HomeMy WebLinkAbout2008-00443 - addn/remodel/repair � ,
CITY OF ORONO PERMIT NO.: 2oos-oo443
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 12/i U2008
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 4360 SIXTH AVE N
PIN : 31-118-23-12-0011
LEGAL DESC : SHARON HILLS
: LOT 006 BLOCK 001
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 1,000.00
NOTE: SEPERATE PERMITS REQUIRED: ELECTRICAL(STATE)
APPLICANT pERMIT FEE SCHEDULE 41.25
R&B CARPENTRY PLAN REVIEW 26.81
5079 MAIN ST.E. STATE SURCHARGE VALUATION 0.50
MAPLE PLAIN,MN 55359- � �
(952)68&3665 TOTAL 68.56
Minnesota State License#:20454577
OWNER
HIBBS,WILLIAM
4360 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 does
not grant permission for additional or related work which requires sepazate
permits. 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 issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked a any tim�ue cause.
�,c�/z'�%r,ew1 -�r �a ,/r o i�, ,0 8'
pplicant Permitee Signature Date Is By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�� ��
l�
Total Fee: $�J U►�� Date Received: � / O$
Entered By: Permit#• $�-
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: �(3 �� -�i� �-1� N �Q y.� �Q,�e 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 Department and City Council approval
60 days prior to the event. Shuttle bus service widl be reguired unless applicant demonstrates
su�cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: �p �1,�Rs PHONE: (home) �63 Sl�?—ay77
(work)
MAILING ADDRESS: ��� �!�r �VQ/V CITY: Oldl�o ZIP: ���6
CONTRACTOR: �� i' 2 PHONE: QS�"ro��'(o��
CONTACT PERSON: MOBILE/PAGER: 763`�17�1-1 S�.S"
MAILING ADDRESS: �o?� J�?Q ►? ST"� CITY: /yiu�J PJ�Lq�h ZIP: 5�S3S`l
STATE LICENSE: # d 0� �y�'77 EXPIRATION DATE: I'1'!a� 0R
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration(ie: Siding,Windows) �—
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detai�: �u W/�o tc7- �f���'"gLl�'S/ a �`
��� y �e����q
STORIES: ���'Lew�L SQ.FEET OF EACH FLOOR: /J�OB
NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED� DETACHED_
�
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ����'
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 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: (i DATE: � l� P�
31
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. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be
informed of. (a)the purpose and intended use ofthe 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 azising from his supplying or refusing to supply
private or confidential data;and(d)the identiry 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 law enforcement officer.
• T'he commissioner of revenue may place the notice reauired under this subdivision in the individual income tax orprocerty 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 informed 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 informed of the content and
meaning of that data. ARer 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 privatc 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 shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date ofthe request,excluding 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 himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe 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 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 adminisVative 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 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.
�8�`� Ca rfo� �jr�fr�lc�vl �
First Middle Last
S�o7� h��l�t s7' �"a5�
Address
�'�1.L� ��l�i tiI y12 Yt �"�"� �(03--�il�1/��
C�tY State Zip Phone
I understand my rights as stated above.
���7Z���� _��� .
Signature
i
32
V
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ y36 0 .S�x�.� A v e N.
PID:
DESCRIPTION OF WORK: C nr r�¢.�, �Ct,�p �-�-ti o�
ZONING REVIEW BY.• M DATEAPPROVED: /L-t c'>- v8
B UILDING RET�IEW BY.• DATEAPPRO ijED: t Z.-r,- O�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/' No
PLAN REVIEW Yes �/ No SEWER CONNECTION
STATE SURCHARGE Yes 6� No WATER CONNECTION
INVESTIGATION FEE Yes No�- PARK FEE
S�4 C Yes No-�- SITE INSPECTION
Number of SAC Units OTHER (spec�)
�_____ _ �
ZONING CHECKLIST ZoningDistrict: NO C�/A�►b t
Fire Department: Post O�ce: School District.•
LotArea: Sq;fi. ,9cres Width Depth •
Survey Submitted.• Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Righ Side:
Rear(Street): Left ide:
� Adjacent Structures: N�et/and: -
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Slafj'Approval Date: By: Council Approval Date:
Septic: Staff.4pproval Date: gy;
Zoning File: t� Resolution: Resolution Date:
Shoreland District. MCND Permit.•
Avg. Setback: BI Setback: LotCoverage:
Exi ting Proposed
Hardcover: D-75'
75-250'
2.i 0-.i DO'
�00-1000'
Ha�•dcover [�'ariance Required: I'es No Date of Council Approval:
REMARKS(in house): vN4h t�"x �s�r►N� d� �.�.�yy��r
'— v
33
N
B UILDING REVIEW CHECg LIST
UBC: �•3 CONSTRUCTION TYPE: �(N
' Sg Footage $Per Sg Ftg
Basement' • • x = ` .
1 st Floor x =
2nd Floor x =
Garage x =
� x = '
TOTAL
Estimated Construction l�alue: S ��pvt) �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Remova! Meclianical Water Connection
Footing Septic Sewer Connection
�o Framing Fireplace Lawn Irrigafion
_�Insulation (Masonry) Other
• Wall Board (Mfg.) Well(State Permit)
_�Final Grading/Filling �Electrica!(State Permit)
Other
RE1lIARKS(INHOIISE):
REVIEW BY OTHERS: � DATE: �
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
34
CITY Of OF3�t��
�i��������,� ;���. � s
F3tJii�IP�G Prc'�Prll i��y L� :'��: Fic.L":f=411 .
ItlS�'�f�7C�R.__. ` _� _i.l�---�---�__� ���'V,,'� �,�� V+ ���`t'� . -
�✓AT�__._�2 tUr�`b _��t_,�f,:;�l-i!:..------- � �
� ' ��i�; :i�, ` ri,�;, ':_:? .
�� � ��:�i, �._1�,. � . ,.�i. ..'{"7. .x„vr��. ..� �• � . .
..� i ._i.� . � 1i1., �ti. ~C�
� i� i t . � i �..�,� .. ..'1, � -, r .. � �...`.4'! . . .
T'sr � _ .,. a.:t�r �: .�„ �;. . .•�; .:�..ril 1,r;^ens
in *i _ , �. r��l appl c...�.;_ �.. �r ,�� ���.: ccde. .
F',�r7 _ , !. i �7:. ,�� y i;;ca!!y r i.��r,i.,�� ' .
1�'����' ri-fi5;-'l.t�i��::f�T ON�iT AT N L 1l1it�S
r
�,
•�-("t 1�U/�'vl��i,</
� � 1�C��(.�iYl!�iN���'� WkN+o �v�,41 �v��� � �
� �u�BL� �"xtsti h9 ��o�,r pc�of �
�����►n � �+ S ��
` S�Ev �,�
��F� a� �r��� �ve,�l�v�
v�,fl f �- �-� F'�l n� �
wl�►�.+tiv
�8
� �1��"1 Yl�j � � �r
� o v�if �Pc� a v r �,�v1+���S.� y���,✓ vzr��,: � � �vr�' ,
� � I�C�,� +�'��t,�v � �r'
bc�o--� � f L �5t-ln� lv��a�✓ ��� �����4✓
�Ud o � � 0��
� r x�Sd;�� .�' -i-1i�
� ���� �
� =� �-� 6 S r� �� 1`i J�. » 1a za. .2�� �� =�S' 3a 33� �p 3� ��" 5r4 4� �`! � �4� � G� 6�1 � d� 74 �'�. ��r��
j �fe�✓li'flvo-r' � `�
� S�ag �s
�. B;�►������- ' �
� �
+ l'lLu� �v� - - fo:�t- ✓�
! t �'y��`y � � n�w � � tr'y
; �'� � � �'`�" ���5 - ,� �x �k ��t wa d�15
� ' �,v' �� � � ��� � � ��-- �-� �-��
►,j, ,
' j,�` �.�� �, ;��i � 1��
, , , E x,s�;h� �����;,��,
1 i N'i , i , I - h
r ���� ��.�� �t�P �ou�� �i�o�i
� � �d�� �L ; a�r o
�� � �� � i _
- ,
'��c �� �Zo���"e'���-� �i� �G_ � a �-�- 8uvr►� �w�' .�,���,
n�fi � SLa4 �
' i I � � � i � ow ��'l �� Q
- ��-£'� � �'( r R
�, , N,� : ; ' � ' , �;- � -- �v,-�-h �v" o v��r 1�a�4 �ve�-
I/.�� I�D0.Yi� a��5��'� �j�� i `� ��`o S�t�C' w�LI�
_.
___ �� ✓l-t' Da� Ir1�i�h
���".��p� � �ob��h�'h� _� __ �X��t��� �ves- �-ahg �
_'
� - � '_ o vr� fioo�' � v2r G-ir�t,�l�s arr ���e{
_ . __. ,
��DC'
� � � V
� � � �
� � �.
o � d �
' e
� � � �
� � � �
�- � ,
� `
� �
� ,
� � o
c �
w � �
(�' V—
� � V�
G �
�