HomeMy WebLinkAbout2007-P11100 - entrance monuments PERMIT
CITY OF ORONO Permit ►vumber:
2750 Kelley Parkway- PO Box 66 P11100
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 149-4600 Date Issued:
6/19/2007
SITE ADDRESS: 960 Brown Rd N Unit#
Long Lake,MN 55356
P��� 27-118-23-43-0025
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Permit T e: Accessory Structures Permit Sub-type(s): Entrance Monuments
YP
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 139.25 valuation: $ 6,800.00
Plan Review Fee: $ 90.51
State Surcharge Fee: $ 3.40
TOTAL FEE: $ 233.16
APPLICANT: Ken Larson Masonary Inc. OWNER: Garry&Shannon Banks
P.O. Box 576 960 Brown Rd N
Excelsior,MN 55331 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMtSSION 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.
`-�-�_ ���.�°-�-�-- � r`�-��- �- f (�'rl � � �� /�/�
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
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'�,;' Total Fee: $_ 3,(, DateReceived: (D'1 ��, �1'I�"^
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Entered Ey: rermit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(plense print all inforrrentioii)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (ci�•cle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �(' � �Y0`'�`� � d ZIp; �S 3
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 Deparbnent and City Council approval
60 days prior to the event. Shuttle birs service wil!be regzeired iGnless applicant demonstr•ates
sa fficient on-site parking is available. Non-per•n�itted events ivill not be allowed.
NAME OF OWNER: Ga Y y �jj �vr /� S PHONE: (home)c/s� �lQ� •�-��'`�
n (work)
MAILING ADDRESS: �� � ,U r����+ f1'c� CITY: aN a �, ZIP: 3
CONTRACTOR: �` �- ti � a rJ��i �as�hry PHONE: ���-2 y7o i/i2
CONTACT PERSON: j�� `-� MOBIL /PAGER:
MAILING ADDRESS: �a /�� x S�6 CITY: �X�/s�oY ZIP: SS33%
STATE LICENSE: # �t10'r ll.tyv�.t�0 d°�, EXPIRATION DATE:
ARCHITECT/ENGINF.ER: PHONE:
NIAILING ADDRESS: 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(desa�ibe in tletui�: � d d,� l o� o -� �2
�r«i< <— hf�-a�� �i�, o�� �� � f-s
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land j: � G ��U �
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�vith the ordinances and codes of tl�e City and with the State Building
Code;that I understand this is not a permit and�vork is not to start without a permit;and that the work�vill be
in accordance with the approved plan.
APPLICAIVT'S SIGNATURE: ,�c� �l�.-�„-�, DATE: 6 7 -0 7'
;�
,
Sec.13.04 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. Information required to be given individual. An individual asked to supply private orconfidential data conceming himselfshall 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 identiry 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�,to a law enforcement officer.
The commissioner of revenue mayplace the notice required under this subdivision in the individual income ta�or propercv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authorit��,an individual shall be infonned whe[her he is the subject of
stored data on individuals,and whether it is dassitied 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 shown the data without any charge to him and,if he desires,shall be informed ofthe content and
meaning of that data. After an individual has been shown the private data and infonned 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 aud�oriry shal I 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 shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,escluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f 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 coinplete. An individual may contest the accuracy or completeness of public or private data
concerning himself. To exercise this right,an individual shall notity in writing the responsibfe audiority describing the nature ofthe disagreement. The
responsible authority shall widiin 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccura[e or incomplete data,including recipients named by the individual;or(b)nocity the individual that he believes the data to be correct. Data in
dispute shall be disclosed only ifthe individual's statement of disagreement is included with the disclosed data.
The determination of the responsible audiority 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 ofdata",we would like to infonn you that your request
for a pennit 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 wiil 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 a�encies to the extent necessary to
process the permit or license.
4. If your requested permit or license requires Council action to approve,some infonnation may become
public.
5. You have eertain rights under M.S. 13.04(available upon rec�uest)to review private data on yourself.
6. Your full name is required to process this application or permit.
First ��� �liddic Last
/� /� ;1 .
Address )
`J
CitY State Zip Phonc
I understand my rights as stated above.
/ ��� �� � �� 0�1
Si�naturc
Reset Form .?�
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �6� ��w r-► �°'� l�a
PID:
DESCRIPTIDIV OF�VORK: c:,iv i RAn�cl vvl.on����'f"S
---------------------------------------------- --------------------------------------------------------------Q;------
ZONING REVIEW BY.• � DATEAPPROVED: 6 -�l�
BUILDING REVIEW BY.• _ DATEAPPROTfED: 6-i �-07
FEES TO BE CHARGED: ll�lisc. Fees Calcz�lated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes_/� No SEWER CONNECTION
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE Yes No ✓ PARK FEE
SAC Yes No 1/ SITEINSPECTION
l�rtrnzbe��of SAC Unils OTHER (specify)
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ZONING CHECK LIST 7_o��i�Tg Disrricr:
Fire Departrnent: Post Office: School Distr�ict:
Lot:(rea: Sg.ft. .9cres YI%iclth Deptlz
Survey Szrbmitted,- Yes v'� No Date of Siuvey: o� F�w
Proposed Setbacks: /
Front(Lake): 5 Right Side:
Rear(Str•eet): L�ft Side:
o�
�C.� Adjacent Strirctzrres: Wetland�
�(/ 13ziilding flerght: Def. H�t. Peak Ngt.
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Lot Coverage:
Grnding: St�rff.dpprovalDate: Bv: Caunci(,4pproti�alDate:
Septic: Stnf'f.4pproval Date: �y
Zo��ing File: � Resoh�tiof�: # Resolulion Da(e:
Sha��elc�nd District: A-lCGG'D Per•�rrit:
�lvg. Setback: BluffSetback: LotCover�age:
Earslrng Proposed
Hnr•dcover: 0-7�'
7i-?i�' `
?so-snn�
�on-�000�
Ha�dcover 6'nrinnce 12equired }"es :\'o Date of Cou��cil.9pprol�n(:
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�Jv� �� � � DATE TIME �
�� CITY OF ORONO CALLED IN � ��C'
INSPECTION NOTICE SCHEDULED /„ �2 O
PERMIT NO. PII/C4� COMPLETED
ADDRESS �� � /v L��� �'�
OWNER o��� CONTR. ����'✓
TELEPHONE NO. `�'�� ' 7�v �� � '
� D TION �1.� e�� ' '�'�l
l� 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRAD G/FILLING
� NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 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 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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED f� PROJECTCOMPLETE
W ❑ ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS.
Cali for the next inspection 24 hours in advance. (952� 249-46��
OwnerlContractor on site:
Inspector. l�f ��r�"���
White Copyllnspector's File Canary CopylSite Notice