HomeMy WebLinkAbout2002-P05386 - addn/remodel/repair , PERMIT _..
CfYY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Pos3s6
Crystal Bay, Minnesota 55323 P@�t111t Typ2: Addition/RemodeURepair
(952) 249-4600 Date Issued: �i23i2oo2
SITE ADDRESS: 525 Sussex Circle
I.ong Lake,MN 55356
P I D: 04-117-23-3 2-0012
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residenrial
Pernut Class: Building Census Code 434
Permit Type: Addirion/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate pernuts required: riumbing iviecnanicai rirepiace r,iectricai�siaieJ
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 643.75 Valuation• $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.50
TOTAL F'EE: $ 1,087.78
APPLICANT: Tony Eiden OWNER: Jon&Susan Campbell
4100 Berkshire Ln 525 Sussex Circle
Plymouth,MN 55443 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 BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE I D BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Avnlicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
J �
Total Fee: $ I C �� ' �� Date Receive : �����
Entered By: ,�?9'v�L,. Perm.it#: �"3
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CITY OF ORONO - BITII,DING PERIVIIT APPLICATION
A.11 information must be submitted in full before plan review will be started.
(please print all inforncation)
1'HE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �J� s�./� � . ('�ZIP: _�'.�� �C.P
NANIE OF OWNER: PHONE: (home)
(work)
I�IA�I,Lti'G ADDRESS: CTTY: ZIP:
C0�1'TRA.CTOR a�'1 � H0�1E: -.5�5 - �Z,��
COti"TACT PERSON: N OB /PAGER: - � ll .
I�IAILI�i tG ADDRESS: CTTY: ZIP:1„�(Q ..
STATE LICENSE: # �2
ARCHITECT/ENGTiVEER: PA���
I�IAILI�i'G ADDRESS: CITY: ZIP:
N��,�: REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
�- '
PROPOSED tiVORK(describe in detai�: ��l�1 IS�1 ��SP "'
STORIES: SQ.FEET OF EACFi FLOOR: �O(�,B✓ �l�I � ���8
NO. OF BEDROOI�IS: GARAGE STALLS: ATT. DET.
ESTI1�iA'ITED CONSTRUCTION VALUATION (excluding lan�: $ �D�D�0 -
I hereby apply for a buildinj perm.it and I acknowled�e that the information above is complete and
accurate; cha[the work will be in conformance with the ordinances and codes of the City and with
� the State Building Code; that I understand th.is is not a perm.it and work is not to start without a
perm�t� ��d that the work will be in accordance with the approved plan.
� � � DATE: �T� ��D�
APPL�.CANT S SIGNA'I'URE:
NOTE! Parade o�Horrtes events require separate permit approval by Poliee Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.0�t RIGFiTS OF SL'BJECTS OF DAT�
Subd. 1. Tvpe of data. The righ�s oi icdividual on whom che data is s:or.d or n�be scoctd shall be as set forch ia�his secrion.
Subd.2. Informaaon reqirired to be gi.en individual. .�.n individual uY:d to suFpiy private or confidendal da¢concerning himseif shalI
be iaFormed of: (a)che purpose and iac:nded use of che rtquesud dam withia�e couecang�aL agency,po(idcai subdivisioa,or seicewide ryst:m:
�b)whe:her he may rfuse or is le3ally cequir.d m n:ppiy rhe rzquesud dars:(c)any I�own coas..';ueace arisin3 from his supplyi.^.g or refusing ro supply
priva�:or con::dendal dam;and(d)che idenrirr of ocher peaoas or enades auchoriz:d bY suc_or fr.d�ral law ro re_eive the dan. This requir_mea�s�alI
no�apply whzn an individual is�sked to sspply iar•udgaave dam, pursuanc�o sec=on 13.82,subdivision 5, co a Iaw enforceWeat officer.
'Ihe comr.iissioner oF rvenue r,�av vii:;che nocce re�uired und:r this subdivision in �he individua! incortie e�x or vrooem az refur.d
instrucaons instead of on�hose forms.
Subd.3. access to dac�bc indiriduaI_ lipan requesc co a ctsponsible auchoriry,an individual shall be informed�vhe�her he is the subjecc
of scor_d dara on individuals,and whe:her it is c[usif:ed as public, Qrivace or con::Ce:�Qal• LFon his fur�her tequest,an individual who is the subjec�
of stoc-d privace or public daa on indir-iduals shaR be shown the daa wi�hout any ciu3e rn h�and;if he desires,shall be iniormed of che con[er.c
ar.d meaniag oi ch3�d�a• After an individual has�een shown che privare dac►ar,d informed oi iu meaniag,the dam aeed not be disclosed to him for
siz mon�s cherac�er unless a dispute or acrion pu:suanc co this secdon is pending or addiao�.l dara on�he individual has beea collected or crea�ed.
The responsible au�horiry shall provide copies of�hz privau or public dac�upon requ:sc by the it3ividual subject of che daci. T'ne responsible auchoriry
may r:quirr[he �equesring per�on ro pay[he acnul cosa of mafcing.cerrifying.u:d:ompiling[he copies.
'Ihe responsibla auchoriry shall compty inrs:edia[e[y,if possibte,wi[h���qa�st¢=�=Pursuan�to this subdivision,or wirhin five days oi
the dare of[he requesc,ezcluding Satucdays,Suadays and legal holidays,if is.med��complia.cce is noc possible. If he cannot compty wi[h the requesc
wi[hin dvt dme.he shall so inform�he individual,and may have an addidoaal five days wi[hin which to:omply win[he requcst,ezcluding Sanirdays.
Sundays and Iegai holidays.
Subd.4. Procedure when data is not accurate or complete. An indivi�ual may concest che a�curacy or comptaeaess of public or pri�•ate '
data cor.ceming himself. To exer.ise�is right,an individual shall nodfy in wridn;:i::respocsioie auchoriry describing ehe naeu:e oi che disagreemaac. .
The rtsponsiblt authoriry shail wi[hin�0 days ei�`.:r: (a)correc[the dara found ro te inaccL3�or incompiece and aaempe to nodfy past recipiene�of
inaccura:a o�incomplece dan, inciuding recipieea named by [he individual;or(b)coafy d:= i�dividual�[hac he believes the dara to be correct Dan
in dispuG:shall be disc!osed onIy if[he individual's stacement of disagreement is ir:luded wi*`�[he disetosed data.
Ihe dzcermirvzdon of che rzsponsibl�au�horiry cnay be appealed purss�.:ro [he pr�visions of[hz adminisaarive pro.edure acc reladng ro
concesced c�ses.
DAT�. PRIVACY �D`'ISOR�'
In accordance wich v1.S. 13.04, Subd.2, "RiQ.hts of subjects oi data", �c�e would like to inform you tha[your reques�
for a permic or license from che Ciry of Orono or any of its depz�.ments nay require you to fumish certain private or
confidential informacion.
You are nocified that: .
1. The information you furnish will be used[o decermi.�.�your qu�lification for che perm.it or license requested.
�. You may refuse to suppiy data, buc refusal may reeuire that che Ciry deny the permit or license.
;. The informa�ion may be shared wich ocher local, sca��or federal agencies to the excent necessary to process
the permit or license.
:�: If your requested permit or licease requires Council action to approve, some information may become
public.
�. You have cenain riQ.hcs under �i.S. 13.04 (availabl� upon requesc) to review private data on yourself.
6, Your full,name is required to process chis applica�:on or pe.:Lit.
Finc titiddle Last
�1dd�ss
C iry Sttm Zip Pha aa
I understand my righcs as scaced above_ .
Signatur_
�' ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: S 2 S S�s s�x c�2 c.uc"
PID:
DESCRIPTION OF WORK: _f,��gs�,��?- �',,�„s�
ZO.�TING REVIEW BY: DATE APPROVED: ?-t�• n z
BUII..DING REVIEW BY: DATEAPPRUVED: � -i o -oZ,
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ✓ No
PLAN REVIEW Yes v� No SEWER CONNEG"I'ION
STATE SURCHARGE Yes � No WATERCONNECTTON
IiWESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning Districr. N v t -{� .
Fire Departmenr. Post Office: Schoal District: �
Lot Area: Sq.ft. Acres idth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetlan
Building Height: Def. Hgt. Peak H .
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # esolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
, �
BUII.DING REVIEW CHECK L�ST �
UBC: _ R •3 CONSTRUCTION TYPE: �l�
, Sq Footage $Per Sq Ftg
Basement x =
lst Floor x _
2nd F1oor x =
Gazage x =
a —
TOTAL
Estimated Construction Value: $_S0,c�pd ��
Inspections Required: Work Requiring Separate Permits:
Site _�Plumbing Fire
Hazdcover Removal _�Mechanical Water Connection
- Footing ' Septic Sewer Connection
� _�Framing p� Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
_�Wall Board � (Mfg.) Well(State Permit)
_ � F� Grading/Filling o[ Electrical(State Permit)
Other
REMARS.S(IN HOUSE): .
-------------------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
REMARI�S (TO BE NOTED ON PERMI7�: � ~�
8
DATE TIME
CITY OF ORONO � CALLED IN
INSPECTiON NOTICE SCHEDULED
PERMIT NO.P�S ��� COMPLETED ��' z3_� � �
ADDRESS.��ZS� SuSS�'�C�,�,,�
OWNER CONTR.� 1'"l.����
TELEPHONE NO. /
� DESCRIPTION
� O�G 11 MECHANICAL RI 18 EXCA�//GRADING/FILIING
RAMING 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
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
\� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: t
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W ORK'SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
� ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR W{LL RETURN
- ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTiONREQUIRED.CALLTOARRANGEACCESS.
Cail forthe next inspec ' n 24 hours in advance. 2� 249-4600
.
OwnerlContractor on site:
�
Inspector.
Whi Copyllnspector's File Canary Copy/Site Notice
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BEDROOM WINDOWS
FIRE EXIT REOUiRED
24" NAHN. CLEP.,,R Hii,:FIG --111-
5.7 SO. FT. MIN. OPEN NG
44" MAX. SILL HEIGF T
SPECIAL NOTE
SEE ATTACHED SHE]
FOR
CODE REQUIREMENI
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BUILDING P R 51 N REVIEW
INSPECTOR
DATE
2. PERMIT NO. A
"7
0 APPROVED AS SU21,%4ITTED
WITI H 00R.TRECTION-S AS DOTED 3,4,�eKv—fi
0.1")IOT APMOVED -7 CORRECT & REISUEMIT
Thv-,a comments are, for your in,,
ormation. Ail work shall be do
ro
In full compliance with, all, app',IcaLle 1u,i�.rlin Zoning code.
-n
Requir,,rn3nts jn.-iu-LjjnG i!uzns ni
ly ncilled in tffz reAew.
KEEP THIS PLAN SET 0 SITE AT ALL TIMESS