HomeMy WebLinkAbout2005-P08399 - addn/remodel/repair .
1
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Pos399
Crystal Bay, Minnesota 55323 P21"f111t Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 4�g�2oos
SITE ADDRESS: 220 Big Island
Excelsior,MN55331
PID: 23-117-23-23-0028
DESCRIPTION: UBC Occupancy U1
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
� - - - �-- =�-
FEE SUMMARY: Permit Fee: � 23.50 Valuation: $ 200.00
Plan Review Fee: $ 15.28
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 39.78
APPLICANT: Owner/Self OWNER: David& Sandra Lovelace
M� 3120 Westedge Blvd
Mound MN 55364
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.
_ �
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APPLICANT PERMITEE SIGNATURE 'ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required). 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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7
Total Fee: $ ��• �� Date Received: �—3�—D-S�
Entered By: � Permit#: _�083�1�
_,,:y��';� �/1�
CITY OF ORONO — BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all informatio�z)
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THE APPLICANT IS: (circle o�ie) OWNER R CONTRACTOR
�
JOB SITE ADDRESS: ����; � U �-5 I�ln'1+� ZIP:
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 Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER .��V / l� L �'��/�P I�G� PHONE: (home) 5 .02- .d�Z�
, (work)
MAILINGADDRESS: ( S 3? � � �CC� �S I O�2 CITY: ���,U C� ZIP: �53L/S
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New � Accessory Structure
Addition Move
RemodeUAlteration Land Alteration
PROPOSED WORK(describe in detai�: � X � S�-r2� ct�12.Q �'� I�(u� �;
1 � CQ_��PZ r�� �� -� c�� lQ�
STORIES: � SQ. FEET OF EACH FLOOR: �j U
NO. OF BEDROOMS:I� GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a building pernut and I acknowledge 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 pernut; and that the work will be in accordance with
the approved plan.
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APPLICANT'S SIGNATURE: i�_ '��� - DATE: l- 2J�—Z���
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Sec13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type of data. The rights oi 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
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 supplv
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 individua►is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law entorcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or proaertv 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 conCdential. 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 its meaning,the data need not be disclosed to him for six
months theresfter unless a dispute or action pursuant to this section is pending or additional data on the indivldual has been collected or created. The
responsible authority shall provide copies of the private or public data upon request by the individuai subject of the data. The responsibie authority may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall compty immediately,if possible,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 immediate 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,ezcluding 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 days either: (a)correct the data found to be inaccurate or incompiete 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 statement of disagreement is included with the disclosed data.
The determination 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 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.
Your full name is required to process this application or permit.
��
F�rst Middle Last
Address
City State Zip Phone
I unders d my ghts as stated abo e.
Signature _
CHECK OFF LIST FOK ISSUAIVCE OF PEI�tiIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: zZ b (3i b �s� -
PID: '
DESC��IPTIO:V OF yl�ORIC: To�� �3��1���
------------------------------------------------------------------------------------
ZOtVI�YGREVIEyi�BY: DATEAPPROVED: Z-ZY-o�'
BUILDIIYG REVIEW -8Y. �ATEAPPROG'ED: 2 • z..� a 5
---------------------------
FEES TO BE CHARGED: h'Iisc. Fees Calctcfated By:
PERILIIT Yes ✓ !tio
PLANRE�IEGV Yes ✓ �Vo SEWERGO�VNECTION
ST,�TE SURCH.4RGE Yes�� �vo tiVATER CO�Wi ECTIOIV
I�VVESTIG,4TIOtV FEE Yes tVo PARK FEE
SAC Yes Ivo SITE NSPECTIO�V
Number• of SAC Units OTHER (specify)
-------------------------------------------------------------------------------------------------- - - -
ZO�VIIVG CHECh'LIST Zor�i�t�Dist��icc:
Fire Deparhrterrt: Post Office: School Dish'ict: __..
Lor,�{rea: Sq.ft. Acres �Yicfth Depth
Scuvey Scebmittecl: Yes�C_ No Date af Sctrvey: on� F�c.�
P�•oposed Setbacks: � i +
F,•or�r(Galce): 1�5 Right Side: . `{�6
Renr(Str•eei): 1 Oa� Left 5ide: �°� �
Adjacent Str•ucuu-es: N �� G�etland: f9•�
Building Height: Def. Ngt. Q � Peak K,;t. cZ �
Lot Coverage: � N (l�
Grading: Staff.4pproval Date: — By: Cotuicil App�roval Date:
Sepcic: Staff,�ppr�ovaf D�te: — BY�
Zonittg File: # Resofution: # Resol<<tion Dnte:
S/toreland Dish•ict: �IO,�
Avg. Setback:, Blc�ff 5etbnck: Lat Coverage:
Elistin� P�'oposed
Har�dcover: 0-7.5' 6��
75-2�0'
Z50-500'
500-1000' '
Hardcove�• Var�iarice Reqaiir•ed: Yes No� Date of Coiirtcil Approval:
RE1I�IARKS(in house):
31
B UILDING RE UIE l�CHECh LIST
UB C: � - � CONSTR UCTIO�Y TYPE: �1.�
Sq Foota,�e .5 Pei•Sq Fc,�
Basernerir � _
!st Floor � _
3nd Floa• t =
Garcge � _
s =
TOTAG
Estiruated Co�istrc�ctio�c L'alue: ,5 ?�o o'�-
Lzspections Required: Yf'ork ReqcciriitJ Separate Perruits:
Si.te Pl�ur�birtg Fire
Hardcove�•R��nova( titechanical GYnter Co�u¢ection
Fooh:ng Septic SeLver Coii,iectio�i
Framin� Fireplace Gawr�. lrr•iga[ion
h7sulation (r�lasonl}�) Otlier
6L"al1 Boar•cf (/vlfg.) G�ell (Stczte Per»tit)
�� Fiitad Gradiiig/Filli�t,; Elecn-ical(Stare Perniit)
Other
P•E1titARXCS(.CN HO USE):
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REIfIEYV BY OTHERS: DATE:
.4ccess: Existin,; iVe�v
.Qccess�(pp�•oval: Date B�:
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RE�tiI�=LRh'S (TO BE NOTED O�V PERN,CIT):
32
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o�r;:=_._2• Z5� -�$ - - �. x 's 12 inch on �
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1 '/z inch tongue and I���-`�`"� i
groove maple
Overlapped on sills 1 g/4
inch
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Standard 3' exterior
door
\ Frame is 4 x 4 post and
� beam structure
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Foundation: \, � P P
6 x 6 treated post at each �� filled by 4 in cordwood
corner, buried 48 in deep infill
p�1,�� ��-e S'' o� Co� c�
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