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2005-P08669 - addn/remodel/repair
CITY �F ORONO PERMIT 275� Kelley Parkway - PO Box 66 Permit Number: Pos669 Crystal Bay, Minnesota 55323 P2ft711t Typ2: Addition/Remodel/Repair (952) 249-4600 Date Issued: si2i2oos SITE ADDRESS: 930 Cox Farm Rd Long Lake,MN 55356 PID: 27-118-23-33-0013 DESCRIPTION: UBC Occupancy R3 Consh-uction Type VN Proposed Use: Residential Permit Class: Building Census Code 434 Permit Type: Addition/Remodel/Repair Pernut Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: i'iumoing �,ieciricai�s�a�ej NOTICES/REMARKS: _�_i w s'_ _.r�_.t n_ r r _.i_ FEE SUMMARY: PernutFee: $ 401.35 Valuation: $ 26,000.00 Plan Review Fee: State Surcharge Fee: $ 13.50 TOTAL FEE: $ 414.85 APPLICANT: Daiku Corporation OWNER: Mr. &Mrs. Killingstad 2116 Glenview Lane 930 Cox Farm Rd Bloomington,MN 55425 Long Lake,MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEIv1ENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � ����,� � APPLICANTPERMI"I'GES[GNATURE I SUEDBYSIGNATURG Copies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reoorts. 1-Assessin�, 1-Finance Page 1 CHECK OFF LIST FOR ISSUANCE OF PERMITS � FOR OFFICE USE ONLY ADDRESS OR LEGAL: 9 3 b Go�' f=�9�LsK �i� PID: DESCRIP'TION OF WORK: Z ���i (j,�;��eL.S ZO.�IYi G REV�`V BY: `v(� DATE APPROVED: BUIZDING REVIE`V BY: � DATE APPROVED: 5• Z --c�s� FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes _� No PLAN REVIEW Yes o � SEWER COiVNECITON STATE SURCHARGE Yes __�No WAT'ERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC Units OTHER (specify) ---------------------------------------------------------------------------------------------------------------------- ZONI�i 1G CH�CK LIST zoning Districc: a _( Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres Width Dep[h Survey Submi[ted: Yes N Date of Survey: Proposed Setbacks: Front (Lake): Right Side: Rear (Street): ef[Side: Ad;acent Structures: Wetland: Building HeiGht: Def. Hgt, eak Hgt. Lot Covera�e: r i Grading: Staff Approval Date: By; Council Approval Date: Septic: Staff Approval Date: By:� � Zoning File: # Resolution: # Resolution Date: Shoreland Distric[: Avg. Setback: Bluff Setba : L.ot Coverage: Ezisting Proposed Hardcover: 0-75' 75-250' 2�0-500' 500-1000' Hardcover Variance Required: Yes o Date of Council Approval: REMARKS(in house): � � BUILDING REVIE`V CHECK LIST ��� _ � � covs�ucTTON�E: �N Sq Foota�e $ Per Sq Ftg Basement n x _ lst Floor z _ 2nd Floor x = Garage z = z — TOTAL Estimated Construction Value: $ Z G., o�o �- Inspections Required: �Vork Requiring Separate Permits: Site _�Plumbing Fire Hardcover Removal Mechanical Water Connection Footing � Septic Sewer Connection _� Framing Fireplace Lawn Irrigation _�Insula[ion (Masonry) Other �Wall Boazd (Mfg.) Weil (State Permit) F�� Grading/Filling �_Electrical (State Permit) Other RENTARK,S (ni i HOUSE): - ------------------------------------------- RE'VIE`V BY OTHERS: DATE: Access: Ez.isting New Access Approval: Date gy; ------------------------------------ REI�IARKS (TO BE NOTED ON PERivIIT�: 8 � . � T � � - . -.,_ ___"__ _ ___. ' -. �. _-L1I� - _:::�'lr:3 .- :""r`i'i17777Z' �'��^� =1� ��:.f��i€� - ��.+��,�Ij'v�� P�R�IiT APPLICATI4N °1.' c:z!'::r:;:�t::��: :�ust be submitted in full before nlan review will be started, (�ile�se print all inform�tionj -- / -____. i a� �i'�-i.ii,ri��i i�: �ciTcie���j 1)m4%NER OR';CONTRACTOR `� � ._� Jo$srr������ss: 'i 3c� Lox -+-,h�,� 'r,a zlr� `�� ���: Will #his be a P�rade of Homes, Remodelers Showcase Home or other Dispiay Home:' j_� Yes ��fl If y'�s, a apecia!e�-e�pt permit is required wi[h P�lice Department and City Counci!approval h0 davs prior to the euent. Shuttle hus.�en�ice will be reaurred unless applicant demonstrntes suffreient on-site parking is available_ r'�/on-permitted eventr will not be allowed NAMEOFO�'NEI�:(�,t���S =; l�� n �V ������-��•�1+;� PHQNE: (home) i�� �y��-�2c.-/ (wor�)(�>I Z 7��'�G�:`� �VIAILING ADDRESS: `',��, C'_`x �—�a�'�,� ',�i'� CTTY: C;:�,J c ZTP: �,a' � - CON'I'RACTOR: �F�1 1�� C.��` ?�;���'����i PHONE: ��:5 L b�i`� ` ��1�7� CONTAC`�'PE�tSfl�1: iv'�i I�� kf r��_�.,�� MOBI�,�IPAGER: �-�( 3�]'(�� l� ?'VIAILit'+T�G ADD,R�SS.1►I(,� L�i�►�v����� �r�� CITY: '�:-�:.��� ►�t�, �,Z � : ���f`�� STATE LICENSE: # ��'-��c y�$' EXPIR�TION DATE: ' / Z�,�; ARCHITEC'T'/ENGINE�R: PHONE: 1JIAILiNG ADDi�SS: CITY: ZIP: NAME: R�GI�'I'I�A�IO1V: # TYPE OF �(JIZK: �ew Addi#�on A��ssc��sr Structure �Vlove Horne Reznodel�Alteration L� PRflPiDSE���D�K{describein rieruil�:M�S�z� `�jAnd _ ��LP�.�i� E.XI S'i i►ly'Ti ���� L--C���I` ��/�.L ��i 1 f V - 1/���1 �1..L. l�I V.l l�1/�y �V/`l�� �/�l-1 w��Sl� /�� � �yl(: '�r�ITP4�;L�.'��7�1� STOI�IES: SQ,FEE'�'OF�ACH FI,O�R: �O. OF BEDR+D+OIVIS: GARA+GE STALLS: ATTACHED DE'TACHED ESTIMATED C�1�STRUCTION YAL[dATION{excluding land): $ ,��, oz:z�.. e� I hereb��apply for a buiiding per�nit and I acknowledge ti�at the information above is complete and accurate; ._iai ine worit r�°i�i� in confonnancc with the ondin�nces and cades ofthe City and with ihe State Building Code_that I understaaid t,his is not a�ea�rr�it and worlc is not to start without a permit;and that the work will be in accordance�vith the apprflved plan. APPLICAI�+TT'S S�G�ATURE;/ ���t , DATE; ,'� r���. �Z�� ✓� �.�3.w ��c;�rrs oN s�;s.�crs�r v�T� 5utid. d. Tti�:c>�daZa. "I�c right�af individua!oa whom fhc daYa is siorzd or to t�.:stor�d chall bz az zct forth in ihi�section. Jubd.2. Infonnaiion required to be given individuaL .�1n individual asked to supply private or confidential dala wncerning himself shall be intormed ot: (a)the purpose and intended use ofthe requested data within the collectuig siate agency,political subdiv�sion,or statewide system;(b) wheUier lie may refuse or is I�gally required to supply the requested ciata;(c)any known cunszquence arising frotti his supplying or refu5ing to supply pri vxte�x ti�n�de�li�t�dutn;�d{d)t�ie idecntily of otl��tx�rsais or entili�nuth�rized by stale vr feder�l Ixw lo receive k�daia. This r�eyuirement shall noi apply when an individual is asked to suppty investigative data,pursuant to section 13.82,subdivision 5,to a law enforcemeat officer. "Ihe co_mmissiqner of revenue ma�lace the notice rec�uired under this subdivision in the individual income tax or property tax refund instructions instead of on thosc forms. Subd.3. Access to data by individual. Ilpon requ�.ct to a re.cperosible authority,an individual shall be informed whether he is the subject of stored data on individua(s.and wheth�r it is claQ4ified as�ufilic,privaYe or u�nfidential. IJpon his f�rcther reyuest,an individual who is the subject of stored private or puUlic data on individuals shall be shown flie data without any charge to him and,ifhe desires,shall be informed of the content and meaning of Ihal ciata Atier.ui indi�°idual has been shown the privatc dala and i�ilormed of its meanu�g,th�data ne�J not be disclosed to him for six cnonU�s thzraafter anless a disput.,or ar:tiun pursuant to this se�ti�ni is p��tiding ur additionai data on t1re u�dividual has bean collected ur cteaiad. "Ihe responsible authority shall provide copies of the private or public d:tCa upon request by the individual subject of the daW. The responsible authority mav require ih2 requestint,person io pay the actual costs of making,c�rtifying,and compiling the copies. 1'he responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the datz of the requesL,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with ihe request within that time,he shaii so inform the individual,and may tu�ve an:idditionai five days within which to comply with the reyuest,exctuding Sahirdays, Sundays and legal holidays. Subd.4. Procedure when data is not accuratz or complete. An individual may contzst the accuracy or completeness of public or private data �onceming himselt: To exercisa this nghY,an individual sha11 notily in writing the responsible authority describing the naiure ofthe disageement. The resperosible xuthority shall within 3D days either. (a)correc[the data Yuund to be inaccurate or incomplete and atte�npt to notily past recipienLs of inaccurate or incomplzte data,including recipients named by the individual;or(b)notify the individual that hz belicves the data to be corcect. Data in dis�ute sh�ll be disclosed only if 4hn individual's statt�»��et of disa�,,n�c�tr:nt is ins:luded with die disclosed ciaka. The detetmination of the responsible authority may be appealed pursuant to the provisions of the administrxtivc procedure act relating to .:ontzsted cases. DATA PRIVACY ADVISORY In accordance with MS. 13.04.Subd.2,"Rights of subjects of data",we would like to inform you that your request for a pernut or license from the City of Orono or any of its depariments may require you to fumish certain private or confidential infonnation. You are r�tified tlut: 1. Thc uiforn�ation you funush will be used to deternuue your qualif"ication for the pemut or license requested. 2. You may refuse to supply data,but refusal may require that the Ciry deny tt�permit or license. 3. The infonnation mav be shared with ott�er local, state ar federal agencies to the extent necessary to process the pennit or license. -�. If your requested pern�it or license requires Council action to approve, some information may become public. �. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process t�us application or pennit. (�/I i �kJ A--�� L t�/`A �t � �' r irst Middle I,ast Z i i l„ l�"l t-�:rC�j 1 �-`�t` �A �.1 � lddress ���z>,��►�L��;� �� ����l z� [:.��i 3�?-(�� 73 C'itv State Zip Pfione �understa d my rights as stated above. , �� � ` cia....f�trp - �-��'-� �—��,� _s—��S � ,�;w�: ��. .� �.� , � ,��� ¢ � a , ;� ��. , �`F _ ^� -�s�a�....,....w�:.w.�•�,+.++�a+ h..7�,�w-w.sNF'.:"".,""'.�`1""'�., -.�-�' ' Sd" � � , � � - - y �� �� �4 fy�, t k.. - � �{ ��,�� ������.�.-��"4�"-,- � T.��,,..��.� , ��s," ���t �„r. 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COMPLETED ADDRESS ����`�'�' �CL'./�,!'�1 /�-� OWNER CONTR. � TELEPHONE NO. � � ' r � DESCRIPTION , ���C� -- � 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 Z04 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 i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � W a � � O � � O � W � Q � Z W � W � � d W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED _� ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALI_FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. �; pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR C INSPECTION REQUIRED.CAL�TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContract�r-en�sit : Inspector. White Copyllnspector's File Canary CopylSite Notice � � � A� TIME ✓ CITY OF ORONO CALLED IN � � INSPECTION N �y SCHEDULED Z� � PERMIT NO. �� l COMPLETED ADDRESS ��O � � OWNER CONTR. �Q�u-C �/�/�/d' TELEPHONE NO. Lol Z r �,�3 �a U �O� . � DESCRIPTION _ ���`' � ���'LiaUU� � QCC-CSS tL 01 FOOTING 11 MECHANICAL 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-FINAI 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: � . W � 0 ��� � � v � � O � W � Q � Z W � W � � d W� ORKSATISFACTORY:PROCEED Cl PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED �:i ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECTUNSAFECONDITIONWITHIN HOURS. �, PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED C INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next i spection 24 hours in advance. (J52� 249-4600 OwnerlContractor 't : Inspector. White Copyllnspector's File Canary CopylSite Notice ��\ -���� DA E ---• TIME // Y OF ORONO CALLED�N � � �t� j INSPECTION NOTI E SCHEDULED � PERMIT NO. COMPLETED ADDRESS �.�C� ��'X ��%'�� �' OWNER CONTR. �r/1.L-F.1-� ��1 TELEPHONE N0. ����� � (n� '" J�� � � DESCRIPTION ;-y��-�cY--=�I� u`� � FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 0� AMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 03 SULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 4 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 COMPIAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC F1NAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU�YES_NO � COMMENTS: � W a � J O � � O � W � Q � Z W � W � � d W� ❑ RK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W CORRECT WORK&PROCEED C' ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CAL�FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call forthe next nspection 24 hours in advance. (952� 249-4600 OwnerlContra pr6n i e: Inspector. � White Copyllnspector's File Canary CopylSite Notice � �/ DATE � TIME � CITY OF ORONO CALLED IN � ��� `vj INSPECTION NOT C�/ /(� SCHEDULED 2 ' �� 'c%��r'�� PERMIT NO. /�C,�(L�f�/ COMPLETED ADDRESS `7���� �C�X �4���'1 i�c11. OWNER CONTR. �� �"��c�( TELEPHONE NO. C���e�(�%.� ��C�' �� � DESCRIPTION 1����%�� �� � � l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING QA2 FRAMING ' 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 I LATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z 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 � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � � O a � O � W � Q � Z W � W � � d � WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑ CORRECT WORK 8 PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next in ection 24 hours in advance. (J52� 249-4600 Owner/Contractor o � : Inspector. White Copylinspector's File Canary CopylSite Notice i � D TIME CITY OF ORONO �N 7' INSPECTION TI SCHEDULED - �0 %� PERMIT NO. COMPLETED ADDRESS '�130 G07C t'Q�'� OWNER CONTR. ��4� �1� TELEPHONE NO. �O�Z �J�3 p ��� � DESCRIPTION �� ' J`E'�'�""� � � 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 Z04 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 � 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/CONTHACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � � O >. � O � W � Q � Z W � W � � d W WORKSATISFACTORY:PROCEED PROJECTCOMPLETE � O CORRECT WORK&PROCEED '-i ISSUE CERTIFICATE OF OCCUPANCY W � ❑Cl7RRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �� pH0T0 TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next in ection 24 hours in advance. (952� 249-4600 OwnerlContract e. , Inspector. White Copyllnspector's Fite Canary CopylSite Nofice