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Home My WebLink About2004-P07624 - addn/remodel/repair CITY C�F ORONO PERMIT 2750 Kelley Parkway- PO Box 66 Permit Number: Po�62a Crystal Bay, Minnesota 55323 Permit Typ : add�t�o�xemoaeiixepair (952) 249-4600 Date Issue : 6i23�2ooa SITE ADDRESS: 4440 Bayside Rd Maple Plain,MN 55359 PID: 31-118-23-34-0012 I DESCRIPTION: Proposed Use: Residential Pernut Class: Building I ensus Code 434 Permit Type: Addition/Remodel/Repair ermit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: PermitFee: $ 153.25 , Valuation: $ 8,000.00 State Surcharge Fee: $ 4.50 TOTAL FEE: $ 157.75 APPLICANT: Luse and Son,Inc. OWNE : Q C GMINKIN&7 A CAMERON 2420 W Industrial Blvd. 4440 BAYSIDE RD Long Lake,MN 55356 MAPLE PLAIN MN 55359 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE RE L IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK iN STRICT COMPLIANCE WITH ALL CI OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILD DE QUIREMENTS. . � � li � � < c'�-r� c � � �� APPLICANT PERMITEE SIGNATURG ISSUED BY SIGNATURE Copies: 1-File(Si�nitures Required), 1-Anplicant. 1-Monthlv Reports, 1-Assessin�, -Finance Page 1 V� n��L ,� '� • Total Fee: $ c7� �� Date Received: L� "Z Z �O y �v � Entered By: G , '1� Permit#: �U�7(�Z�% �,`2 CITY OF ORONO - BUILDING P RMIT APPLICATION All information must be submitted in full be ore plan review will be started. (please print all info nation) THE APPLICANT IS: (circle oiie) OWNER O CONTRACTOR JOB SITE ADDRESS: y�lO �� s� �o , � » ZIP: .:�5 35 `J Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑ Yes ❑ No If yes, a special event permit is required with Police Department and City Council appYova160 days pf� r to the event. Non permitted events will not be allowed. NAME OF OWNER: ��z ��r' �,n� I�,�: < ' /1/I ��T c ��c� PHONE: (home) 1�� - 4�.Z -v;c! �j (work) MAILING ADDRESS: `��/�/0 %3�. ;;c� !�a�. CITY: (�,,-c., � ZIP: �S35`j --� CONTRACTOR: � �5 P �,� � Sv� .�`�G_ PHONE: �S�� y�S' `�� U CONTACT PERSON: MAR K ORT�/��' OBILE/PAGER: `l�z - i�y- ��7� � P�S r�•� MAILING ADDRESS: � y�-6 ��, _I� Ksf��, l� . CITY: L�� ,/� -� ZIP: SS35 STATE LICENSE: # _5/ 3 y ARCHITECT/ENGINEER: o�-, -� PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move Remodel/Alteration _� Land Alteration PROPOSED WORK(describe i�z detai�: ��u a� � ��'; -� �-'-l�'��- �<<f��'� �i �� ; ;�, K -r�� t�� _ ��„«;, STORIES: SQ. FEET OF EACH FLO R: NO. OF BEDROOMS: GARAGE STALLS ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excl ding land): $ �� n� I hereby apply for a building permit and I aclrnowledge that the i formation 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 w� out a �t; and that the work will be in accordance with the approved plan. �' APPLICANT'S SIGNATURE`! ,' o�' z DATE: U� 02 (] 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. 5ubd.2. Information required to be given individual. An individual asked to supply private or confldential 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 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 identity o[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 5,to a law enforcement officer. The commissioner of revenue may place the notice requlred under this subdivision in the individual income tax or propertv tax refund instructions instead of on those 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 conFdential. Upon his further 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 intormed of the content and meaning of that data. After 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 action pursuant to this section is pending or additio�al data on the individual has been coliected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The respansible authority may require the requesting person to pay the actual costs 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 Gve days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the requestwithin that time,he shall so inform the individuai,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 duys either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's stutement of disagrecment is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions o[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 inforin 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 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. ��A�lc C_' O/�T�Uc�"� First Middle Last Address City State Zip Phone I up er tand m '.hts s tate above. � �'� / � Si a r ✓ DATE I IIME CITY OF ORONO CALLED IN 7'� INSPECTION NOTIC SCHEDULED `7 ' � �� PERMIT NO. �� COMPLETED ADDRESS �� a �efi � i OWNER � ^�' CONTR. � �° �_ TELEPHONE NO. �S a` ��4 � �3 q I � DESCRIPTION K�r�ti /��nc�E,� I � l� 01 F 11 MECHANICAL RI 18 EXCAV/GI ADI /FILLING/ 02 FRAMING 13 MECHANICAL FINAL 19 LAKESH�RE/W TLANDS y 03 ULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE RE�v10VA Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INS�ECTI N Q 05 FINAL 14 SEWER HOOK-UP 06 PROGREISS � � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLPjINT � J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLL0IM-UP i = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD C�VER i EMOVAL � 10 PIUMBING FINAL 36 FOUNDFITION/ EMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENT . � �� .. � � � 0 � 0 � W � Q � � z w � � W � � GW ORK SATISFACTORY:PROCEED '_l PROJECT COMP4�E W ❑ CORRECT WORK&PROCEED C�, ISSUE CERTIFIC/��TE OF CCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTIOtV TEMPORAR V BEFORECOVERING PERM�ANEN ❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN � INSPECTOR WlLL RETURN i ❑ CITATION ISSUEp ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. ' Call for the nex inspection 24 hours in advance. �95�� Z� 9-46�� OwnerlContra n it : Inspector. � White Copyllnspector's File Canary CopylSit�Notic