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Home My WebLink About2008-00415 - gazebo ' ^ CITY OF ORONO PERMIT NO.: 2oos-oo4�s 2750 KELLEY PARKWAY ORONO,MN 55356- DATE IssuEn: 12/02/2008 952 249-4600 FAX: 952 249-4616 ADDRESS : 395 SUSSEX LA PIN : 04-117-23-24-0007 LEGAL DESC : FOX BEND : LOT 006 BLOCK 001 PERMIT TYPE : ACCESSORY STRUCTURE PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : GAZEBO ACTIVITY : 329-STRUCTURES OTHER THAN BUILDINGS VALUATION : $ 79,800.00 NOTE: SEPERATE PERMITS REQUIRED:ELECTRICAL(STATE)AND FIREPLACE(MASONRY)PERMIT GAZEBO APPLICANT pERMIT FEE SCHEDULE 906.75 MANTIS DESIGN&BUILD PLAN REVIEW 589.39 465 NEWTON AVE S MINNEAPOLIS,MN 55405- STATE SURCHARGE(VALUATION) 39.90 (612)377-0123 TOTAL 1,536.04 Minnesota State License#:20470400 OWNER CAMPBELL,JON&SUSAN 395 SUSSEX LA 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 separate 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.T ' permit may be revok any time for due cause. pplicant Permitee Signature ! /Da� / `� �--- ��l D �/ U � Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. _ � CQ �t..L�$, ��sl Total Fee: $ � � 3�'D � Date Received:�i °�� ` v�' Entered By: � Permit#: o�f� _d p�_� 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) OWNE OR CONTRACTOR JOB SITE ADDRESS: � �',s Sv SS��C' C v� ZIP: ,�� 7��S� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ yes �No If yes, a special eveni pe�-mit is reguired with Police Department and City Council approva! 60 days prior to the event. Shuttle bus service wiU be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. NAME OF OWNER: ��n f j Q �� PHONE: (home)�— �76—�95� (work) G/2 — �y9_ 3Z3z MAILING ADDRESS: ,3�,5 ,SvSg� �.y CITY: �,�� ZIP: T S3 S6 CONTRACTOR: � r �� PHONE: � /Z� 3 7 7- O/z 3 CONTACT PERSON: ' MOBILE/1'AGER - d - `7G g/ MAILING ADDRESS: �f d S �lle�.✓fa� /�1Q .S CITY: ,` � a .SLIP: Jr,S��f STATE LICENSE: # �� Y ?p c� U o EXPIRATION DATE: 200 ARCHITECT/ENGINEER: S�a� � /'K�xr,✓�-`� PHONE: 73�� 3 3 7-3 3/� 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 detuin: j��,'lo{ G� z��v-o �s ,�� ;�� STORIES: J SQ.FEET OF EACH FLOOR: �4 rox `�O 0 s �� NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETA ED ��L L Z�I, �Lv = �''t ESTIMATED CONSTRUCTION VALUATION(excluding land): $ '��, `w ; 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 ardinances 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 SIGNATUR �� DATE: /� Z� "�� 31 Sec.13.04 RIGHTS OF,�UBJECTS 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 privatc or confidential data conceming himself shall be informed of (a)the purpose and intended use of the requested data within the col lecting state agency,pol itical subdivision,or statewide system;(b) whether he 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 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. The commissioner of revenue ma lace the notice re uired under this subdivision in the individual income tax or ro ert 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 publ ic,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. Afrer 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 private 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 shal l 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 ma��have an additional five days within which to comply with the request,exduding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individua]may contest the accuracy or completeness of publ ic or private data conceming himself. To exercise this right,an individual shal]notify in writing the responsible authoriry 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 o£ 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 PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we wouid 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: ]. The information you furnish will be used to determine your qualification far 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. First Middle Last Address City State Zip Phone I underst nd my rights as st d a�ove. G� ,� l� l/"�" Si ature Reset Form 32 CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: 39� .Svss�.=-�z GA�cr PID: DESCRIPTION OF WORK: �q�z,�,g� ZONING RET�IEW BY.• G % �� DATEAPPROVED: �•z�i - c�� BUILDING REi�7EW BY.• � DATEAPPROijBD: �� - z�(- ��► FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes � No PLAN REVIEW Yes �/ No SEWER CONNECTION STATE SURCHARGE Yes !/ No WATER CONNECTION INVESTIGATION FEE Yes No_� PARK FEE SAC Yes No � SITEINSPECTION Number of SAC Units OTHER (spec�) ZONING CHEC%LIST Zoning District: Fire Department: Post O�ce: School District.• Lot Area: Sq fi. Acres Width Depth Survey Submitted.• Yes No Date of Survey: Proposed Setbacks: Front(Lake): Right Side: Rear(Street): Left Side: � Adjacent Structures: Wetland: Building Height: Def. Hgt. Peak Hgt. Lot Coverage: Grading: Staff Approval Date: //•2 I- C�'� By: (,cJG Counci/Approva!Date: Septic: StaffApproval Date: gy; Zoning File: # Resolution: # Resolution Date: Shoreland District: MCWD Permit: Avg. Setback: BluffSetback.• LotCoverage: Existing Proposed Hardcover: D-7.i' 75-�50' 2.i 0-500' .i 00-1000' Hardcover f'ariance Reqz�ired: 3'es N'o Date of Council Approval: REMARKS(in house): �c�N►N v l� ,D D�UP� �•zS -O� w �-n� '�p�N,,Q�4r ovJ � � � Zvo$—oc�o9 � s,T � � a —0 09 33 BUILDING REVIEW CHEC%LIST UBC: V-� CONSTRUCTIDN TYPE: �/Y� Sq Footage $Per Sq Ftg .Basement • x = 1 st Floor x = 2nd Floor x = Garage x = x — TOTAL EstimatedConstruction Value: $ �l°i,4j� �� Inspections Required: Work Requiring Separrrte Permits: Site ' Plumbing Fire Hardcover Removal Mechanica! Water Connection �E-�eeting Septic Sewer Connection ,�_Framing �Fireplace Lawn Irrigation �Insulation �(Masonry) Other Wall Board (Mfg.) YY'ell(State Permit) _Q�Final Grading/Filling _�Electrica!(State Permit) Other RE1tIARKS(INHOUSE): REVIEW BY OTHERS: � DATE: Access: Existing New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMIT): _ s� ,n�,�,�,S�„�� -�7�,��_o o�S Y 34 !J �Q� /�, ��/�'-� 7/DAT O TIME CITY OF ORON CALLED IN " � � �� INSPECTION NOTICE SCHEDU�ED � � PERMIT NO.o7DD S�-�S�lS COMPLETED ADDRESS �� GLS.S�iSL� ` OWNER CONTR. TELEPHONE NO. � l ` � � � DESCRIPTION ` C/� � ❑ FOOTWG � MECHANICAL RI ❑ EXCAV/GRADWG/FILLWG Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE O ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q �"FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � J O >. � O � W � Q � Z W � W � � d � ❑WORKSATISFACTORY:PROCEED ROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-4600 OwnerlContractor on site: � Inspector. ,_�o�/ - White Copyllnspector's File Canary CopylSite Notice � � DQTE TIME CITY OF ORONO CALLED IN -� INSPECTION NOTICE SCHEDULED -�"� % PERMIT NO.o?DOFl�Dd S��S COMPLETED ADDRESS S � �-n- OWNER CONTR.rna''��`a �t"4� TELEPHONE NO. ��2 70Z 71$ � � DESCRIPTION ��h�� ❑ FOOTING � MECHANICAL I ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z p WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP = p PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO v�, COMMENTS: � W a � J O � � O � W � Q � 2 W � W � � WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W OFiRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑COR ECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFOREC�IERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN INSPECTOR WFLL REfURN- ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION RE�UIRED.CALLTOARRANGE ACCESS. Cai�for the next inspection 2a hours in advance. (952) 249-4600 Owner/ConVactor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice