HomeMy WebLinkAbout2005-P08247 - add/remodel/repair PERMIT '
� CITY OF ORONO Permit N'um er:
2750 Kelley Parkway - PO Box 66 Pos24�
, Crystal Bay, Minnesota 55323 Permit T�ype Aad�t�o�xemoaevxepa�r
(952) 249-4600 Date IssUed 3/24/2005
SITE ADDRESS: 4360 Bayside Rd
Maple Plain,MN 55359
PID: o6-ii�-23-i2-000i �
DESCRIPTION:
Proposed Use: Residential �
ensus Code 434
Pernut Class: Building �
Permit Type: Addition/Remodel/Repair ermit Sub-type(s): Garage-Attached
DETAILS:
Approved per resolution#: 5288
Separate pernnts required: Eiecuicai�staiej
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 441.75 Valuation: $ 29,710.00
Plan Review Fee: $ 287.13
State Surcharge Fee: $ 15.40 �
TOTAL FEE: $ 744.28
APPLICANT: Owner/Self OWNE : Mr. &Mrs. 7ames Olson
� 4360 Bayside Rd
Maple Plain MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE AL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH A,LL C TY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS. �
� __. 1��� , , - ' �`�C�"�
AP LICANT PGRMITEE SIGNATURE SSUED BY SIGNATURE
Copies: 1-File(SiQnitures Repuired), 1-Applicant, 1-Monthlv Reports. 1-As�essin , 1-Finance Page 1
� Total Fee: $ i ' � , � ate Received: I Z-Z -Qy
� Entered By: ����� P rmit#: /� 0�,�y 7
.
CITY OF ORONO - BUILDING PE MIT APPLICATION
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'��� All information must be submitted in full befo e plan review will be started.
�� (please print all iiifori�iatio�z)
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THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR
JOB SITE ADDRESS: �1 -���L� �j�� �J�C��cl''--- ��rP-(�! O1'(7��� ZIP: ;��J�
Will this be a Parade of Homes, Remodelers Showcase H me or other Display I3ome?
❑ Yes � No If yes, a special event permzit i �•equired with Police Department and Citv
CoT�yacil approval 60 days pf•io to the everrt. Nofa per�nitted evei�ts will not
be allowecl.
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1 �
NAME OF OWNER: , �G.-�mE�S � l/'�`:��� PHONE: (home) �j�� �{���'h�S(r� �
� � �I �work) Lz i� �%'�^ ���i�' �
MAILING ADDRESS: ���U ���.'s���-�:��(;�: �_�r�(�� � ITY: ���tC7�r : ZIP: ��� ��'
� �b _ ' .
CONTRACTOR: �� � liC�'=�� �,�� �ti�� �� PHONE: C�j,��c�,'�19� )
CONTACT PERSON: ��c�c r� OBILE/PAGER: �,,1- —<�( �— �V�c
C� L �� �. � C. J I �
MAILING ADDRESS: (,�"� �!�r4 i;:s ru 1�;",� . CITY: � � p,�� ZIP: r��31�
STATE LICENSE: # �;3::3(,� � ,
ARCHITECT/ENGINEER: C� �p�'� � 'Si � �tc �i�:s PHONE: ��� �`���1`Sf����
MATLING� DDRESS: �� c F , �� - 51�;��'�� rc�. ��ITY: r/���r�1--c��i���' I��)�ZIP: ��37�3�
NAME: • ��t:�<_ O� � - �- REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition �_ Move
Remodel/Alteration Land Alteration
�, � -� � -- �
PROPOSED WORK(describe i�z cletai�: ��C��� � �� �' ��'�x � ����.� G�,'�r���'- '�c>
4' I`- ii�� �,< <<, ;
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STORIES: SQ. FEET OF EACH FL OR:
NO. OF BEDROOMS: GARAGE STALL : ATT. DET.
<c'
ESTIMATED CONSTRUCTION VALUATION (excl ding land): $ �.�; ��1 r<���
I hereby apply for a building permit and I acknowledge that the nformation above is complete and accurate;that the
work will be in conformance with the ordinances and codes o the City and with the State Building Code; that I
understand this is not a permit and work is not to start withput a ermit; and that the work will be in accordance with
the approved plan. _ .__
��,� ;�I�
APPLICANT'S SIGNATURE: /l�� .�'� DATE: l� a`�-�f'/
I �
Sec.13.04 121GHTS OF SUBJECTS OE DATA
Subd.1. Typc of data. Thc rights uf individual on whom thc 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 con�dential data concerning himself shall be
intonned of: (a)the purpose and i�tended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is Icgally required to supply the requested data;(c)any�known consequence arising trom his supplying or refusing to supply
private or confidential data;and(d)the identity of othcr persons or entities authorized by state or federal Iaw 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 Iaw enforcement officer.
The commissioner of revenue mav n�ace the notice required under this subdivision in the individual income taz or aropertv tax reCund
instructions instcad of on those forms.
Subd.3. Access to data by individual. Upon request[o a responsible authority,an individual shall be informed whethcn c�is the subject ot
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 privatc or public data on individuals shall be shown the data rvithout any chargc to him and,it he desires,shall be informed of the coatent and
�neaning of that data. A[ter an individual has bcen shown the privatc data und informed of its meaning,tlie data nced not bc 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 wllected or created. The
responsible authority shull 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 mal:ing,certifying,and compiling the copies.
Thc responsible authority shall comply im�nediately,if possible,with any requcst made pursuant fo this subdivision,or within Eve days of thc
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compl��with the request within
that time,hc shall so in(orm the individual,and may hxve an additional fivc days within which to comply with the request,cxduding Saturdays,Sundays
and Icgal holidays.
Subd.4. P�roccdure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning hiroself. 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 eithe�: (a)correct the data found to be inaccurate or incompletc and attcmpt to notify past rccipicnts of
inaccurate or inwmplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correcL Data in
disputc shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
7'he determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested crses.
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 pernut 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 qualitication for the peraut 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 pernut 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.
�
Ja�� %�-��.���. -:��� Y,
First Middle Last
�'-;�� ��z,cl�cG� �Cx-�cX
Address �
^
����.-y�..;_, i��,��. ���t-���1�� ��`�.--`( jl,_��`-64
City State Zip Phone
I understand my rights a1s stated above.
,-- ;
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Signatu e '
� CKECK OFF LIST FOR ISS�IA� CE OF PER1ti.tITS
FOR OFFICE USE NL Y
ADDRESS ORLEGAL: �I3�v AYS/rJC� �
PID:
DESCRIPTIONOFYf�O,RK: 6�R� c:. A/JDr io
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ZOzVI�VG RE VIE Yi�B Y: �-- D.ATE APPRO VED: 3-i�-o S
B LiILDI1VG REVIE Y��.8 Y. Dr�TE APPRO�'E.D: 3-i�-�s
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FEES TO BE CHARGED: hlisc. Fee Cnlcicfate�f By:
PERNIIT Yes ✓ No
PLAIV REVIEGV Yes _�� 1Vo SEWER GONi�IECTIO�V
ST�.TE SURCH.4RGE Yes ✓ t�Io tiVATER GO�VIVECTI0IV
IIVVESTIG,4TIO1V FEE Yes tVo PARK FE'E
StIC Yes No SITE NSPECTION
��Vtunber of SAC Units __ OTHER (specify)
---------------------------------------------------------
Z'O�VIIVG CHECh'LISZ zoiurig Disn•tcc:
Post O �ce: Sdi.00l Dish•ict: __..
Fire Deparhner�t: ff
Lot,�{rea: S t. Acres 3•S� � idtlr y Z to Depth
�•�
Sicrvey Scebr�iitted: Yes ___�C__ No Date of Su�vey: 1Z'�'Dy
Propased Setbncks:
F�•orir(Lalce): �12' � Right Side: � I 23.b �
� t Le t Side: �S fi
Rea�•(Sh�eet): �(�d f
Adjncent Sti•uctu�•es: /4iTr�c-lfL-'n F�etla�t : �/A
Buildi�rg Heiglit: Def. Ngt. D.l� PhRk gt. O.K
Lot CoverRge: � N�P�
Gr'nding: Stnff.4pprovcclDczte: — By: Cocuicilr[p�rovctlDRte:
S�pttc: Scnff,�pproti�a!Date: — By�
Zorti�zg File: � �� Resolutio�t: # Resolutio�z Dnte: Z-Z 8 ' �S
Slio�•eland Dish•ict: N�
�(vg. 5etbnck: Blccff Setbac/: Lat Coverage:
Esistin; PropoSed
Hardcover: 0-75'
75-250'
250-500' �
500-1000'
Hardcover Vm•iatzce Req�cit•ect: Yes N Date of Coautcil�ipproval:
REMARKS(irt house):
31
: ,
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B UILDItVG.RE VIE F�Y CHECh LIST
UBC: _ (L• 3 CONSTRUCTIO�V TYPE: '�!N _
Sq FoatnJe .�Per•Sq Fr,�
Basen�erit x =
!sc Flaor x =
3ncf Floa• s =
Gara�e 1 =
.� _
TO T�{L
Estirrcated Consh•uctio�c L'alue: S ��j,11U
Lispections Required: tF'ork Regcciri��;Separate Perniits:
Sr�e Plctuibing Fi�•e
Hardcover R��noval N(echani.cal GYnte�•Ca�uaection
_�C Fooh:ng Septic Setiver Catriection
_�Franiir�� Fireplace Lawn. lrrigatio,:
lnsulation (��lasonn;) Ocher
GY"a1!Board (Nlfg.) G�efl(Srate Perrnit)
_Qc Fina! Gradirtg/Filli�t�; Oc Elecb•icaf(State Perjr�it)
Other
RE1tiIA.R1';S(IN HO USE):
-----------------------------------------------------------------------------------------------------------------------
RE f�IE YY'B Y OTHERS: DATE:
.4ccess: Existin,� rVew
,�iccess�{pproval: Date By;
-----------------------------------------------------------------------------------------------------------------------
1ZE�'�I�IRh'S (TO BE tvOTED ON PERctiIIT):
32
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FROM : 0'KeeFe Des�9n Associates PHONE N0. � 952 447 5046 Mar. 16 2005 08:54AM P1
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DATE TIME
CITY OF ORONO CALLED IN � -.3�v-�
INSPECTION NOT E SCHEDULED .� "fv 'O� ' � �/�
PERMIT NO. �' � COMPLETED N �
ADDRESS `�� s[� ��� ��
OWNER �1���1�- CONTR. � O�
TELEPHONE NO. ��� T• � • ����
� DESCRIPTION C�' cz , I
� 01 FOOTING 11 MECH ICAL RI 18 EXCAV/�RADI G/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHOR ETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE R�MOV L
� 04 WA�L BD. 12 WATER HOOK-UP 17 SITE IN PECT ON
� 5 FINF�,L 14 SEWER HOOK-UP 06 PROGR�SS
MO-SITE 27 SEPTIC MAINT. 21 COMP INT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOWI-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD C70VER�tEMOVAL
J 10 PLUM8ING FINAL 36 FOUNDATION REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO i
� COMMENTS:
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� s�GWORK SATISFACTORY:PROCEED �OJECT COMPLETE
W ❑CORRECT WORK&PROCEED Il ISSUE CERTIFICATE OF CCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORAR
V BEFORECOVERING PERM�NEN
O CORRECTUNSAFECONDITIONWITHIN HOURS. L, pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUEDI I
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z 9-46�0
OwnerlContractor it •
Inspector.
White Copyllnspector's File Canary Copy/Site I�otice
i �� DATE,/ ' 'TIME
�� CITY OF ORONO CALLED IN L ' 'L�`{ I
INSPECTION NO ICE SCHEDULED _`��� �
PERMIT NO. a�� COMPLETED
ADDRESS �-�' ��
OWNER CONTR. �
L�
TELEPHONE NO. r� �� � �� �
� TION �'`
01 FOOTING 11 MECHANICAL I 18 EXCAV/(�RADI G/FILLING
13 MECHANICAL FINAL 19 LAKESHIDRE ETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE R�MOV L
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE IN�PECT N
Z
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRLSS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLb,INT �
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOV�-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD O�OVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDJITION EMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� NORKSATISFACTORY:PROCEED r:, PROJECTCOMPLIIETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATIE OFOCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPPRAR
� BEFORE COVERING PERM NEN
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN �
INSPECTOR WILL RETURN I
❑ CITATION ISSUE�
❑STOP ORDER POSTED.CALL INSPECTOR I
C INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
t
Call for the next spection 24 hours in advance. 95 I 2 Q-46QQ
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OwnedContrac�a s�t : '
, �
Inspector.
White Copyllnspector's File Canary CopylSitelNotic