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Home My WebLink About2006-P09866 - addn/remodel/repair PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po9866 Crystal Bay, Minnesota 55323 P2r'r711t Type: Addition/RemodeURepair (952) 249-460�� Date Issued: 5/24/2006 • SITE ADDRESS: 800 Brown Rd N Unit# Long Lake,MN 55356 PID: 34-118-23-11-0007 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Addition/RemodeURe air Permit Sub-type(s): Addn/Remodel/Repair Permit Type: P DETAILS: Approved per resolution#: Separate permits required: Electrical(state)Other-(Must Hook Into City Sewer By 12/31/07) NOTICES/REMARKS: Minor Framing,Replace Insulation&Drywall Main Floor&Bedroom FEE SUMMARY: Perniit Fee: $ 167.25 valuation: $ 9,000.00 Plan Review Fee: $ 108.71 State Surcharge Fee: $ 4.50 TOTAL FEE: $ 280.46 APPLICANT: Owner/Self OWNER: Meg&Jon Pendleton MN 800 Brown Rd N 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. � � ` �.�� —��{ �� `�� L 'T PERMITEE SIGNATURE ISSUED BY SIGNATLJRE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 /V�.c�.�r L�� c��c' .i�.�y� � , �-�� S��er— t3�1 �� -�� , �,. i`'.. � ��s / ��5'��C.� ,Total Fee: $ �� ' � �L Date Received: EnteredBy: �-/� c: ;r�", �/?� Permit#: � —/� �(�� CITY OF ORONO - BUILDING ERMIT APPLICATION All information must be submitted in ful before plan review will be started. (please print all ' formation) -------------------------------------------------------------- --------------------------------------------------------- THE APPLICANT IS: (circle o�ze) O R OR CONTRACTOR JOB SITE ADDRESS: �� ,� I�� N� � ��o /`'t.ti� ZIP: �� 3 �� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �NO !f yes, a special event pernait is requirec!with Police Deparfinent and City Council appr•ova! 60 days prior to the everzt. Shuttle bus service will be regt�ij-ed unless applicant demonsti•ates satff cient on-site parking is avnilable. Non-perrnitted evef�ts�vill not be allowec! / NAME OF OWNER: � �'�� P�''�� ''� PHONE: (home) 9SZ y7 2. S� 8 � �� e:1� � �� ,;�,�a�y --� (wock> 6rz- f�Y"— Y9 Y7 c�l� MAILING ADDRESS: 5�� rM �� CITY: L? r un o ZIP: 5'S3 !c�{ — CONTRACTOR: �- 5�- ��* ��" PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home RemodeUAlteration (ie: Siding, Windows) � Any earth movement may require MCWD review and permits ! PROPOSED WO/jRK(describ/e in ctetain: ��+� �r�;�^�� '�eC��r�� n�� (�p ��c� I�S�"(R,tr�Ii s1�1(}� rca N,��t�( i�� h1��n �� j!V ' !' ,� �@ c�i U:;�•�t STORIES: ✓ SQ.FEETOFEACHFLOOR: A �-c� Z`�00 �Y'�='�� l�ls�.� Zc�e � ��er NO. OF BEDROOMS: �� GARAGE STALLS: ATTAC ED 2 DETACHED ��r � cL ESTIMATED CONSTRUCTION VALUATION(excluding land): � "'��'�' ` i hereby apply for a bui►ding permit and I acknow(edge 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 plan. � �� APPLICANT'S SIGNATURE: � l�L �{% DATE: � � � C� _ 3t Sec.13A4 RIGHTS OF SUBJECTS OF DATA > Subd. 1. 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. Infonnation required to be given individual. An individual asked to supply private or confidential data concerning himselfshall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide systein;(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 priva[e or contidential data;and(d)the identity oti other persons or entities authorized by state or federal law to receive[he data. This requirement shall not appiy 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 mav olace the notice required under this subdivision in the individual income t�x or arooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon requestto a responsible authoriry,an individual shall be infonned whether he is the subject of stored data on individuais,and whether it is classitied as public,private or contidentiaL Upon his fuRher request,an individual who is the subject of stored private or public data on individuals shall be sho4vn the data�vidiout any charge to him and,if he desires,shal I be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meanin�,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 ofthe private or public data upon request by the individual subject ofthe data. The responsible authority may require d�e requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible aidhority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days oP the date of the request,eachiding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannot comply with the request within that time,he shall so inform the individual,and may have an additional fi��e days�vithin 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 conceming himself. To ezercise this right,an individual shafl notity in writing the responsible authority describingthe nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data fow�d to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notity die individual that he believes the data to be correct. Data in dispute shall be disclosed only iti the individual's statement of disagreeinent is included with the disclosed data. The detennination 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 pern�it 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: l. 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. ��o n �Vt ;Z��t.a.e�� C'"E'��P ��1 First �liddle LAst �� s� N �q��,�,,, �� Address �,-�.-�o M ,,� � �� z � <��- �r9�� Cih� State Zip Phonc I understand my rights as statpd above. � '• �ti�'�'ti��'L-LIr� Signature Reset Form �� CHECK OFF i,IST FOR ISSUANCE OF PERiVIITS FOR OFFICE USE ONL�Y ADDRESS OR LEGAL: 4U �� ' ' PID: � DES�RIPTION OF WORK: ,�.'. l � �� -- ��'" -------------------------------------- ----- --- ------ --- ----�- ,---- ------------- ' ZO�G REVIE�V BY: v _/� -. DATE APPJ20VED: '—`S / ? 06 BUILDING REVIEtiV BY: DAT`E APPROVED; FEES TO BE CHARGED: Misc. Fees Calculated By: PERNIIT Yes ✓� No PLAN REVIEtiV � Yes —,� No SEti�IER CO�INEC`T'ION STATE SURCHARGE Yes _ / No WATERCOiVNECTTON INVESTIGATION FEE Yes No —� PARK FEE SAC Yes No � SITEII�TSPECTION Number of SAC�Units OTHER (specify) ------------------------------------------------------------------ U ZONii�IG CHE.CK LIST Zoning Districr. 12— I /V' C �f��CJ� � Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Froat (Lake}; Rioht Side: Rear(Street): Left Side: Adjacent Structures: Wetlan : Buildin� Height: Def. Hgt, Peal:Hgt. Lot Covera;e: Grading: Staff Approval Date: Council Approval Date: ' Septic: Staff Approval Date: �Y� Zonin� File: n Resolution: # Resolution Date: _ Shoreland District: Avg. Setback: Bluff Setba : L.ot Covera�e: E�isting Proposed Hardcover: 0-75' 75-250' 2�0-500' 500-1000' Hardcover Variance Required: Yes No Da�e of Council Approval: RE��L4RKS (in house): BUII�DING REVIEtiy CHECK LIST + �, �C� � ' 3 CONSTRUCTTON TYPE: �l� Sq Footage $ Per Sq Ftg Basement x = lst Floor x = 2nd Floor x = Garaae x _ z — TOTAL Estimated Construction Value: $ �, �� Inspections Require�: tiYork Requiring Separate Permits: S ite Plumbing Fire Hazdcover Removal Mechanical Wacer Coaaection Footing ' Septic Sewer Connection _�Framing Fireplace Lawn Irrigation �_Insulation (Masonry) Other Wall Board (Mfg.) Weil (S[ate Permit) __�F�� Grading/Filling Ac' Elec[rical (State Permit) Other REMARKS (TN HOUSE): � --------------------------------------------------------------------------------------------------------------- REVIEtiV BY OTKERS: DATE: Access: Ezisting New Access Approval: Date By; -------------------------- RE1�IA_RKS (TO BE NOTED ON PERIIRT): 8