HomeMy WebLinkAbout2001-P03823 - addn/remodel/repair PERMIT
CITY OF ORONO
275�C Kelley Parkway - PO Box 66 Permit Number: Po3g23
� C rystal Bay, Minnesota 55323 P@f1711t Typ@: Addition/RemodeURepair
(952) 249-4600 Date Issued: s�3o�2ooi
SITE ADDRESS: 2650 Countryside Dr W
Long Lake,MN 55356
PID: 04-117-23-12-0014
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Kesicientiai
Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ �25•25 Valuation: $ 5,500.00
Plan Review Fee: $ 81.38
State Surcharge Fee: $ 2.75
TOTAL FEE: $ 209.38
APPLICANT: Miller Joseph Construction Inc. OWNER: Robert Jorgenson
17171 Ipava Avenue 2650 Country Side W
Lakeville, MN 55044 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.
� � � �M �� ����
p APPL[CANT PERMITEE I ATURE ED BY SIGNATURE
./
Copies: City,Applicant,Assessor, Finance Page 1
Tc�tal Fee: $ �-� ��C�. �� Date Received: ��"� j � �'�
Entered By: �c'� Permit�: C�/"; ���"� =;
� . i��efti"�)� =` .-; -�;
CITY OF ORONO� - BUII�DING PERMIT APPLICATION
All information must be submitted in full before plan re�iew will be started.
� (please print all information)
THE APPLICANT IS: (circle one) OWNER CONTRACTO
�
JOB SITE ADDRESS: �Z�� CO�^�-j 5' ��: �"� ZIP:
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NAME OF OWNER: ��r c' ��� ���S�n PHO\'E: (home)
/ (� (work)
�IAILL�iG A.DDRESS: Z 67� �U�^�,�y S�f�r U.�; CITY: (��un o ZIP: .
cozv�rxACTox: � � .�.��, �,� � � �� Pxo`�: �� Z- ��z-.�/�5
CONTACT PERSON: MOBILE/PAGE�:�Z � D
MAII.I�i tG ADDRESS: ' �. i/ . CITY: � ' ch c ZIP: /�r/� �j����
STATE LICENSE: # )�v j `3,r 5 �3�
ARCHITECT/ENGINEER: �, /��c��� PHO\"E: �(Z 5�I J- 3 60�J
MA.ILING ADDRESS: CITY: Z�:
N�,�; REGISTRATION# �
��� � ��/
TYPE OF WORK: New Addition %� Accessory Structure
Move Remodel/Alteration Land Alteration
� c�i�ci2 � �
PROPOSED`VORK (describe in detain: „ ��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. � DET.
ESTL�IATED CO�'STRUCTION VALUATION (excluding land): � ���'�'
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 Ciry 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: � � ��
NOTE! Parade of Homes events require separate permit approyal by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
.
Sec.13.04 RIGHTS OF SUB.TECTS OF DaT,� '
Subd. 1. Tvpe o[data. The ri¢hcs of individual on whom�a data is s�:�or to be scored shall be as se[fo�th in this secaon:
Subd.2. Information reqirired to be given individual. An iLdividual askr3 co supplY privace or confidearial dara concerning himself shall
be informed of: (a) the purpose and incended use of the requested dam wi�in the collccring'stare agency,poliacai subdivision,or sratewide rystem;
(b)whether he may refuse oY is legally required to supply the requested dari:(c)any 3�own consequeace arising from his supplying or refusing to supply
priva�e or conndendal data;and(d)the idenricy of orher persoas or enaries aachorized by sta[e or federal law to receive the data..This requiremeoc stiall
no�apply when an individual is asked to svpply invesdeadve dac�, purs�:c co secaoa 13.82,subdivision 5, to a law enforcement officer.
The commissioner of r��enuz r-iav place the norice reauired �rd�r this subdivision in the individual income tax or propem tax refund
ins�ructions insczad of on chose forms.
Subd. 3. Access to data bp indi�-idual. Upon requesc to a respoasible ae�.oriry,an individual shall be informed whether he is the subject
of scored data on individuals,and whe�her it is ctassified as public,privac�or conFid�r.rial. Upon his further request, aa individual who is the subjecc
of scorzd private or public data on individuals shall be shown the data wi�out any c:arge to him and;if he dzsires, shall be infomted of the content
and meaning of chac data. Aftzr an individual has been shown che priva��ac�and ir:ormed of ics meaaing,che dara need not be disclosed to hirn for
six monchs thereaiter unless a dispute or acdon pursuanc to [his secdon is�ending o:addidonal data on the individual has been collec[�d or creaced.
The responsible aurhoriry shall provide copies of the private or public da�a n�on reql=s:by the individual subject of�he data. The responsible authoriry
may require the requesdng person co pay the acrual cosa of makin¢, cer;:ing, az:d compiling the copies.
The responsible authoriry shall comply immediately, if possib!=,wich any requesc made punuant to this subdivision, or wichin five days of
the data of the reques�,excluding Saeurdays,Sundays and legal holidays,it ir..mediac=compliance is not possible. If he cannoc comply with the reques�
wirhin tha�rime,he shali so inform the individual,and may have an addi�onal Five days wichin which to comply wi[h the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or compieteness of public or pri�•ate
dara concerning himself. To exercise chis rieht,an individual shall norif;+Lz wricing c:�responsible authoriry describing che nacure of the disagreemeac.
The �esponsible auchoriry shall wichin 30 days either: (a)correct the da�.icund to be inaccurate or incomplece and attempt to nodfy past recipien�s of
inaccura�e or incomplece data, including recipients named by[he individLJ;or(b) r_oafy the individual thac he believes the data to be correc�. Data
in dispuce shall be disclosed only if the individual's statemene of disagre��:nc is i:c:::ded with the disciosed dara.
The decerminarion of the rzsponsible authoriry may be appea�:�pursu�:to the provisions of[he admuustrarive procedure act reladng to
contested cases.
DATA PRI`':�CY AD�ZSORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects oi data", we would like to inform you that your reauest
for a permit or license from the Ciry of Orono or any ot i:s deparments may require you to fumish cercain private or
confidential information.
You are notified that:
1. The information you fumish will be used to de:ermine �'our qualification for the permit or license requested.
2. You may refuse to supply data, but refusal nay require that the City deny the permit or license.
3. The information may be shared wi�h o�her loc�l, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
. public.
�, You have certain rights under M.S. 13.04 (a�ailable upon request) to review private data on yourself.
6, Your fuli name is required to process this applicacion or permit.
Firsc Middle Lasc
Address
Ciry State Zip Phone
I understand my ri�hts as stated above.
io acure
� CHECIi OFF LIST FOR ISSUA��TCE OF PERl�1ITS
FOR OFFICE USE ONL.Y . ' .
�}�kESS OR LEGAL: Zc�s c� C��,� , s� o�
PID:
DE,SCRIl'T�ION OF�ORK: e �rc
.
ZOtiZ�'G REVIE��BY: DATE APPR�V�D: 5 � L�i� �t
BUZLDIti'G REVIE�V BY: _ D�.TEAPPROYED: � - Z`��-v i
FEES TO BE C�i4RGED: Niisc. Fees Calcuiated By:
pEg�'r Yes �/' No ��
PLAN REVIEW Yes �' No SE�TER CO�tNECTION _
STATE SURCHARGE Yes � No �TATERCONNECITON
Ii�iVESTIGATION FEE Yes No PARK FEE
SAC Yes � No SITEINSPECITON
Number of SAC�Units OTHER (specify)
ZO\Z�IG CH�CK LIST zoni.n�Districr. R tZ -I.� _ .
Fire Department: (e�_�(}�� Post•Ofuce: nr s School District: �-+������ �
L.ot Area: Sq.fr. Ivv C k�rd�r�-- Acres — � R'idch -- Depth �
Surve;� Subritted: Yes oC No Date of Survey: �U - `1 " c7 �
�N � �e�
Propased Setbacks: ,
Front(Lake): Z `� v Ri�ht Side: � SS
Rear (Screet): S�� Left Side: 1 ��1 —
� Adjacen[Structures: i4TrALt-E�c,� tiVetlzs:d: N I (�' •
Buildin� Hei�ht: Def. H�t. — Pe��H�t.
Loc Coverage: —
Gradin�: Scafi Approval Date: — By: Council Approval Da[e:
Septic: Staff Approval Dace: — By:
Zonin� File: R � Resolution: � Resolucion Date: �
Shoreland District: /�v
Av�. Setback: Btufi Setback: LotCocera�e:
E���� Proposed
Hardcover: 0-7�' --------
7�-250' ----
ti0-500'
500-I000'
Hardcover Variance Required: Yes No Dace of Council Aoproval: _________
REI�IA.RT�;,S (in house):
7
. �
BUII.DING REVIEW CHECK LIST
c.nac: 2• 3 - co�vs�xucTTov�E: �l�
Sq Footage $ Per Sq Ftg
Sasement x =
lst Floor z —
2nd F1oor z =
Garage z —
z =
TOTAL
ao
Estima[ed Construction Value: S S,j(�� '
Inspections Required: �Vork Requiring Separate Permits:
Site . Piumbing ' Fire
Hardcover RemovaI Mechanical Water Connection
� Footin� Septic Sewer Connection
_� Framin� Fireplace Lawn Irrigation
Insula[ion (Masonry) Other
Wa11 Board (Mfg.) Well (S[ate Permit)
_� Final Grading/Filling Electrical(State Permi[)
Other
REtiiARKS (I�i t HOUSE): .
RE'V�W BY OTHERS: � DATE:
Access: Ezis[in� ��eW
Access Approval: Date By;
RE��LARKS (TO BE i�`O'I'ED ON PERil�II1�:
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DATE TIME
CITY aF ORONO CALLED IN ����
INSPECTION NOTIC Q''� SCHEDULED :�' ��'��.�
PERMIT N0. �(JP COMPLETED ^r L �d� �• -'�
ADDRESS_ �� �c�Gt ,5��� �� .
OWNER CONTR. � �
TELEPHONE N0. ��— �� �j�O�p F,�
� DESCRIPTION / � �� � ��
� 01 FOOTING 11 MECHANICAL RI 18 EXCA�//GRADING/FILLING
Q 02 FR,4MING 13 MECHANICAL FINAL 19 LAKESHORE/WE�LANDS
y 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 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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��ORK SATISFACTORY:PROCEED �OJECT COMPLETE
W ❑CORRECT WORK 8�PROCEED � ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
�NSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnedContractor on site:
Inspector.��'v .c� ��"��'� �
White Copy/inspector's File Canary CopylSite Notice
DAT TIME
CITY OF ORONO CALLED IN S"�
INSPECTION I�O I E. SCHEDULED �D=U O
PERMIT N0. ���� COMPLETED '— � �D`���
ADDRESS .��a�7 C' �'���,i f7t:�5.��:Q.e. ��-• ��
OWNER �CONTR..1��-� �•��f'
TELEPHONE NO. ���a J� �� ��O Ct�
� DESCRIPTION ��r
lV 01 FOOTING 11 MECHANIC RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 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 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� 1�NORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W{❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REiNSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP OR�ER POSTED.CALL INSPECTOR �CITATION ISSUED
� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-46QQ
OwnerlContrac o on site:
GLL�r� � '�?
Inspector. �- �
White Copyllnspector's File Canary CopylSite Notice
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� Eatabliahcd in 1862 446;2
. LOT SURVEYS �OMP'�►NY, ��C. F B NUE N0. 748-1� `.
� LAND SURVEYORS SCA�E: 1 " � �
REGISTERED UNDER THE LAXS OF STATE OF A(INNESOTA o penot�i Iroc� F,,{orxx»ent
7001 79rd �l�enue North a12-6d0-3093 0 Denotei Wood Nub S�t
, Fax No. 6G0-3622 for oxcavatlon only
aiinneapoli�, Yinnesota 66428 x000.0 De�oten Exittfn9 Ebvotion
�u r v p��a r�c �Ll�.1�r�t�t�tt�p �o•o •Denote� Propo��d ENvation
EIDEN CONSTRUCTION --�•�•�-�- Denote: Surfac• Drafnage
Property located in Section ��'1.� Proposed Top of B�ock
qq�,o — � 4, Township 117, Range 23, �oo�,v
Hennepin County, Minnesota �opa�ed Gora� Fbor
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t�15� - ' ������✓ � Lot 6, Block 2, OLD CRYSTAL QAY
' 99Z,o
Cp��. ROAp ADDITION
993 ZS
TG
Proposed building ;n(ormation musi be checked with approved buiiding
plan be(ore excavotion and conslruction. ••
Thc only easements shown are irom plots of record or information
provided by client. .
We hereby certify thot lhis is a irue and correct representation of .
a survey of the boundaries o( tho abovo described land and the �
�ocation of all buildings and visible encroachments, i( any,(rom or on J � � �...�.�
said lond. '
Siqn�d _,.
Surveyed by us thiag�71 day of October �g96 C�� F, k�� ��, R�, ryp,�17a3
1 k _