HomeMy WebLinkAbout2001-P03437 - addn/remodel/repair _ .
PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po�43�
Crystal Bay, Minnesota 55323 P@CiTllt Type: Addition/Remodel/Repair
(612) 249-4600 Date Issued: 1i2i2oot
SITE ADDRESS: 930 Cox Farm Rd
LONG LAKE, MN 55356
PID: 27-118-23-33-0013
DESCRIPTION: UBC occupancy R;
Construction Type VN
Proposed Use:
Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: riumbing iviec;nanic:ai Eiecuicai(siaiej
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 251.25 Valuation: $ 14,400.00
Plan Review Fee: $ 163.28
State Surcharge Fee: $ 7.20
TOTAL FEE: $ 421.73
APPLICANT: JACK& FREDA KLINGERT OWNER: JACK&FREDA KLINGERT
930 COX FARM RD 930 COX FARM RD
LONG LAKE, MN 55356 LONG LAKE, MN 55356
THE UNDERS[GNED 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 NfINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT ERMITEE S► NATURE SSUED BY SIGNATURE
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Copies: City, Applicant, Assessor,Finance Page 1
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
� (please print all,infomt�tion)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �(�.2 L� C C�X 1�,���;�'t � l� ZIP:
NaME oF owivER: ���� � , f��C ll�� i; � �� Pxoti-E: �nome� ��� �-7`�1�
(work)
I�IAILING ADDRESS: `Z�� C�>C �/��f� �C�I�_ CITY: C�'�C��`�K u ZIP: �� �S C,
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CONTRACTOR: `� � L �� PHO\�E:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: Z�:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHO\�E:
MAILING ADDRESS: CITY� Z��
rJ�ME; REGIST'RATIO�T#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�'_ Land Alteration
PROPOSED WORK(describe in detai�: � t � �S f--� /� � < < L � �-�" � �_
�� l� C���� L% �— � � /� Q � �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): S �' `7'�, �/ c:s�U ` �'
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 p rmit and «•ork is not to start without a
permit; and that the work will be in accordance wit th�approved plan.
�
APPLICANT'S SIGNATURE: �� �'`�i%���_ } � D�TE: � 'L �
NOTE! Parade of Homes events`require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.0�RIGHTS OF SUBJECTS OF DaTa
Subd. 1. Type of data. The ri¢h�s of individua!on whom[he data is stored or[o be stored shall be as set forth in this secdon.
Subd.3. Informatioo reqirired to be given indiridual. An individual asked to supply private or confidenaal dara concerning himself shall
be informed of: (a) [he purpose and in�ended use of the requested data wichin the collecting'state agency,poliacai subdivision,or sratewide system;
(b)whecher he may refuse oY is legaily required to supply che requested data:(c)any}�own consequence arising from his supplying or refusing to supply
private or conndendai data;and(d)[he idenriry of o�her perso�s or enrides auchorized by state or federal law to receive the dara. This requirement shall
not apply when an individual is asked to supply invesrieadve dara, pursuan[to secdon 13.82, subdivision 5, to a law enforeaent ofFicer.
The commissioner of re�enue mav place the norice reouired under this subdivision in the individual income taz or orooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data b�indi�ldual. Upon requesc to a responsible auchoriry,an individual shall be informed whe[her he is the subject
of stored data on individuals, and whether it is classified as pubiic, priva[e or confidendal. Upon lvs further request, an individual who is the subject
of scored private or public data on individuals shall be shown[he data wiehout any charge to him and;if he desires, shall be iruormed of the contenc
and meaning of chac dara. Aftzr an individual has been shown[he private data and informed of ics meaning, the data need not be disclosed to him for
six mon�hs[hereaiter unless a dispute or acrion pursuanc to �his secdon is pending or addidonal data on the individual has been collected or crea�ed.
The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of che data. 'Ihe responsible authoriry
may require[he requesring person to pay the acnial costs of making,cerrifying,and compiling the copies.
The responsible authoriry shall comply immedia[ely, if possible,wi�h any request made pursuant to this subdivision, or wi[hin five days of
the date of the requesc,excluding Saeurdays,Sundays and legal holidays,if immediace compiiance is not possib(e. If he cannot comp(y with the requesc
wichin thac rime,he shall so inform the individual,and may have an addirional five days within which to comply with[he requ�st,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple�eaess of pubtic or pri��ate
data conceming himself. To exercise chis riehc,an individual shall nodfy in writing the responsible authoriry describing�he nacure of the disagreemeac.
The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompie�e and attempc to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual thac he believes the da[a to be correcc. Data
in dispuce shail be disclosed only if�he individual's stacemenc of disagreemenc is included with che disclosed data.
Ttte decerminadon of�he responsible authority may be appealed pursuanc ro the provisions of the adminis[rarive prxedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data", we would like to inform you that your reauest
for a permit or license from the City of Orono or any of its depanments 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 perm.it or license.
3, The information may be shared with other local, state or federal a,encies to the extent ��:.essary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
j. You have certain ri�hts under M.S. 13.04 (available upon reques[) to review private data on yourself.
(. Your full name is required to process this application or permi[.
�� '� C l� ��} t� � l � '� <_ �� ��
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First tifiddle ^ Last �
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Address � � i�,y /f ( � � j� � � �F—� — �C�� �
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Ciry State Zip � Phor,e
I understand my ri�hts as stated above. l
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Signacure
J.
� CHEC�i OFF LIST FOR ISSUA.��rCE OF PER�tiTITS
_ FOR OFFICE USE ONLY � .
ADDRESS OR LEGAL: ��o C�x �A-��- ��
PID:
DES CRIPTION OF�ORK: �=r�,�s�r �rn� s�1 A � �� ���cb0
, �
ZOti'Lti�G REY�ti�BY: �1 �� D�iTE APPRO��D:
BUILDI�'G REVIE'6V BY: D�TE APPROVF•D: �- Z -c�l .
FEES TO BE CH.4RGED: Niisc. Fees Calculated By:
pERMIT Yes _ � No :
PLAN REVIE�1 Yes _� No SE�CO: :'ECI'ION
STATE SURCHARGE Yes � No `�ATERCOi�Iti�CTION
II�'VESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (speciy)
ZO\�L�iG CZ-i�CK LIST zanin�Districr.�U
Fire Depar[ment: Post Office: School District: � �
I.ot Area: Sq.fc. Acres Width Depth
Survey Sub.Litted: Yes No Date of Survey:
Proposed Setoacks:
F:oa[ (La.ke): R.i;hc Side: �
Rear (Screet): Left Side:
Adjacenc Struccures: �Vet and: �
Buildin� Hei�hc: DeE. H�t. Peak H�t.
Lo� Covera�e:
Gradin�: Stafi Approval Date: By Council Appro��a! Date:
Septic: Staff Approval Dace: By
Zoning File: n Resolution: : Resolutioa Date: .
Shoreland District:
Av�. Setback: Blufi Setback: LOCCO"`a="
Eacisim� ProFosed
Hardcover: 0-7�' ----
7�-250'
ti0-500'
Sd0-1000' —
Hardcover Variance Required: Yes No Dat� of Co�ci? Aoproval:
REI�LAR�iS (in house):
7
BUILDING REVIEW CHECK LIST
UBC: U�' � � - CONSTRUCTION TYPE: �/�
Sq Footage � Per Sq Ftg
Sasement x =
lst F1oor z =
2od Floor z =
Garage z =
z =
TOTAL
Estimated Construction Value: $ 1�(, `�(U U u`�
Inspections Required: «ork Requiring Separate Permits:
Site � Plumbing ' Fire
Hardcover Removal '� Mechanical Water Connection
Footin� Septic Sewer Connection
� Framin� Fireplace Lawn Irrigation
�� Insula[ion (Masonry) O[her
,� �Vall Board (Mfg.) Well (State Permit)
�_ Final Grading/Filling � Electrical(State Pecm.it)
Other
RE�IARKS (I�i I HOUSE):
REVIEW BY OTHERS: � DATE:
Access: Existin� New
Access Approval: Date By:
RE`�IAFtK.S (TO BE NOTED ON PERMIT�:
8
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