HomeMy WebLinkAbout2003 - P06755 - addn/remodel/repair PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P06755
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 9/10/2003
SITE ADDRESS: 2715 White Oak Cir
LONG LAKE,MN 55356
PID: 04-117-23-42-0026
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 139.25 Valuation: $ 7,000.00
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 143.25
APPLICANT: Du-All Construction(see notes) OWNER: S&L JENNIGES
10265 99th St.NE 2715 WHITE OAK CIR
Otsego,MN 55362 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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APPL ANT PERMITEE0 ATTIRE A's SUED BY SIGNATURE
Copies: 1-File(Si&nitures Required). 1-Applicant, 1-Monthly Reports, 1-Assessine, 1-Finance Page 1
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. I. Type of data. The tights of individual on whom the data is stored or to be noted Shell be as set forth in this section.
Subd.2. Information regtdred to be given individual. An individual asked to supply psivafe 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 oY 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 slate 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 commissio r of revenue may • . e the notice • ired pder this tuiivision in the individual income tax or prr perey tax refund
insrn,ctiatuin testi g.� Ste 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 scored private or public data on individuals shall be shown the data without any charge to him and:if he desires, be be informedeof to hon fthe otr
and meaning of that data. After an individual has been shown the private data and o addiof tional
s dataa individual need es been disclose or hire f or
six months thereafter unless a dispute or action pursuant to this section is pending theo individual o the indiv the data. The collecrespoted
created.
The responsible authority shall provide copies of the private or public data upon requestby
uthority
esti Caton to pay the actual costs of making.certifying,and compiling the copies.
may require the requesting penton possible,with any request made pursuant to this subdivision,or within five days of
The responsible autlhorigr shall comply itnmcdiately,if
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 inaccurateor ividual omth t ate ecen Bete pthe dnt to o.totify past correct. Dara
recipients of
inaccurnu or incomplete data, including recipients named by the individual;or(b)notify
the indin disputa shall be disclosed only if the individual's statement of pdisagreement ded pursuant to the ons disclosed
of the administrative procedure act relating to
The determination of die responsible authority may be appealed
contested cases. .
DATA PRIVACY VISO Y
•
Irl 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 than
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.
FiMiddle
rst t h
. Last
. _ sena Zip PhoneCityy
I understand my rights as stated above.
n
/►d& ;.rte, 7-
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z1i5 wt- A\IC CI(L.
PID:
DESCRIPTION OF WORK: b. p A — v e+Ao r ,D ecterA,G
ZONING REVIEW BY: .i/e,_ DATE APPROVED: 4'-4-�3
BUILDING REVIEW B . DATE APPROVED: CS-5=03.
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes i No
PLAN REVIEW Yes No t SEWER CONNECTION
STATE SURCHARGE Yes t/ No WA IER CONNECTION
INVESTIGATION FEE • Yes No PARK FEE
SAC Yes No SI'1'EINSPECTION
Number of SAC-Units OTHER (specify)
ZONING CHECK LIST Zoning District: o
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 Sias.:
Rear(Street): Left Side:
Adjacent Structures: N -tland:
Building Height: Def. Hgt. Pe. -Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: 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: CONSTRUCTION TYPE: ("-)
Sq Footage $Per Sq Ftg
Basement x
1st Floor z . _
2nd Floor x =
Garage z =
z
TOTAL
Estimated Construction Value: $ 000 `'`'
Inspections Required: Work Requiring Separate Permits:
Site PIumbing Fire
Hardcover Removal Mechanical
Footing - Water Connection
Septic Sewer Connection
Framing Fireplace
Insulation Lawn Irrigation
Wal (Mason') Other
Wail Board _
— pl (Mfg.) Well(State Permit)
Grading/Filling Electrical(State Permit)
Other
REMARKS(nit HOUSE):
•
REVIEW BY �w ------- ---
OTHERS: DATE: ---�--
Access: Existing New
•
Access Approval: Date
By:
REMARKS (TO BE NOTED ON PERMIT):
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' GUARDRAILS
No, c.i.s._ po, '\\\ \\ •M\StrUCtUraisMent:erS Must Be Approved
V I a 40\ \ \\''s' \NOod Of Natifral Reeisiance To Decay Or 's- 36" . HEIGHT
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED j d• "03 9; 0/4-44
PERMIT NO. 710765 COMPLETED
ADDRESS 97'5 ��ir � Cr-s4-
OWNER
r4-OWNER CONTR.—Da 4if CU SI--
TELEPHONE
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TELEPHONE NO. if;(�- �7�---- P ?
DESCRIPTION 2 r e c a
01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
,Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 BD. 12 WATER HOOK-UP 17 SITE INSPECTION
05 FIN 14 SEWER HOOK-UP 06 PROGRESS
0 O-SITE 27 SEPTIC MAINT. 21 COMPLAINT
`-1 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
IQ 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU: YES_NO
c., COMMENTS:
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2 WORK SATISFACTORY:PROCEED ROJECT COMPLETE
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0 CORRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY
0 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN
INSPECTOR WILL RETURN
0 CITATION ISSUED
13STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne `inspection 24 hours in advance. (952) 249-4600
Owner/Contfa s ter,n v ,y
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
�_ CITY OF ORONO
THIS ITE.. HAS L -- SITE PLAN GRADING PLAN
IC )(E APPROVED F. ED
WITHWITHREVISIONS
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CERTIFICATE OF SURVEY BY / Z —/I i ea
FOR STEVE JENN I GES DATE c' rd 7)144 41'1
OF LOT 4, BLOCK 1 , WHITE OAK OVERLOOK I I
HENNEP I N COUNTY, MINNESOTA 01'0.6143e 101 ID
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I hereby certify that this is a true and correct
representation of a survey of the boundaries of
SCALE : 1 " = 50' Lot 4, Block 1 , White Oak Overlook, the location
DATE : 2-4-88 of all existing buildings, if any, thereon, and
o Iron marker the proposed location of a proposed building. It
does not purport to show other improvements or
encroachments ,
COFFIN & GRONBERG, INC.
Mark S. Gronberg ' ic. No. 12755
Engineers, Land Surveyors & Planners
• Long Lake, Minnesota
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rhs:3, comnitt:t* : for your i"formetico.. All ,.vork shall be do
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