HomeMy WebLinkAbout2004-P07955 - addn/remodel/repair w PERMIT
f�ITY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07955
Crystal gay, Minnesota 55323 Permit Type: Addirion/RemodeURepair
(952) 249-4600 Date Issued: io�i�2ooa
SITE ADDRESS: 2108 Sugarwood Dr
I.ong Lake,MN 55356
P I D: 34-118-23-21-0024
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate pernuts required: riumbing iviecnanicai Eiec�icai�siaieJ
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 279.25 Valuation• $ 17,000.00
Plan Review Fee: $ 181.48
State Surcharge Fee: $ 9.00
Misc.Fee: $ 1.50
TOTAL FEE: $ 471.23
APPLICANT: Owner/Self OWNER: Micheal&7acqeline Ricks
M� 2108 Sugarwood Dr
Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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CANT PE ITEE SIGNATURE SSUED BY SIGNATURE
Copies: 1-File(SiQnitures Re4uired),1-Atrolicant, 1-Monthlv Reuorts, 1-AssessinQ, 1-Finance Page 1
� ���. a3 �
Total Fee: $ Date Received: q`/6'D �
Entered By: Permit#: �k(�19 5�
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) �NER OR CONTRACTO -�}c-���/C !�S'
�
JOB SITE ADDRESS: � � 0� �S'uaar (/1/c����� v� zir: S.S35�
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. Non permitted events will not
be allowed.
,� {� �S�-
NAME OF OWNER `JcIG u�l( h� !��� ' B& /� S PHONE: (home) �{'15- OOb�
' (work) `ts.� -7'f� - SIX
MAILING ADDRESS: 1 b 8' S� ur �/ccds br: CITY: Lc�1 p L2 /�E ZIP: $�5 3S"�
CONTRACTOR: eti.rx.�✓"� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration X Land Alteration
(IN ��-ow
PROPOSED WORK describe in detai�: �-�i h I� 5�1 Y`CSf af �ase r'he✓� � , 6Q� �ki f�-��rr�
�2�i�a , �.�a{-� �-o�� m , be�iro��� , -Fa;rn r lv roor�
,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �7 p0 0 a D��
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ '
�
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 pemut and work is no�start without a permit; and that the work will be in accordance with
the approved plan.
�.
.
APPLICANT'S SIGNATURE: DATE: �� ' <<.� - C�
.
,
Sec.13.04 RIGHTS OF SUB�ECTS OF DATA
Subd.1. Type of data. T6e 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 contidential 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)
w6ether 6e may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or conCdential data;and(d)the idendty 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.
The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or urooertv 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 dsta on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject ot
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. 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 of the private or public data upon request by the individual subject of the 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 of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is oot possible.If he cannot comply with the request within
that time,6e s6a11 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
concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreemenw The
responsible authority s6all wit6in 30 days either: (a)correct t6e data found to be inaccurate or incomplete and attempt to notlfy past recipients of
inaccurate or inrnmplete data,including recipients named by the individual;or(b)notify the individual t6at he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with t6e 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 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 eztent 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.
�a� �
First Middle Last
Address
City State Zip P6one
I understand m ' ts as stated bove.
r �
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z+� 43 5t�6A 2w o o✓� d R•
PID:
DESCRIPTION OF WORK: l owt� C.CvcsL G���sH
ZO�TIIIG REV��V BY: DAT'E APPROVED: 9-?�- o�
BUII�D11tG REVIE`V BY: DATE APPROVED; c,-u� .oK
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNiIT Yes �/ No
PLAlv REVIEW Yes � No SEWFR CONNEC"IION
STATE SURCHARGE Yes � No WATERCONNECT'ION
INVESTIGATION FEE � Yes No _/ PARK FEE
SAC Yes No �" SITEINSPECTION
Number of SAC�Units OTHER (specify)
Z0�1ING CH�CK LIST Zoai.ng District: /Vo C biAN6 e �,
Fire Department: Post Office: School District: �
Loc Area: Sq�.ft. Acres ' Width Depch
Survey Submitted: Yes No Date of Survey:
Progosed Setbacks:
Front(Lake): Right Side:
Rear (Street): Left Side:
Adjaceat Structures: �Vetl .
Building Hei�ht: Def. Hgt. Pe Hgt.
Lot Coveraoe:
Gradino: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: $Y:
Zoning File: # Resolution: # Resolution Date: _ �
Shoreland District:
Avg. Setback: Bluff Setbac : LocCovera�e:
g���e Proposed
Hazdcover: 0-75' .
75-250' .---.--
250-500'
500-1d00'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUII.,DING REV�W CHECK LIST
��: n'3 CONSTRUCTION TYPE: .,�
_ Sq Foo[a;e $ Per Sq Fta
B�semen[ x =
lsc F1oor z =
2nd F1oor z =
Garage x =
z —
TOTAL D.(c � rt�,o,• `P��`��
Estimated Construction Value: $ �� f�� � o o �`�
Inspections Required: `Vork Requiring Separate Permits:
Site �_Plumbing Fire
Hazdcover Removal � Mechanical Water Connection
Footing � Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
�`Vall Board (Mfg.) Well (State Perm.it)
Final Grading/Filling �Electrical (State Permit)
Ocher
RElYIARK�(.�i t HOUSE): .
--------------------------------------------------------
REV��V BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
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RENIA.RKS (TO BE NOTED ON PERil�II1�:
8
� V
�!/ //DA TIME
CITY OF ORONO CALLED IN _30
INSPECTION N SCHEDULED �
PERMIT NO. 55 COMPLETED
ADDRESS��
OWNER �t� CONTR._J����c.�-r
TELEPHONE NO. �5 Z. �t'7S O�O Q
i
� DESCRIPTION
tV 0 OOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q�AAAING�'� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
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 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� RKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK$PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN p CITATION ISSUED
O STOP ORDER POSTED.CALL INSPECTOR
O INSPECT�ON REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nex nspection 24 hours in advance. (952) 249-4600
OwnerlContra _it :
Inspector.
White CopyMspector's File Canary Copy/Site NoUce
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