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Home My WebLink About2004-P07336 - addition PERMIT C ITY O F C�RO N O Permit Number: 2 7 5 0 K e l l e y`P a r k w a y - P O B o x 6 6 P o�3 3 6 Crystai Bay, Minnesota 55323 P2C'1711t Typ2: Addition/RemodeURepair (952) 249-4600 Date Issued: 4i12i2oo4 SITE ADDRESS: 2635 Countryside Dr w L.ong Lake,MN 55356 P I D: 04-117-23-13-0007 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Buildin Census Code 434 Permit Class: g Permit Type: Addirion/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: Separate pernuts required: riumoing iviecnanicai r,ieciricai�statej NOTICES/REMARKS: ,., - ,� -,,:.:-- -- �---�- -r� �--�-- - FEE SUMMARY: Pernut Fee: $ 593.25 Valuation: $ 45,000.00 Plan Review Fee: $ 385.68 State Surcharge Fee: $ 23.00 TOTAL FEE: $ 1,001.93 APPLICANT: Owrier/Self OWNER: Da�id&Teresa Gross NIN 2635 Countryside Dr W 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. _..�---- - > �` J ^ � (��1 L-t2� �� APN CANTPERMl7'EESIGNATURE SUEDBYSIGNATliRE Copies: 1-File(SiQnitures Required). 1-Applicant, i-Monthlv Renorts, 1-Assessine, 1-Finance Page 1 � e�.d0�F Total Fee: $ �D D/.93 Date Received: � � Entered By: /�� Permit#: i9 6 733ro CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) THE APPLICANT IS: (circle on�-"`"OWNER OR CONTRACTOR -� JOB SITE ADDRESS: ��,7-� � �,Zy„-��,��, ;, �,� w �, .��,,,Q ZIP: 'SS��',jo_ 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 approva160 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER:�� `r 0. �-. �, oSS PHONE: (home�'�� y�i�,-�3�g (work) MAILING ADDRESS: �C'� 'n�,Y,� ;�, . , �. CITY: l�o�. - ZIP: c-, S � �;v CONTRACTOR: —T',��,,� C, rr� s� PHONE: ��Z� �I�(� - �'-33R CONTACT PERSOI�—�'� �� MOBILE/PAGER �37 u 3�.�� q2 MAILING ADDRESS: 7(L3 5 �';��n-� r„ „c��r 'vvCITY: i� - ZIP: ti� STATE LICENSE: # ARCHITECT/ENGINEE� 1 � c �� PHONE:��(��3� 24 q �<��J MAILING ADDRESS: -�. �' �, ,� . CI : �I��,.��,-�,�ti��ZIP: �5�u�+�- NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition �� Move RemodeVAltera�ion�� Land Alteration , PROPOSED WORK(describe in detai�: ( Z x I�", ��--��;,� <ZQ� ,-�:�.� } --�-� ��;��'�� _ k:�� ,.��, STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $�j �� I hereby apply for a building permit and I aclrnowledge 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: �. �� DATE: � � � Sec.13.04 RIGHTS OF SLBJECTS 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 informed oL• (a)the purpose and intended use of the requested data within the coliecting state agency,political subdivision,or statewide system;(b) whether he may retuse 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 shail not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law entorcement officer. The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or oroaertv 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 indi�iduals,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,shaii 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 thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsibie authority shall provide copies o(the private or public data upon request by the individual subject of the data. The responsible authority may reyuire the requesting person to pay the actual costs o[making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possibie,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 requestwithin 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 o(public or private data concerning himself. To esercise 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 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 wrrect. 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 ot the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with NI.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 ticense 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 NI.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. __-- 1 c> r o. ��- —� �-v��5 First Middle Last Z�fi��C��t��Y'��\� � \ � Address l�-�Y-, c� �--r,,`f� � '�l��\ S �� n ��Z , �I��o -� � C�tY �� State Zip � Phone I understand my rights tated above. � <--- --� Signature ` +�► CHECK OFF LIST FOR ISSUANCE OF PERMITS . FOR OFFICE USE ONLY ADDRESS OR LEGAL: 2,h�s �;�,;,,,� ,,� —,,,, _ �)`, PID: DESCRIPTION OF WORK: i� � �r�.l-�:_ y.},��, � �� , ------------------------------------ ----- ZO.�IYi G REVIEW BY: DATE APPROVED: �-L ��'y BUILDING REV�W BY: s_ ,� - �,�.- _ DATE APPROVED; 4-� � Y FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes �' No PLAN REVIEW Yes ✓' No SEWER CONNECITON STATE SURCHARGE Yes —� No WATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC-Units OTHER (specify) ZONING CH�CK LIST Zoning District: Fire Department: Post Office: School District: Lot Area: Sq.fr. t�cres � Width Depth Survey Submitted: Yes oc No Date of Survey: c� ;_��: Proposed Setbacks: � Front(L.Rict}: i L U ' � Right Side: �r`��' Rear (Street): z 5 a� + Left Side: � Z�% Adjacent Structures: � , , ,-,.�/�,�� Wetland: �� r,�- Building Height: Def. Hgt. __�Jo C��r.�,p Peal:Hgt. — Lot Coverage: f�X� C�-,:..�,-�.r...,Q Grading: Staff Approval Date: — By: Council Approval Date: Septic: Staff Approval Date: — By: Zoning File: # -- Resolution: # Resolution Date: Shoreland District: ,�i)(� t#vg, Setback: Bluff Setback: I.ot Coverage: Ezisting Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS(in house): 7 � BUII.,DING REVIEW CHECK LIST �C� �`1 `' CONSTRUCTTON TYPE: �(N _ Sq Footage $Per Sq Ftg Basement x _ lst Floor x _ 2nd Floor x = Garage z _ x = TOTAL Estimated Construction Value: $ �{�.��nn"�' Inspections Required: `Vork Requiring Separate Permits: Site _�Plumbing Fire Hardcover Removal �Mechanical Water Connection _�Footing � Septic Sewer Connection _uS Framing Fireplace Lawn Irrigation ��Insulation (Masonry) Other �C Wall Board (Mfg,) Well (State Permit) ''�' F�� Grading/Filling .� Electrical(State Permit) Other REMARKS(IN HOUSE): . ------------------------------------------------------- REVIEW BY OTHERS: DATE: Access: Ezisting New Access Approval: Date By; --------------------------------------------------------- REMARKS (TO BE NOTED ON PERNII�: 8 ✓ DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. l�D�33(o COMPLEfED S � 'aY �'1� ADDRESS 7/�3 S ��/r'7�Sr S�/LP OWNER CONTR. TELEPHONE NO. ` � DESCRIPTION lL�$OOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION 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-UP ? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEEf YOU:_YES_NO � COMMENTS: � W a � J O �. � O � ti � Q � Z W � W � � O 4Y�GVORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�� OwnerlConUact o si Inspector. White Copyllnspector's File Canary CopylSite Notfce DA/TE 1 TIME CITY OF ORONO CALLED IN 7��J ��/ INSPECTION NOTICE SCHEDULED � 'S �� PERMIT N0.�� 3j 4' COMPLETED ADDRESS �W�� /�� OWNER , CONTR. � TELEPHONE NO. � �z��-�1�C'� C 7��'`S� � DESCRIPTION �/t-�� Gt_.�+�-r''� ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 0 ING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS h O 03 INSULATION 24/25 WOOD BURNER/FIREPIACE 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 J 10 P�UMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � 0. ,,.�_�_ !:lc.c.� ...��__r�'L�'`c�i ��-e'-�-cv�.�-�p_ � � O � � ,p�� O �`�� C/V C/ W � Q � Z W � W � j d W� WORK SATISFACTORY:PROCEED C 1 PROJECT COMPLETE W ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY � ❑Ct�RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next spection 24 hours in advance. �95Z� Z49-4600 OwnerlContr t n s : Inspector. White Copyllnspector's File Canary CopylSite Notice DATE TIME � CITY OF ORONO CALLED IN '�`�� INSPECTION N TICE SCHEDULED � � � �d: 3 U PERMIT NO. C � 33 COMPLETED ADDRESS ��3-� �-t`'wn.�/�.�,�pLe !-1 h � OWNER (1�OSS �. CONTR. .�1-�",( TELEPHONE NO. �� a-9 4 �' 0 �I15� � DESCRIPTION f' �'�-�� '�- � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � ION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS � 07 OEMO-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 J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � �� . �.�-�- .�� n�' � � � 0 � � � 0 � W � Q � z W � W � � d � _l WORK SATISFACTORY:PROCEED f i PROJECT COMPLETE W ❑CORRECT WORK 8�PROCEED C ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. �� pH0T0 TAKEN INSPECTOR WILL RETUFN f 7 CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIR .CALL TO ARRANGE ACCESS. Ca11 for ext inspection 24 hours in advance. (952� 249-460� OwnerlCo r tor si : Inspector. White Copyllnspector's File Canary Copy/Site Notice � � �� ` " DATE TIME CITY OF ORONO CALLED IN �� INSPECTION NQTICE SCHEDULED � PERMIT NO�� COMPLETED y` �� ADDRE � OWN � CONTR. TELEPHONE NO. � lo` �``L� "�� -� � DESCRIPTION / / �l� �y ��'�'°.Q�� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z 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 J 10 PLUMBING FINAL / 36 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � W C � J O � � O � W � Q � Z W � W � � d W�GVORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE i W ❑ CORRECT WORK&PROCEED '7 ISSUE CERTIFICATE OF OCCUPANCY 0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTIOfV REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContc r�e�qr on si • J Inspector. — White Copyllnspector's File Canary CopylSite Notice � DATE TIME CITY OF ORONO CALLED IN ��f y -�� INSPECTION NOTICE �/� SCHEDULED 7-� �CX� A/1 PERMIT NO. ��y�"dL/ COMPLETED ADDRESS � � � • OWNER CONTR. TELEPHONE NO. Q( t�` „ (' + ( � DESCRIPTION ��C� C��0�Vi• CSU►J�IC}U(' �nS��-f�a� � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 �.4KESHORE/WETLANDS 03 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 +—_ 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 � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a j Q t�1 O � � . O � W � Q � Z W � W � � d W WORK SATISFACTORY:PROCEED [i PROJECT COMPLETE � ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALI INSPECTOR ❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Call for the nex inspection 24 hours in advance. (J52� 249-46�� OwnerlContractor s t : Inspector. e White Copyllnspector's File Canary CopylSite Notice L �' ��V�YS C:��PANY� i�C. O Denotes Iron Monument LAND SUR� EYORS ❑ Denotes wood H� Set T for excovation only REGISTERED UNDER THE LA�VS OF STATE OF MINNESOTA �000.o Denotes Existing Elevation 7601 73rd Avenue North 812-560-3093 000.0 Denotes Proposed Elevation Fnz No. 580-3522 �sY�— Denotes Surface Drainage Yinnenpolis, Yinne9otn 55426 Proposed Top af Block �urur�urs �prtif ira�P �Proposed Garage F�oo� ��Proposed Lowest Floor 7ype of Buiiding � ��.�.� � . 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