HomeMy WebLinkAbout2002-P05021 - addn/remodel/repair L • .
PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Poso2i
Crystal Bay, Minnesota 55323 Per-mit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 4illi2oo2
SITE ADDRESS: 4225 Forest Lake Dr
Mound,MN 55364
PID: 07-117-23-12-0025
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Permit Sub-rype(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: ����icai(stazej
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 83.25 Valuation: $ 2,500.00
State Surcharge Fee: $ 1.25
TOTAL FEE: $ 84.50
APPLICANT: Owner/Self OWNER: Kenneth Anderson
MN 4225 Forst Lake Dr
Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVENIENTS 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 PERMITF,E SIGNATURE ISSL'ED BY SIGNATURE
Copies: 1-File(Sienitures Required). 1-Applicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
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Total Fee: $ � � . =�� Date Received: �� 7 �" � �
Entered By: ��_ � Pernut#: ��/ � ,�
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CITY OF OR�NO - BUILDING PERMIT APPLICATIOleT
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) ( OWN. E�R CONTRACTOR
JOB SITE ADDRESS: y 7 Z S ��re6`t- �-�2 �R i v2. ZIP: �-`��3� �/
NAME OF OWNER: -�eN ��2✓3 J`'� PHONE: (home) `� 7 Z `� `��76
(work) �'�-w�-�-
MAILING ADDRESS: ;-�-�.� CITY: a2�,ti� ZIP: 553� �J
CONTRACTOR �; -'�� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New _.,,___.��-it-iag Accessory Structure
Move ��emodel/�lte�a�'ron k Land Alteration
PROPOSED WORK(describe in detai�: �.4-��N� I�W t� `�v�-� �,�� �`Ns�.c��.���
w�-i�s
STORIES: Z SQ. FEET OF EACH FLOOR: Z, S c+o
NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET. z !L
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �, ao v
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 Ciry 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 SIGNATURE: � DATE: �y /� a z
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
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Sec.13.04 RIGHTS OF SLJB.TECTS OF D�TA
Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be stored shall be as set fonh in this secdon.
Subd.2. Information reqirired to be given individual. M individual asked to supply private or confidendal dara concerning hicnself shall
be informed of: (a)the purpose and iatended use of the requested data within the collecang"state agency,polidcal subdivision,or sratewide 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 confidendal data;and(d)the idenrity of other persons or enrides auchorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieauve dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or pro�ertY tax refund
instructions instead of on those forms.
Subd. 3. Access to data by indi�idual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject
of stored data on individuals, and wherher it is classified as public, private or confidenoal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown[he data wirhout any charge to him and, if he desires, shall be informed of the content
and meaning of rhat dara. 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 acaon pursuan[to [his secdon is pending or addiaonal data on the individual has been collected or created.
The responsible authoriry 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 coses 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
[he date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with[he 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 pubiic or pri�•ate
data concerning himself. To exercise this righ[,an individual shall noafy in wridng the responsible authoriry describing[he nature of the disagreeme�t.
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, inciuding recipients named by che individual;or(b)nodfy the individual that he believes the data to be correcc. Data
in dispute shail be disclosed oniy if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible aurhoriry may be appealed pursuant to the provisions of the administradve procedure act relaring 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 deternune your qualification for the pemut 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 pemut 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.
(, Your full name is required to process this application or permit.
�nn�Gt"� C�c'r� �� �jvG���50.tJ
First Middle Last
Lf Z Z S —�.'c'�� %s4�i� �i-r��
Address �_�U.vJ �-(/" SS36�� �.SZ / 7Z �����i
C%
Ciry State Zip Phone
I understand my rights as stated above.
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Signa[ure
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: L12 2S F n czxsT �..iA�c.�, p�2 .
PID:
DESCRIPTION OF WORK: �q�-�,t E�,-� 1�nr�s N
ZOrT�i tG REV�W BY: /� DATE APPROVED:
BUII.DPIG REV�W BY: DATE APPROVED: 4/_i/- o Z
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ,/ No
PLAN REVIEW Yes No � SEWER CONNEC"ITON
STATE SURCHARGE Yes �/ No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CH�CK LIST Zoning District: N 0 G/-f i9�G-P
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Wi th Depth
Survey Submitted: Yes I�10 ate of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetlan :
Building Height: Def. Hgt. Peal:H t.
Lot Covera�e:
�
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # esolution Date:
Shoreland Distric[:
I
Avg. Setback: Bluff Setback: L.ot Coverage:
Ezisting Proposed
Hardcover: 0-75' ''i
75-250' �
250-500' �
500-1000' �
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
, ,
BUILDING REV�W CHECK LIST
�C� /2� 3 CONSTRUCTION TYPE: v�
Sq Footage $Per Sq Ftg
Basement x _
lst Floor z =
2nd Floor x =
Garage x =
R -
TOTAL
Estimated Construction Value: $ 2,5 do '�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
F�t�g � Septic Sewer Connection
o� Framing Fireplace Lawn Inigation
�^Insulation (Masonry) Other
�Wall Board (Mfg.) Well (State Permit)
_�Final Grading/Filling �_Electrical (State Permit)
O[her
REMARKS(IN HOUSE):
-------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy:
REIVIARKS (TO BE NOTED ON PERNITT): M
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_'tP THIS FL,r,h jLT(Ui�J 1"E AT ALL Tllvlc8
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO IC SCHEDULED �/-�� �h
PERMIT N0. � U� COMPLETED ��
ADDRESS `���5— f"li�I-�'�� �G:�-c- `�1_�`�
OWNER�I��y� �,t���-��c� CONTR. �'��r1�%c
TELEPHONE NO�"� �7� S��'�C.�
� DESCRIPTION
l� O7 F / 11 MECHANICAL 18 EXCAV/GRADING/FILLING
Q2 FRAp It�� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPIAINT
� 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:
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W/D�tlQORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
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W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP OR�ER POSTED.CALL INSPECTOR
❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �95Z� Z49-4600
OwnerlContrac r t :
Inspector
White Copyllnspector's File Canary Copy/Site Notice
�,ei�%� DATE TIME
CITY OF ORONO CALLED IN
INSPECTIO NOTISE SCHEDULED -� �� --��.�3 �
PERMIT NO�� � � �I COMPLETED ' �O2— ��(Z
ADDRESS
OWNE�i �o�?��-�-J CONTR. -a���
TELEPHONE NO. s� �7v� .S-D��
� DESCRIPTION
� Ot FOOTING � 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATIGN 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
� 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:
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W� �/ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W j�CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ( ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
�NSPECTOR W{LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTIONRE�UIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContrac r �t�
Inspector. � �f�
White Copyllnspector's File Canary CopylSite Notice
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION nIC SCHEDULED " "�� 3��
PERMIT N0. L" �Q COMPLETED -0� � � U
ADDRESS � � - /1.<--�
OWNER C.�-+��-- CONTR. �
TELEPHONENO. �S�- S �
� DESCRIPTION
� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAt�ING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�03 INSULATIO� 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z U'4�1ALt'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
� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ,�VORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W �❑CORRECTWORK&PROCEED ❑ ISSUECERTIFICATEOFOCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTEO.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARFiANGE ACCESS.
Cali for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContr ctor on site:
Inspector. :��� ��-��
White Copyllnspector's File Canary CopylSite Notice