HomeMy WebLinkAbout2006-P09561 - addn/remodel/repair PERMIT
CITY �JF C�RONO
2750 Kelley Parkway- PO Box 66 Permit Numb r: p09561
Crystal Bay, Minnesota 55323 Pel'mlt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
2/23/2006
SITE ADDRESS: 4455 Bayside Rd Unit#
Maple Plain,MN 55359
PID: 06-ll 7-23-21-0002
DESCRIPTION: BC Occupancy R3
onstruction Type VN
Proposed Use: Residential
ensus Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair ermit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
OWNER TO SIGN SEPTIC AGREEMENT
FEE SUMMARY: Permit Fee: $ 1,273.75 valuation: $ 150,000.00
Plan Review Fee: $ 827.94
State Surcharge Fee: $ 75.00
TOTAL FEE: $ 2,176.69
APPLICANT: GabrielJabbour OWNER: WofMinnetonka
21 University Avenue NE 4455 Bayside Rd
Minneapolis,MN 55413 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 CIT OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
� �� ��.� ��}-Y 7C��+, ���f G��,.
A LICANT PE TURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, If Septic, 1-Septic) Page 1
uM- �" � " � .
�
Total Fee: $ a,�76. �29 Date Received: �=�7�'�"
Entered By: �r Permit#: -�,L,' `l��j�^�
CITY OF ORONO - BUILDING PE IT APPLICATION
All information must be submitted in full efo e plan review will be started.
(please print all in orn ation)
THE APPLICANT IS: (circle one) OWNE�2 O CONTRACTOR
JOB SITE ADDRESS: � r ✓� � ZIP: - �f
i
Will this be a arade of Homes, Remodelers Showcas Home or other Display Home?
❑ Yes �No If yes, a special event perrnit is reqarired tivi h Police Depar-t�rrent and Ciry Coamcil approval
60 days prio��to tl�e event. Shzrttle bars servi e tivill be r�eqa�ired zrnless applicant demo��strates
sz�cient on-szte parking is available. No pe�mitted events will not be allowed.
NAME OF OWNER: ` a.J �'L %' fJ n; T c� PHONE: (home) �t 5 Z- `���-�y S�G
(work) � �2- s���-Z�3 �
MAILING ADDRESS: � � 5 T��K� ;,c.'A� ITY: c� R�'l�C� ZIP: 1�5-351 l'
CONTRACTOR , � � PHONE: ,��I Z-52i��z �3 �
CONTACT PERSON: OBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # E RATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: GISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/ lteration(ie: Siding, Windows)
PROPOSED WORK(descrihe in detai�:
STORIES: SQ.FEET OF EACH FL OR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excl ding land): $ �-5�0 Dov
I hereby apply for a building pennit and I acknowledge that the information above is complete and accurate;
that the work will be in conformance with the ordinances and odes of the City and with the State Building
Code;that I understand this is not a permit and work is not to st rt without a pennit;and that the work wi11 be
in accordance with the approved plan.
APPLICANT'S SIGNATURE: �� �, DATE: � - 2 � Ol�
31
Sec.13.04 RICHTS 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 or confidential data concerning himself shall be
infonned 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 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 5,to a law enforcement officer.
The commissioner of revenue mav ulace the notice required under this subdivision in the individual income tax or nropertv tax refund
instructions instead of on those fonns.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of
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 private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and
meaning of that data. After an individual has been shown the private data and informed of i[s meaning,the data need not be disdosed 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 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 shall comply immediately,ifpossible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immedi3te compliance is not possible. If 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 complete. An individual may contest the accuracy or completeness of public or private data
concerning himself. To exercise this righ[,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attetnp[to notify pas[recipients of
inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Daca in
dispute shall be disclosed only if the individual's statement of disagreement is included witlt the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the adtninistrative 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 infornl 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 pern�it 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 pern�it 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 pennit.
First Middle Last
Address
C�ty State Zip Phone
I understand my rights as st above.
Signature
32
� �
�HECK OFF LiST FOR ISS�JAN E OF PERMITS
FOR OFFICE USE O LY
ADDRESS OR LEGAL: 5�yss yS�O� i �
PID:
DESCRIPTION OF WORK: =v�.-�o Z
ZO.�i G REVIEW BY: DATE APPROVED: �J (A
BUII�DING REV�`V BY: DATE APPROVED: 2-�-o�
FEES TO BE CHARGED: Misc. F�ees alculated By:
PERMIT Yes � No
PLAN REVIEW Yes _�/ No SEWER CONNECTTON
STATE SURCHARGE Yes _�� No WATERCONNECTTON
INVESTIGATION FEE Yes No _�/ PARK FEE
SAC Yes No _� SITEINSPECTION
Number of SAC Units OTHER (specify)
ZOVI�tG CH�CK LIST Zoning Districr. o G
Fire Department: Post Office: School District:
L.ot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Froat(Lake): Right S' e:
Rear (Street): Left ide:
Adjacent Structures: Wetland:
Buildin� Height: Def. Hgt. Peal:Hgt.
Lot Covera�e:
Grading: Staff Approval Date: Council Approval Da[e:
Septic: Staff Approval Date: /UP�c95 ll,�c�}cpw� B : - pus�� � 5f6� �P��-�
Zoning File: # Resolution: # Res lution Date:
Shoreland District:
Av�. Setback: Bluff Setback I,ot Coverage:
Ezisting Proposed
Hardcover: 0-75' '
75-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REviARKS (in house): nT�/( �6h� /I � /� ��7�vi L-YVT"
7
BUII�DING REVIEW CHECK LIST
�C� I�" 3 CONSTRUCTTON TYPE: �f�
Sq Footage $Per Sq Ftg
Basement x _
lst Floor x _
2nd Floor x _
Garage z =
z =
TOTAL
Estimated Construction Value: $_ (�Q,(�� �'
Inspections Required: 1�Vork Requiring Separate Permits:
Site �_Plumbing Fire
Hardcover Removal _�Mechanical Water Connection
Footing � Septic Sewer Connection
�_ Framing Fireplace Lawn Irrigation
�_Insulation (Masonry) Other
Wall Board
— °�F�� . (Mfg.) Well (State Permit)
Grading/Filling o� Electrical (State Permit)
Other
REMARKS (IN HOUSE): ��
_--_-----------------------------------------------------------------------------------------------------------
RE'VIE`V BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
��-----------------------------------------------------------------------------------------------------------
REI�IARKS (TO BE NOTED ON PERiv1I�:
8
� � � DA TIME �
� �
CI Y OF ORONO CALLED IN �
INSPECTION N TIC� SCHEDULED - r�
PERMIT N0. ��' ��LC� COMPLETED I
ADDRESS _ �S � lJc��- / �J
OWNER ��'"/[� � ._1�E���NTR. '�
�
TELEPHONE NO. C�� � � � �__
__—
�lC� 7� '�
�
� DESCRIPTION �����" l�
l� 01 FOOTING 11 MECHANICAL RI 18 EXCA�//GRA ING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKE$HOR ETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMO AL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE IMSPE �� ION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT�I
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLONV-UP i
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD�OVE REMOVAL
J 10 PLUMBING FINAL 36 FOUNqATlO �REMOVAL
� OWNER/CONTRACTOR TO MEET YO _YES_NO
� COMMENTS: �
� �
W �
0.
�
�
O
�
O
W
�
Q
� �
2
W
�
W
� I
j
d
W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE I
WCORRECT WORK 8 PROCEED Cl ISSUE CERTIFICATEIOF O CUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPOR�RY I
V BEFORECOVERING PERMAN�NT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN �
INSPECTOR WILL RETIJRN
O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED �I
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. i
Call for the next inspection 24 hours in advance. �95Z� a49- 6QQ
OwnerlContra n site: '
Inspector. '
White Copyllnspecfor File Canary CopylSite Noticje �
i ��
�� ��AT� �/ IME /
Z�� � p�' V
CITY OF ORONO CALLED IN
INSPECTION NOTI E SCHEDULED � � D
PERMIT NO. COMPLETED
ADDRESS '
OWNER ��G��t N��D�,vCANTR. � �_
TELEPHONE NO. a � 7�
� DESCRIPTION ' •
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV DIN FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKES E/WE LANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTIO
Z
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- P
= 09 PLUMBWG RI 23 SEPTIC FINAL 35 HARD CO�ER R OVAL
J 10 PLUMBING FINAL 36 FOUNDATION/R MOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COM ENT�S-
a -- °U`i, t' O �' d2 P� t
�
�
O � ` �V (J�.s�-i � �
�
O
�
W
�
Q
� �
Z
W �
�
W
�
�
d
W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
„ '�1 CORRECT WORK&PROCEED r ISSUE CERTIFICATE F OC UPANCY
�
O❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORA Y
V BEFORECOVERING PERMANE T
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. �952� 49- 6QQ
Owner/Contrac ite:
Inspector.
White Copyllnspector's ile Canary CopylSite Notice
li DAT TIME
V
� ITY OF ORONO CALLED IN �Tl `
INSPECTION NOTICE SCHEDULED , a '� �
PERMIT NO. ���CfJ`-�� COMPLETED
ADDRESS Q ��
OWNER �s"�T��'�D�f CONTR. ���-�
TELEPHONE NO.
� DESCRIPTION ' �� �
lL 01 FOOTING 11 MECHANICAL RI 18 I XCAV/GRADING/FILLING
� FRAMING 13 MECHANICAL FINAL 19 KESHORE/WETLANDS
LATION 24/25 WOOD BURNER/FIREPIACE �I 34 REE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP �i 17 ITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP �� 06 ROGRESS
� 07 OEMO-SITE 27 SEPTIC MAINT. �i 21 OMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. �i 22 LLOW-UP
4Qi 09 PLUMBWG RI 23 SEPTIC FINAL �� 35 RD COVER REMOVAL
= 10 PLUMBING FINAL �i 36 F UNDATION/REMOVAL
J i �
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
�I
� COMMENTS:
� ,
a '
j
0
�
0
� '� �
W
Q �I
�
� I
w
� !
� �
d
W WORK SATISFACTORY:PROCEED ❑ PROJEaT CO PLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE C�RTIF CATE OF OCCUPANCY
W
� ❑ CORRECT WORK,CALL FOR REINSPECTION �_TE PORARY
� BEFORECOVERING _�PE MANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOtAKE
INSPECTOR WILL RETURN ❑ CITATIO�J ISS D
❑STOP ORDER POSTED.CALL INSPECTOR i
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. li
Call for the next i spection 24 hours in advance� 9 2� 249-46�0
1 �
OwnerlCon s te �
Inspector.
s ector's File Canary CtlpylSit I Notice
White Copylln p i