HomeMy WebLinkAbout2006-P09642 - addn/remodel/repair PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 Po9642
Crystal Bay, Minnesota 55323 Pe�mlt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 3/17/2006
SITE ADDRESS: 4185 Sixth Ave N Unit#
Long Lake, MN 55356
PID: 31-118-23-11-0004
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approvcd per resolution#:
Separate permits required: Mechanical Electrical(state)
NOTICES/REMARKS:
16 x 20 Family Room
FEE SUMMARY: Permit Fee: $ 265.25 va►uation: $ 16,000.00
Plan Review Fee: $ 172.41
State Surcharge Fee: $ 8.00
TOTAL FEE: $ 445.66
APPLICANT: Owner/Self OWNER: Steven Jacobson
� 4185 Sixth Ave N
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 BUILD[NG CODE REQUIREMENTS.
T' � � c�,,c..�, ' - � L�`�
APPLICANT PE I EE SIGNATURE SSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), l-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page ]
t
Total Fee: $ �'� - �� Date Received: �� ��`'`��-
Entered By: �n � Ty�,-�� Permit#: ��/�'�Ca�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pf�int all infornTation)
---------------------------------------------------------- -------------------------------------------------------
_-----.
THE APPLICANT IS: (ci�•cle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: •��" < <�a`� !����r, � ��'' ;; --�� �,�� 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 wit/z Police Department r��zd Ciry Coa�rncil��pprovcal
60 days prior to the event. Shtrttle bus sen�ice will be required zm/ess applicant cleino�astrates
su�cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: ��.�u e ,�1 �`� J �,_c ,,� ;� � �> ,,f PHONE: (home) �' S'�- �i� �- / ��„',
(work)�S -�,1 �/6 S'/3!�/
MAILING ADDRESS: �f l B� ��tir ,�:/�' /`I CITY:�.-��r-• �,,��r'`� ZIP: �S 3S�
CONTRACTOR: r ,, �.� P ;<; PHONE: 9 ti� - ` ' .` `'� `�
CONTACT PERSON: �-f�� >� ,��-,_ < � '� . i MOBILE/PAGER: - "-''`�
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: � c�J c���' 1�-:. PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition _� Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(descs-ibe in cletai�: _J lo ,t'�? c� � �,<- r �, r o a �t
S'i'ORIES: _� S�.FE�T OF EACH�'d�00R: �� �%
NO. OF BEDROOMS: GARAGE STALLS: A'I'TACHEID DETACHED
ESTIMATED CONSTRUCTIOI�1 VA�,LTATION(excluding land): $ �� , �� � � � � '
I hereby apply for a building permit and I acknowledge that the ulformation 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 wark is not to start without a perniit; and that the work will be
in accordance with the approved plan.
,��!
APPLICANT'S SIGNATURE: � —�., —�,�_ DATE: " � �
;
,�
31
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Sec.13.04 R[GHTS OF SUBJEC'CS OF DATA
Subd. l. 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. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be
informed of: (a)the pwpose 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 lmown consequence arising from his supplying or refiuing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federat 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 place the notice reauired under this subdivision in the individual income tax or propg�y taz refund
instructions instead of on those foims.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be info�med whether he is the subject of
stored data on individuals,and whether it is classified 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 infornied of the content and
meaning of that data. After an individuai 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 upoarequest by the individual subject of the data. The responsible authority may
r�uire 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 within five days of the
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibte. If he cannot comply with the request
within that time,he shall so infonn 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 himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagree�nent. The
responsible authority shall within 30 days either: (a)cmrect 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 correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure 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 pernut or license from the City of Orono or any of its deparhnents may require you to furnish certain private or
confidential information.
You aze notified that:
1. The informarion you fumish 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.
S'�"�., P � �,�'�A2� JQ�a �So (�
First Middle Last
�I( g5 (��1� �4.�e .. G11 ,
Address
or �u /h.�/ . SS�3Sc� S�1—'173-1.36�
City StAtc Zip Phone
I understand my rights as stated above.
S ��
Signature
��
CHECK OFF LIST FOR ISS UANCE OF PERMITS
FOR OFFICE ZISE ONLY
ADDRESS OR LEGAL: <// 43 5 .Si x n� .g v�e /V'.
PID:
DESCRIPTIONOF WORK: /+Dp��o�
ZONING REVIEW BY: ,� DATEAPPROVED: � _g{>�
BUILDING REVIEW BY: DATEAPPROVED: �y o`
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLANREVIEW Yes�� No SEWER COIVNECTION
STATE SURCHARGE Yes ✓ No WATER COIVNECTION
INVESTIGATION FEE Yes No� PARK FEE
SAC Yes No_�� SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: 2lL� 1 K1
Fire Department: Post Off ce: School District:
Lot Area: Sq.ft. �1� 2`�� Acres �•��- Widtla Depth
Survey Sarbmitted: Yes�_ No Date of Su�vey: o c,'�' 4, Zo o Z
Proposed Setbacks: �
Front(Lake): �j0 � Right Side: —1 y '
Rear(Street): � °� � Left Side: I`l L�f
Acljacent Structures: �7T�t��e� Wetland: it//A�
Bc�ilding Heiglzt: Def.Hgt. m�� Peak Hgt. --
Lot Coverage: N/�
Grading: StaffApproval Date: —' By: Council Approval Date:
Septic: StaffApprov�l Date: -- By:
Zoning File: #D6'"'3l lo� Resolution: # Resoltetion Date: Z-�3 -��.
Shoreland District: /U�
Avg. Setback: BluffSetback: LotCoverage:
Existing Proposed
Hurdcove�:• 0-75'
75-250'
250-500'
500-1000'
Hardcover Yariance Req�eired: Yes No Dute of Council Approvul:
REMARKS(in house):
33
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BUILDING REVIEW CHEC%LIST
UBC: R' 3 CONSTRUCTIONTYPE: �/N
Sq Footage $Per Sq Ftg
Basement x =
Ist Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
0
Estimated Construction Value: $ I (.,c9c�o -'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcove�•Removal �C Mechanical Water Connection
�Footing Septic Se►ver Connection
oCFraming Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
�_ Wall Board (Mfg.) Well(Srate Permit) ,
� Final Grading/Filling _�Electrical(State Permit)
Other
REMARKS(INHOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMIT):
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DATE TIME
'J CITY OF ORONO CALLED IN �T�,.��
INSPECTION NOTICE !/ SCHEDULED G/ '-/lL(d �3�
PERMIT NO.�G�l� 7� COMPLETED ��" j�% �' �� '�� �Ni1
ADDRESS `�I�S �Sl ,� �, - Z'�= ��',�
OWN ER �,_������11 Tl.�.C�;�S�vk CONTR. <`C�Yll-�''
TELEPHONE NO. �f,� �- �1��� I_� <r,P�
c�K �i5:� v�-�- /3j�/
� DESCRIPTION �.�-G�Z�--,
1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q � 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
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W� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑ RRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REOUtRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
Owner/Contractor on ite:
Inspector_ �� � l�
White Copyllnspector's File Canary CopylSite Notice
�� D(�ATE/, TIME �
CITY OF ORONO CALLED IN '"� ``�
INSPECTION NO IC SCHEDULED � �
PERMIT NO. ��O �COMPLETED
ADDRESS ���� ��i .�E
OWNER�Sfiet.�/1�T�rn�iSo�_CONTR.
TELEPHONE NO.f� �� ��.� / .3Caa
C.�-t� �'s� ��s i 3 i�{
� DESCRIPTION in'1C�J-r� S{� ;,��.r (,',.;�, -� s�.9 fi��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILIING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
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� ,�WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W �O�ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION W�THIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALlTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
Owner/Contractor on site: /
Inspector. �� J �'� ��iS
White Copy/lnspector's File Canary CopylSite Notice
�I `�'��I � D T TIM
CITY OF ORONO CALLED IN
NVSPECTION NQ�C SCHEDULED �
PERMIT NO. /����'Z COMPLETED 'F•�3�
ADDRESS �•
OWNER CONTR.
TELEPHONE NO. �S2- Tio� I J� I •
� DESCRIPTION � I7 �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FI 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
��., COMMENTS:
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� R�1lORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑�ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTtON REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-460�
OwnerlContractor on site:
Inspector. �,�r � (
White Copyllnspector's File Canary CopylSite Notice
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