HomeMy WebLinkAbout2003-P06439 - addn/remodel/repair PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P06439
Crystal Bay, Minnesota 55323 P21"fTllt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 6�1��2003
SITE ADDRESS: 200 Stubbs Bay Rd
Long Lake,MN 55356
PI D: 32-118-23-42-0003
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: PernutFee: $ 23.50
Valuation: $ 500.00
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 24.50
APPLICANT: Christoper&Gail Bollis OWNER: Christoper&Gail Bollis
200 Stubbs Bay Rd N 200 Stubbs Bay Rd N
Long Lake MN 55356 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
MINNESOT UILDING CODE REQUIREMENTS.
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LICANT PE ITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessins, 1-Finance Page 1
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRE.SS OR LEGAL: Z n o 5-f J (3�S5 (��, 1�� � '
PID:
DESCRIPTION OF WORK: y�l,�.� �c,D6
ZO�IG REVIEW BY: DATE APPROVED: �-�7-�3
BUILDING RE'VIEW BY: DATE APPROVED; �-,-j:0 3 � .
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER11iIIT Yes ✓' No
PLA��i REVIEW Yes No ✓ SEyYFjlt CONNEC"IZON
STATE SURCHARGE Yes r/ No WATERCONNECITON
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CHE.CK LIST Zoning District: 12 2-//S
Fire Department: � Post Office: School District: • � �
Lot Area: Sq�.ft. Acres � Width Depth
Survey Submitted: Yes�_ No Date of Survey:
Proposed Setbacks: � � �
Front(Lake): q o' Right Side: I�►u ' �
Reaz(Street): ���� f Left Side: 30 0 ` t'
Adjacent Structures: N�A- �Vetland: N�� .
Building Height: Def. Hgt. o.1L Peal:Hgt.
Lot Coverage: N /
Grading: Staff Approval Date: — By: Cauncil Approval Date:
Septic: Staff Approval Date: `� By:
Zoning File: # P�2-2�9�i Resolution: # Resolution Date: �
Shoreland District: /�
Avg. Setback: Bluff Setback: Lot Coverage:
� Existin; Proposed
Hazdcover: 0-?5'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMAR]KS(in house):
7 �
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BUII.,D�NG-R�VIEW CHECK LIST .
UBC: �Z• 3 � CONSTRUCTION TYPE:
_ Sq Footage $Per Sq Ftg
� Basement � . . x
lst Floor . � � . . . , ' . .
2nd floor x . — " . . � : .
Gazage x - � � �
x — -
TOTAL �
Fstimated Construction Value: $ 5'�vpO �
Inspections Required: , `york Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical
. ,_,p,S Footing ' Water Connection
• Septic Sewer Connection
� � Framing Fireplace Lawn Irri ation
Insulation (Masomy) Other g
. Wall Boazd • (Mpg,� Well(State Permit) - -
_�Final Gradin g ------, -
Other �� Electrical(State Permit) '
REMARKS(ni T HOUSE): � .
REV�W BY OTHERS: DATE: � � � � ' --
Access: Existing�_ New .
Access Approval; Date �
By: �
RENIA,RKS (TO BE NOTED �""_--"____--�______�_______�------__:�___
ON PERA�IIT�;
8
Total Fee: $ Date Received:
' Entered By: Permit#:
CITY OF ORONO - BUII.D�TG PERMIT APPLICATION
Al� information must be submitted in full before plan review will be started.
(please print all infornwtion) �
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �OD 7'I J I9�j ��I F� Z�P: �J��E�
NAME OF OWNER: a I ►(S PHONE: (home��2��f73��Z�`F
. �work) 2�93�-Z r31
�.nv��inn�ss: 220 ,�fub�, ��( � crrY: cc zrn:�53�b
...�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
11+I�iLING ADDR�.SS: CITY: ZIP:
STATE LICENS�: �
ARCATY'ECT/ENGINEER: PHONE:
MAII.ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION� ,
. .
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteradon Land Alteration
PROPOSED WORK(describe in detain:�1�V� Shc.,;�1��v�� �- N�v�1 �AS
� �o o`fi�nAS
STORIES: I SQ.FEET OF EACH FLOOR: �d l� �
NO. OF BEDRO()MS: GAR�IGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding lancn: $
I hereby apply for a building permit aad I acknowledge that the information above is complete and
accurate; that the work will be in conforn�ance with the ordinances and codes of the City a�cl,with
the State Building Code; that I und d this is not a permit and work is not to start without a
permit; and that the work will be rdance with the approved plan.
APPLICANT'S SIGNATURE 8��� DATE: ' (� �I� "0 3
NOTE! Parade of Homes events require separate permit appr.oval by Police Department and
City Council�60 days prior to the event. Non permitted events will not be allowed.
5
� �
Sec.13.04 RIGHTS OF S[JBJECTS 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. Informatioa required to be given individual. An individual asked to supply private or confidential daha conceming himself
shall be informed of: (a)the purpose and inte�ed use of the requested data within the collecting state agency,polidcal subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or
refusing to supply private or coafidential data;and(d)the identiry of other persons or end6es 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 secdon 13.82, subdivision 5, to a law
enforcement o�cer.
The commissioner of revernie mav olace the nodce rewired under this subdivision in the individual income tax or vronertv tax refund
instrucdons instead 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 individuals,and whether it is class�ed as public,private or confidential. Upon his further request,an individual who
is the subject of stored private or public data on i�lividuals 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 eo 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 authoriry shall pmvide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu 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 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 addidonal five days within which to comply with the request,
excluding Samrdays,Sundays and legal holidays.
Subd.4. Prceedure when data is not accarate 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 tha nature of the
disagreement. The responsible au�oriry shall within 30 days either: (a)correct the data found to be inaccurate or incotnplete and attempt to nodfy
past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)nodfy the individual that he believes the data
to be conect. 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 PRIVACY 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 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 shazed with other local, state or federal agencies to the extent necessary to
process the permit or license.
4. If your requested pemut 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.
Y�h � � i
First _ Q �� ` � Middle �� I,ast
�2 u i� �G�/
Address
�o�n� �c�-�r e ��5 ZJ � 6 � 7 3 ' � Z�'�
Ciry State Zip Phone
I underst�(n. , y rights as state bove.
� r ,� �.��� .
�
Signature
6
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Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII.DING 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: f�D� J�J��S ��I F� ZIP: ����6
�I 1� (home)��2-�l'3-�Z��
NAME OF OWNER: c (S PHONE:
r- � .�, r (work)�t�52�9 3���3/
MAII.ING ADDRESS: 2�-0 ,�j�U�)Cb IJ�K� CITY: ZIP: _ 3�6
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�:�l�Ve, ��,�►lc����►_ �- Ne�nl ���45
STORIES: I SQ. FEET OF EACH FLOOR: �-I bZ�
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
c�-�
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ �� S 0 v �
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 und nd this is not a permit and work is not to start without a
permit; and that the work will be c ordance with the approved plan.
APPLICANT'S SIGNATURE: �� DATE: '�-2 Z-�z
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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Nl.i%r.�IE%r.lJer.32vi8-23 (VCrJ Ip[p�iON
j� �p� ��s Cecl.ificate of Survey
• ,Z20.05 � for Chris Hollis
� 90 in the SE ': of Section 32-I I8-2�j,.'�
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3) �33.0 � . / � Hennepin County, Minnesota �'�y�
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i J.aJF �' � 3�,..d �`a �'��. �!
oFNw%r•!JE%v 29700 �r � ,'•)�
efJee 32-/i8-U l87.05 2��
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5�.1%Yof�deSE%y 30.0
' afle�.J1-iiB'13 O [ristie9 (jnrn
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, r I hereby certi£� th�t tl�is is a true and cocrecL
30.0 o representation of a survey of the boundaries of
� (A) The South l98 fee[ of thc West 220 feeL of .
� the Northwest guarter of the Southr,ast quar-
� � . ter of Section 32, TONnship 118 North, Range
. � 23 West of [he Sth Principal Meridian. . �
m (H) That part of the Southwest quarter of the
Southeast quarter of Section 32, Township
/.i,r p«.iie/ 118 North, Range 23 West of the Sth Principal
.ti%Y� r.f<a/��t Maridian, described as follows: Commencing at�
� � i�•of/A�J4�%y a oint I6.5 feet .South of the Northwest
I of/A�ff%v oF P
Jee.72-ii9-13 rorner of the SouthNest quarter of the South-
east quarter of said Sectian J2; tlic>nce East
i N „� qoarccre oc u�e ooucneasc quarter ot saiu Sec-
O1 a- tion; thence Souf.h 943.5 feeG on a line par-
I � `r allel with the west line of the Southwest
quarter of the SouGheast q�artec; thence
I � ,� West 297 feet to a point 492.3 feet south of �
v � the Northwest corne•r of the Southwest quarter
N3 ofthe Southeast quarter; thence North along
� � '+'! sa.id West line of [he Southwest quar[er of the
. � Southeast quarter of said Section 425.8 feet
to the point of beginning,
the location of a11 existing Avildings thereon,
� an� the Iocation of a proposed addition. It does
not purport to show other improvements or en-
croachments.
COFFIN 8 CRON➢ERC, INC.
�l 3i - P1ari� k S. Gr�er'�g Reg', No. 12755
�
Cordon R. Coffin Reg. No. 6064
Enginr��rs 8 Land Surveyors
' • 29T.02 Long Lake, Minnesota
Wnat I:•..ft�.. Se„tl....,;'�.ftA. 5.-tL,..�t'�. .F S..c. 3.Z-IIS•z3
�. � Date : 10-1-85
Scale: 1" = 60'
.. � � o : Iron marker
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