HomeMy WebLinkAbout2003-P05911 - addn/remodel/repair PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P05911
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 1/2/2003
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SITE ADDRESS: 3015 Watertown Rd
Long Lake,MN 55356
PID: 04-117-23-22-0030
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential Construction Type VN
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Firepiace Eiectricai(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 643.75 Valuation: $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.50
TOTAL FEE: $ 1,087.78
APPLICANT: Tony Eiden Co. OWNER: Tony Eiden Co.
4100 Berkshire Lane N 4100 Berkshire Lane N
Plymouth,MN 55446 Plymouth,MN 55446
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.
APPLICANT ftRMITEE SIGNATURE ISSUPD BY SIGNATURE
Covies: 1-File(Sienitures Required), 1-Avolicant, 1-Monthly Reports, 1-Assessine, 1-Finance Page 1
Total Fee: $ do Q �7Z Date Received: 40 59//
Entered By: ermit#: /Z./ / D2--
CITY OF ORONO-tU LDING PERTNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: ZIP: 5.53 SCP
NA1NIE OF OWNER: PHONE: (home)
�J (work)762 b 0.9.
NLA-jLrriG ADDRESS: 411)6 � CITY: ZIP:
CONTRACTOR: D N! PHONE: 7,0j j, a
CONTACT PERSON: ri0 E/PAGER: D
MAILING ADDRESS: D CITY: IP:�c{(
STATE LICENSE: # ,? a
ARCHITECT/ENGINEER: GST ZSOv� PHONE:
MAII.ING ADDRESS: CITY: ZIP.
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration k,,' Land Alteration
PROPOSED WORK(describe in detail):
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTL iATED CONSTRUCTION VALUATION (excluding land): $ , DDIf
D
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; chat 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
perm;'- ?-nd that the work will be in accordance with the approved plan.
APPL;CANT'S SIGNATURE:
DATE: �����D o2�
NOTE! Parade 12f Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or m 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 conftdeada.dam concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting Sate agency,political subdivision,or statewide system;
tb)whether he may refuse or is legally required to supply the requested dam;(c)any{town coas_- uence arising from his supplying or refusing to supply
private or confidential dam;and(d)the identity of over persons or entities authorized by state or federal law to receive the dan. This requirement shall
not apply when an individual is asked to supply investigative dam,pursuant to sec_on 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue may ola:e the notice recruited under this subdivision in the individual income tax or orooerty 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 dam on individuals,and whether it is classified as public, private or conf.dendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the dam without any charge to him and:if he desires,shall be informed of the content
and meaning of that dam. After an individual has been shown the private dam and informed of its meaning,the dam need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is pending or additional dam 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 dam. The responsible authority
may require the requesting person to pay the actual costs of malting.certifying.and comp4g 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 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 irdiv;dual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right.an individual shall notify in writing dee resporsioie authority describing the nature of the disagreement. ..
The responsible authority shall within 30 days eft.ere. (a)correct the dam found to be inaccuram or incomplete and attempt to notify past recipients of
inaccurate or incomplete dam, including recipients named by the individual;or(b)notify the individual that he believes the dam to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included wit_`t the disclosed dam.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
conmsmd 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 depz.ments 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.
First Middle Last
address
City Smte Zip Phone
I understand my rights as stated above.
Signarur_
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 o Ns wA-re/VrO w n► JUA-eQ
PID:
DESCRIPTION OF WORK:
ZONLNG $EVIEW BY: DATE APPROVED: /z- -.o -o z
BUILDING REVIEW BY: DATE APPROVED: I z. -z.o -o -L-
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes t/ No
PLAN REVIEW Yes _� No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
ZONING CHECK LIST Zoning District: /yo c r-b_4n)&e_
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: We land:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: T
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac : Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
BUILDING REVIEW CHECK LIST
UBC: 2'3 CONSTRUCTION TYPE: �H
. Sq Footage $Per Sq Ftg
Basement x _
1st Floor X . _
2nd Floor x _
Garage x _
x —
TOTAL
Estimated Construction Value: $ S o O o v
Inspections Required: Work Requiring Separate Permits:
Site _—Plumbing Fire
Hardcover Removal _sem Mechanical Water Connection
Footing tic Se
�_Framing p Sewer Connection
�
_ Fireplace Lawn Irrigation
V Insulation (Masonry) Other
Wall Board X (Mfg,) Well(State Permit)
—S° —Final
Other Grading/Filling _ y� Electrical(State Permit)
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERINEM: -
8
DATE TIME
CITY OF ORONO CALLED IN /
INSPECTION NOTICE SCHEDULED ``7-V 3 co xj
PERMIT N0. l COMPLETED n
ADDRESS 301L
OWNER CONTR. / /31j,
TELEPHONE NO.
DESCRIPTION
4j 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
-12'FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
H 03 TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 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
10 PLL)MllING FIN 36 FOUNDATION/REMOVAL
OWN CONTRACTOR O MEET YOU:_YES_NO
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COMMENTS:
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0
0
0
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W
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Wac ORK SATISFACTORY.PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
ci BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
11STOP ORDER POSTED.CALL INSPECTOR 11 CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the t Inspection 24 hours in advance. (952) 249-4600
Owner/Contrast on 't
Inspector. _ w
White CopylInspector's File Canary Copy/Site Notice
i
DATE TIME
CITY OF OR 0 CALLED IN
INSPECTION NQTIQ SCHEDULED
PERMIT NO. COMPLETED
ADDRESS -�
OWNER CONTR.
TELEPHONE NO.
�1
3Z DESCRIPTION l``R
�
4 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
ti 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
09 PLUMBING Al 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU:XES—NO
COMMENTS:
cc
W
a
J
O
rc
O
LL
W
cc
Q
f
2
W
z
W
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41D ORK SATISFACTORY.PROCEED ElPROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next nspection 24 hours in advance. (952) 249-4600
OwnerlContr ct n it
Inspector.
White CopylInspector's File Canary Copy/Site Notice
ORONO G
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TONY EIDEN COMPANY tip'- �'
4100 BERKSHIRE LANE ►'• o" �. v„ it
PLYMOUTH, MN 55446 �'�� �'' 11
763-559-0251A,\,
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