HomeMy WebLinkAbout2006-P10283 - remodel basement c
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p10283
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 9/5/2006
SITE ADDRESS: 2635 Countryside Dr W Unit#
Long Lake,MN 55356
PID: 04-117-23-13-0007
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit T e: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
YP
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Fireplace Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 741.75 valuation: $ 64,000.00
Plan Review Fee: $ 482.14
State Surcharge Fee: $ 32.00
TOTAL FEE: $ 1,255.89
APPLICANT: David&Teresa Gross OWNER: David&Teresa Gross
2635 Counhyside Dr W 2635 Countryside Dr W
Long Lake, MN 55356 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPEC[FIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CfTY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
APPLIC NT� RMITEE SIGNAT ISSUED BY SIG TURE
L
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
�
Total Fee: $ i ���.� -� Date Receive : — �—� L_
Entered By: � Permit#: l ��'�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review witl be started.
(please pf•int ctll infornzatioiz)
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THE APPLICANT IS: (circle o�z�e)'�+ OWN�R OR CONTRACTOR
JOB SITE ADDRESS:��p�j�j C����fl,�Q� ,� ZIP: �j���3
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Z'eS �o Ifyes, a speclal eve�at perntid is regi�ir•ed ivitl7 Police Depnrtrnent and Czty Counci/approval
60 days prior to t/�e evef�t. Sh:ittle bi�s ser�vice ivill be reqi�ir�ed au�less applicai�t dernonsU�•ates
sufficient on-site pnrking is available. r��'o��-permittect even�s will not be allowed.
NAME OF OWNER o,� ��, a � -�.,r�, <-� ��=,�, PHONE: (home) Z 4�I����j�jQ
(work) 3$ -�I q 2.�
MAILING ADDRESS: Z (03 S Cp CITY: ��_ZIP: � �
CONTRACTOR:� �, � � PHONE: c)$O" I�y-9 O
CONTACT PERSON: _�o,.�o►r� MOBILE/PAGER: (�Zo� �,a , ��-�l�
MAILING ADDRESS: °�TO 7_'� � � CITY: ' , 5 ZIP: 5��3
STATE LICENSE: # �5�Z�- Lp EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may requi e MCWD review ar.d permits !
PROPOSEll WORK(rlescribe in detain: �,¢�a,�����ov,�sU�r�..-�-
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACH�D DETACHED
�
ESTINTATEll CONSTRUCTION VALUATION(excluding land): $ 4 ��
—T—
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 with the ordinances and codes of the City and with the State Building
Code;that I understand this is not a permit and�vork is not to start�vithout a permit;and that the work�vill be
in accordance with the approved plan.
APPLICANT'S SIGNATUI2E: DATE: ��
3t
Scc.13.0�1 RIGEITS OF SUBJECTS OF DATr1
Subd. L Type of data. The rights of individuai on�vhom 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 orcontidential data concerning himselfshall be
informed of. (a)the purpose and intended use of[he requested data wi[hin the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is leeally required to supply die requested data;(c)any known consequence arising from his supplying or refusinc to supply
private or confidential data;and(d)the identity of other persons or entities authorized by stare or federal law to receive the data. This requirement shal I
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a Iaw enforcement officer.
The commissioner of revenue ma�place the notice required under this subdivision in d�e individual income tax or properry tax refund
instructions instead of on those tbrms.
5ubd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classitied as pubiic,private or contidentiaL Upon his further request,an individual who is die subject of
stored private or public data on individuals shall be shown the data widiout 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 informed of its meaning,the data need not be disclosed to him for six
months thereatter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or creared. The
responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofdie data. The responsible authoriN
may require the requesting person to pay the actual costs of making,certifyine,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or�vithin tive days of
the date ofthe request,e�duding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot comply�vith the reques't
�vithin that time,he shall so intbrm the individual,and may have an additional tive days�mithin which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complece. An individual may contest the accuracy or completeness of public or pri��ate data
concernin�himself. To esercise this right,an individual shal I notity in writing the responsible authoriry describing the nature of dte disagreement. The
responsible authority shall�vithin 30 days either. (a)correct the data found to be inaccurlte or incomplete and attempt to notify past 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. Data in
dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions ofthe administrative procedure act relating to
contested cases.
DATA PR[VACY ADVISORY
In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inforn�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 will be used to detennine 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 NLS. 13.04(available upon request)to review private data on yourseif.
6. Your full name is required to process this application or permit.
First �liddlc Last
Address
Cih Siate 7_i�, nhcne
I understand my rights as stated above.
�r—
Signaturc —
ReseY Form 3�
; .
�HEC�K OFF i�IST FOR ISSUANCE OF PE�'VfITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z� C���-� � �D� W
PID:
JDES CRII'1�ION OF W ORK: (`�r�5�nncav ,— �Z��-o✓��� --
ZO�G REVLEtiV BY: ----(V I `A_�___._ pAT'E APPROVED:
S�UII�DIl�IG RE'VIEtiV BY: . DATE APPROVED: q-5'-p�
FEES TO BE CHARGED: Misc, Fees Calculated By:
PERMIT Xes ,/ No
PLAN REVIEti�T � Yes ✓ No SEtiVER CO�INECTION
STATE SURCHARGE Yes ✓ No �'VAT�C�N�����
INVESTIGATION FEE Yes No �' PARK FEE
SAC Yes No �/ SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�G CI-iE.CK LIST Zoning District: /U v GH�1��j�2 .
cJ
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres Width PeP�
Survey Submi[ted: Yes No Dace of Survey:
Proposed Setbacks: �
Froat (Lake): Riohc Side: ,
Rea.e �S�icetj: Left Side:
AdjaCeat S[Cu�CLres: e1la.ud:
Builclin�Heiohr. Det. Hgt, Peal:Hgt.
Lot Coverage:
Grading: Scaff Approv� Date: By: Council Approval Date: '
Sepcic: Stafi Approval Dace: Y:
Zoain� File: R Resolution: � Resolur,on Dace:
Shoreland District: Lot Covera�e:
Avg. Setback: Btuff Secbac :
Ecisting Proposed
Ha,�'dcover: 0-75'
�5-2sa�
2�0-500'
500-1dG�J'
�"12.fLCOti�i �r'c:!2uC� .n.�^yU'.;�C�: :.�� �,r0 �'':: CF C0�!IlCI� !��rLOVz:
F.E�L��S (in house):
BUILD►ING REVIEtiV CHECK LIST
�C� i2' � � CONSTRUCTION TYPE: Y/�1
Sq Faotaoe $ Per Sq Ftg
Basemen[ . X _ ,
lst Floor x _
2nd Floar x _ .
Garage z V
z =
TOTAL
Estimated Co�struction value: $ (��{�dp� o 0
Iaspections Required: `Vork Requiring Separate Pertuits:
Site �_Plumbing Fire
� Hardcover Removal ������---=--� Water Coaaection
_�Footing ` Sepcic Sewer Coanectioa
�_Fr��o _�Pireplace n,�,o�� Lawn Irrigation
�_Insuiation (Masonry) Other
Wall Boazd _�_ (Mfg,} Well (State Perm.it)
� F�� Grading/Fillin� � Elec[rical (State Permit)
Ocher
REMAR.KS (IN�IOUSE): - -- --
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REVIE�V BY OTHERS: DAT�E:
Access: Existi.ng New
Access Approval: Date gY:
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REMARKS (,'I'Q SE NQ'I'En Ov PEF.�ti1I'I'):
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in �ull C.^,rr .c2 wi?h , , , . . 'a i;� r.,�,� und zoning code. .
• ' Ra�;;yre��e "��'�.�d � ` i�'t .E�=��cally noted�in th�s�evfew.
� I�EEP TFi4S PU�+N SET ON �ITE AT ALL TfMES -
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OC.
CITY OF ORONO CALLED IN �� `
INSPECTION NOTIC SCHEDULED
PERMIT NO. � COMPLETED
ADDRESS ��
OWNER CO TR. l��Zt �C1-�-�`'�c�
TELEPHONE NO. � �Z�-9�a/ ��a
� DESCRIPTION �
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FR,4MING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑CORRECT WORK 8,PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
��CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CA LTOARRANGE ACCESS.
Call for the t spection 24 hours in advance. (952) 249-4600
OwnerlContr to s t
Inspector.
White Copyllnspector's File Canary CopylSite Notice
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DUFFY ENGINEERINfi
AN�ASSOCu7ES It�.
attx.c�cr+u.av[.s�nvFrnrr
�r,ruvc¢-titctmcu.
350 Highway 10 South
So�nt Cloud, MN 56704
I Phone: (320) 259-6575
Fox: (320) 259-6991
Emoil: mollOduffyeng.com
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direct supenrslan ond Ihot I
am o licensed ENCMEER
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Ryan .Cortlen.PE
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