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Home My WebLink About2008-P11803 -addn/remodel/repair � � PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: p118o3 Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair (952) 249-4600 Date Issued: 1/23/2008 SITE ADDRESS: 2655 Countryside Dr W Unit# Long Lake,MN 5535( PID: 04-117-23-13-0006 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Permit Type: Addition/Remodel/Repair Pcrmit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: Plumbing Mechanical Fireplace Elcctrical(state) NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 1,626.75 valuation: $ 195,000.00 Plan Review Fee: $ 1,057.39 State Surcharge Fee: $ 100.00 TOTAL FEE: $ 2,7$4.14 APPLICANT: Wood Smith Builders OWNER: Neail&Irene Levy 6640 Cherokee Trail W 2655 Countryside Dr W Eden Prairie,MN 55344 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. ( l APN,ICANT PERMITGE SIGNATURE ISSUE BY SIGNATURE Copies: 1-File(Signatures Requrred), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 . . �v� o� �'�� Total Fee: $ °2 7o � ' ` � Date Received: � D d�' Entered By: Permit#: Q3 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 one) OWNER OR CONTRACTO JOB SITE ADDRESS: Z�� SS (,�t z��,� +.� �� (� zir: S53S Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No !f yes, a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. NAME OF OWNER: /�� . � J�-R�+vt� L'�-�`( PHONE: (home) Z�y�y �7z / ,��. �v (work> - - 2,�o s MAILING ADDRESS: ��ss (��ni2441�CITY: �i ,ov�o ZIP: S� CONTRACTOR: n , �c..�t£�2 PHONE: �(,� - 70 S� 8��/!� CONTACT PERSON: � MOBILE/PAGER: MAILING ADDRESS: � CITY: �7�,�1 I�r�,�IP: SS � STATE LICENSE: # 2d 3��y EXPIRATION DATE: 3/��/�Y ARCHITECT/ENGINEER: c. �ZC-ti rr1£� PHONE: -C�.�7�'SO MAILING�RESS: � CITY: W ZIP: NAME: !C M [�J,�� REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding, Windows) � Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detain: k i T'�� /.��2cx�M I��Mc�j�'E(_ STORIES: � SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � / S OC� 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 work is not to start without a permit;and that the work will be in accordance with the approved pla . APPLICANT'S SIGNATURE: � DATE: �Z � 31 Sec.13.04 RIGHTS 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 conceming himselfshall be informed of: (a)the purpose and intended use ofthe 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 confidentiai 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 mayplace the notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those fortns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infortned 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 shali be shown the data without 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 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,if possible,with any request made pursuant to this subdivision,or within five days of the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe 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 conceming himsel£ To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe 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 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 prceedure 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. 6. Your full name is requ' d to process this application or permi . �I L, 'i'�iZ l�l l!Z I First / Middle Last (O b-7�J �I��' �ZA�(� W�i� Address �.�.� 1 �2��, �I� SS3yy G�1- 7��-��i�, City State Zip Phone I u derstand rights as stated above. Si ture Reset Form 32 £E :(asno�u�)S�y'I1t� :lnno.rddylr�uno�fo a1nQ o� sa,� .pa.rtnba�a�unub�1 .tano.�p.rnf,r �0001-OOS �OOS-OSZ ,OSZ-SL asodo.r ,SL-p :.rano�p.�nH P d Bu:�stxg :aBn.rano,71o7 :��v4zaS.�n1S .��bq�as �n� :�zu�.rad Q�I.�W :��u;srQ pun�aao�1S :a�bQ uot7njosa� # :uot�nlosa� # :alt,�8uruoZ ��7 :�ig �� :a�nQ 1nao.rdd��'n�s :�i�das :a�nQ lnno.rddy��rauno� :,Cg :a�nQ lbao.rddy��'nps :�utpn.r� :a�n,rano,7 Jo7 1 a�nad '�H.�aQ :�y�ta�y�u:pjtng �P 11aM :sa.rn��n.�1S tua�nlPy -aP?S ala7 :(Taaa�S).�na� � :apis Tt��i2f :(a�ln7)1uoa� :s��nqzas pasodo.�d :�fan�ns fo a�n o� sa,f .pa�zruiqns�fanans yzdaQ �IIP?M sa.r� 6' '1f bs :na,rFr�07 :j�t.lJS1Q 100t�JS a�t so � .�O� d :Iuaur�andaQ a,rt� - ---- ____�__ ��- :��:.r�stQ�uiuoZ ,LSI7?I��H,� `Jt�INOZ (��ads) ?I�H.LO � s�rull .�I�S.�o aaqurn� �OI�L,��dS1�Il�.LIS /l on[ sa� �b,S �,�.��T�d ./� o� sa� ��OI,L I�JISS,�II�II �OI.L��[1�I0�?I�.Li�fh ot� � sa�I ��?IY'H�?II1S�.Lb',LS �IOLL.��r�1�0�?I��1�1�S o� � sa� r�1�I11�21�II�7d :�Cg pa�n1n�pb� saa� -�s� f Sa� .LILII?I�d _ �Q��?IT�H�,�8 O.L 5�� ► - � �Q�10?IddY'�.L6'Q '�' �d8�1�I�1��IIQ7II28 "�j`'� ��•� •'��''�b/ �Q�1 O?Idd�'�.L I�Q —_ �d 8 M�I�l�J�II�IOZ Z C1'�`^'�►�2 �X�lo�1.�0 r�I011dl?I�S�Q � �Qid "� ")Cl a'F�'S )� , �-�.�p �?,� C C . �7T''��7?IO SS�QQI'' d 7t�I0�S�� L�.�O ?IO.� S.LII�II��d.�0��1�'12SSI�IOd.LSI7.�30)I��H� . . . B UILDING REVIEW CHECg LIST UBC: 12 ' 3 CONSTRUCTIONTYPE: �/�1 Sq Footage $Per Sq Ftg Basement x = Ist Floor x = 2nd Floor x = Garage x = x = TOTAL Estimated Construction Value: $ l 9 S,0 0� ;y Inspections Required: Work Requiring Separczte Permits: Site ��Plumbing Fire Hardcover Removal _�Mechanical Water Connection _ CL Footing Septic Sewer Connection _�Framing � Fireplace Lawn Irrigation �_Insulation T (Masonry) Other Wall Board _�(Mfg.) Well(State Permit) _�Final Grading/Filling �p `Electrical(State Permit) Other REMARKS(INHDIISE): REVIEW BY OTHERS: DATE: Access: F�isting New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMIT): 34 �- �- �+ �i AT TIME � CITY OF ORONO CALLED IN � � �� INSPECTION TIC /� � SCHEDULED ' � r�;3�.� PERMIT N0. �/ COMPLETED ' ADDRESS Z �� - � - ` OWNER CO R. (.(.�./�� VI,�.(�l� TELEPHONE NO. U � ' O — � �l J � DESCRIPTION I�- W Ot 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS Q 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 � OWNERICONTRACTOH TO MEET YOU•_YES_NO � COMMENTS: � a �� .S �,i iV� /�'� T�S �" � � �� o � - ,,? ( - ��S '�f�C�' S� c� �-�P�►�� U �� . � - .�n -�� 0 � W Q ' �� '�^- ^ !' � z W � W � � � �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on site: Inspector. l.�.J 1� ��'JS White Copyllnspector's File Canary CopylSite Notice