � Final Grading/Filling _J�Electrical(State Permit) Other - REIIYIARSS(I1V HOIISE): REVIEW BY OTHERS: DATE: Access: Fxisting New Access flpprwal: Date By: REMARSS(TO BE NOTED ON PERMI7�: 34 I � I ��J DATE TIME " CITY OF ORONO CALLED IN Z�� INSPECTION NOTICE SCHEDULED PERMIT NO.�r'��"�-�Y'i?�c COMPLETED ADDRESS � c C�' �"� -� � � GU- OWNER CONTR. ��C�'�S TELEPHONE NO. ��=�•- �L� � �- c�� DESCRIPTION �a--� � �� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q O FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEEf YOU:_YES_NO c�.� COMMENTS: a ��i�9/ f�� t'�f/�/d��U� A S � �b�C c�c�s S�c{ � 0 � 0 � ° �'9✓L1�.�9 �-t'�� '�f��c� � Q � z W � W � � d W ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE �L�CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑�ORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR ❑INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Cail for the next inspection 24 hours in advance. (952) 249-46�� OwnerlContractor on ite: r Inspector. /7 S White CopyMspector's Flle Canary Copy/Site Notice "'� D TE TIME � CITY OF ORONO CALLED IN =-�� INSPECTION NOTI�E �/� SCHEDULED �-(a-DY � PERMIT NO. a�`l� �GD°�.to COMPLEfED ADDRESS a55o S(�1�. f�'V� /v, OWNER CONTR. �net�5�C ,�6 t4L�.d TELEPHONE NO. 7103 ��53 J'�G�S/!o/Z-ZOF—!/5�� DESCRIPTION �//xLL. —'�J � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE Q ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o /�,./ /�C{4J' C'U . 'D Q ��►C .CS � �� Q ..1 i /'2c� C_�.I •a �:� 1� (V � ° � � C'f�c'G. (� c� �ourc'� Q L cz� � (�c/G� � � (� � z W � W � � � ❑WORKSATISFACTORY:PROCEED �PROJECTCOMPLEfE W ❑CORRECT WORK&PROCEED ❑�ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECTUNSAFECONDITIONWiTHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52) 249-4f)0� OwnerlContractor on site: Inspector. f ' White Copyllnspector's File Canary Copy/SNe Notice