HomeMy WebLinkAbout2008-P12139 - unit #150 - addn/remodel/repair PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P12139
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
6/18/2008
SITE ADDRESS: 2060 Wayzata Blvd W Unit# /5-0
Long Lake,MN 55356
PID: 34-118-23-21-0037
DESCRIPTION: UBC Occupancy B
Construction Type VN
Proposed Use: Commercial-Business
Census Code 324
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
Tenant Improvements-Suiite#150-Chiropractor
FEE SUMMARY: Permit Fee: $ 585.00 Valuation: $ 41,000.00
Plan Review Fee: $ 380.25
State Surcharge Fee: $ 20.50
TOTAL FEE: $ 985.75
APPLICANT: Interspace-West,Inc. OWNER: Amber Woods Office Center LLC
P.O.Box 670 2060 Wayzata Blvd W
Wayzata,MN 55391 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 BD NG CODE REQUIREMENTS.
A s_
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PPE'MITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
Total Fee: $ 905 76 Date Received: 4/....4-4)
Entered By: J'Yl4 . Permit#: / ,a>3 g
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 tonne) OWNER OR CONTRACTOR --u1 „ 5
Vv (vii
JOB SITE ADDRESS: 01®60 , �� (�� ZIP:
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. Shuttle bus service will be required unless applicant demonstrates
sufficient on-site t9
parking is(available.. Non-permitted events will not be allowed.
NAME OF OWNER: A wt b�tf' 0 0 6C,S (J1 ;j C e PHONE: (home)/001
(work)
MAILING ADDRESS:� 0,13 Oic 6 7(0 CITY: (A)rky t,tiN,, ZIP: 6-5-,3q
CONTRACTOR: n-Pev$ Ot Le_ i G PHONE: 6 /c - S`-
CONTACT PERSON: l) S._ t. a\ o e r MOBILE/PAGER: i / 2 — gO d 7
MAILING ADDRESS: p, t e jC 7() CITY: (J/c,y 'u!_n ZIP: S`s--3q
STATE LICENSE: # EXPIRATION DATE:
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ARCHITECT/ENGINEER: C,4 Vl rn ((A((So PHONE: /e,1 —� 2S, ?q
MAILING ADDRESS: T , 6 7 p 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(describ in de�taif) e r ,� AJ / V'0
- CD �YV1 ✓( t1,�� Q;�'�(L p 7'
STORIES: SQ.FEET OF EACH FLOOR: 9/ ( 0 0
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ C e d,
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 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 planes / /
APPLICANT'S SIGNATURE: f/� DATE: I a
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.I. 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 private or confidential 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)
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 identity 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 may place the notice reouired under this subdivision in the individual income tax or property 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 public,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. 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 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 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 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 of
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 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 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.
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City State Zip Phone
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I undersan. ' ghts as states s e.
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• CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Zo(00 a,, Lo Ay � Qt ,O „, ,", I S-0
PID:
DESCRIPTION OF WORK: TE,ANT Pi N tsh4
ZONING REVIEW BY: N ( ,. DATE APPROVED:
BUILDING REVIEW BY: _--M-_� DATEAPPROVED: b 14-0 5
FEES TO BE CHARGED: (J Misc. Fees Calculated By:
PERMIT Yes ,/ No
PLAN REVIEW Yes L No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No e/ SITE INSPECTION
Number of SAC Units PA,o OTHER (spec)
ZONING CHECK LIST Zoning District: v6 c
Fire Department: Post Office: School District:
Lot Area: Sgft. 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: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: MCWD Permit:
Avg. Setback: Bluff S:tback: Lot Coverage:
Existin: Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes Ne Date of Council Approval:
REMARKS(in house):
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BUILDING REVIEW CHECK LIST
UBC: 0— I CONSTRUCTION TYPE: Vi'V
Sq Footage $Per Sq Ftg
Basement x =
1st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ '41,00t
Inspections Required: Work Requiring Separate Permits:
Site I( Plumbing Fire
Hardcover Removal pe Mechanical Water Connection
Footing Septic Sewer Connection
X. Framing Fireplace Lawn Irrigation
pc Insulation (Masonry) Other
ward (Mfg.) Well(State Permit)
pi, Final Grading/Filling 'k Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
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