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HomeMy WebLinkAbout2007-P11623 - accessory structure PERMIT CITY OF ORONO Permit ►vumber: 2750 Kelley Parkway- PO Box 66 P11623 Crystal Bay, Minnesota 55323 Permit Type: (952) 249-4600 Accessory Structures Date Issued: 11/1/2007 SITE ADDRESS: 4680 Creekwood Tr Unit# Maple Plain,MN 55359 PID: 30-118-23-33-0005 DESCRIPTION: UBC Occupancy U1 Construction Type V Proposed Use: Residential Census Code 328 Permit Class: Building Accesso Structures Permit Sub-type(s): Accessory Structure Permit Type: ry DETAILS: Approved per resolution#: Separate permits required: Electrical(state) NOTICES/REMARKS: Pool House Only With Electric,No Plumbing,No Heat FEE SUMMARY: Permit Fee: $ 209.25 Valuation: $ 12,000.00 Plan Review Fee: $ 136.01 State Surcharge Fee: $ 6.00 TOTAL FEE: $ 351.26 APPLICANT: Twin Lake Design Group Inc. OWNER: Dale&Jonmari Olsen 3071 Colbert Ave.N.W. 4680 Creekwood Tr Buffalo, MN 55313 Maple Plain, MN 55359 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. -•-------_ .._ -_....._ ( -�-�e- � �JY�'1�,��/'�� APPUCANT PERMI`FEE�S} URE ISSUED QY SIGNATURE Copies: l-File(Srgnatures Required), I-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 Total Fee: $ ���. DateReceived: �� ��'� � Entered By: Permit#: ,�`L�,� 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 CONTRACTOR JOB SITE ADDRESS: ��U�J ����,peoc� �r��.� ZIP: �-��� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YeS �NO If yes, a special even!permil is required with Police Department and City Council approvaJ 60 days p��ior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site pa�-king is available. Non permitted events will not be allowed NAME OF OWNER �U�E k J o,-,v�l�i�J�_ O�SP�- PHONE: (home) (work) MAILINGADDRESS: �lo�U�i�z 'Lw;�,�1 ,�� CITY: ��c-y►c ZIP: �Sl CONTRACTOR:-C w,;�� l._� �r- L��.v�; PHONE: CONTACT PERSON: '� MOBILE/PAGER:�3�-Zo(c- 33���- MAILING ADDRESS: ���� C'�. l lr,.� v�, l���� CITY: ��f{��.lo ZIP: 553�3 STATE LICENSE: # t�ti t",�� w/ C,-�-�i EXPIRATION DATE: ARCHITECT/ENGINEER: —r-�,�, ;,�� �_��. C'�„`,� 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 require MCWD review and permits! PROPOSED WORK(describe in detai�: �aoL �{���, - ���_ fl,���, ,�lt� �Ww�F��i�IC� t�c� ��c-1�—� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �a, (��� 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 accardance with the approved plan. � � � � v yc� c� APPLICANT S SIGNATURE: � ATE: � � 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. I. Type of data. The rights of individual on whom the data is stored or[o be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply priva[e 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 leeally required to supply the requested data;(c)any known consequence arising from his supplying or refusin�to supply private or confidential data;and(d)the identity of other persons or entities authorized by state 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 5,to a law enforcement officer. The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or property tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon requestto a responsible authority,an individual shall be informed whether he is the subjectof stored data on individuals,and whether it is classi6ed as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the 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 ofthe priva[e or public data upon request by the individual subject ofthe data. The responsible authority may require the requesting person to pay the actual costs ofmaking 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. If he 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible au[horiry describing the nature ofthe disagreement. The responsible authority shall within 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipieots 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 ofthe administrative procedure 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 wili 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 ar ficense. 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 required to rocess this ap lication or permit. `7'r,v//�-/ �4/� �ES/�ati� �I��/� iXl� First Mid� Last _�>>i �L���,eT � l Address ��{-F-���-zo �I�/ .�.�/3 � �-��2 -�z�� City State 7,ip Phone I understand my rights as stated above. �, 7 � �� Signature ,�fZF-S /�E=A 'i Reset Form 32 CHECK OFF LIST FOR ISSU.ANCE OF PERMITS FOR OFFIC�USE ONLY ADDRESS OR LEGAL: � `f��'C� ���(c..t�c-,�–���� PID: DESCRIPTIONOFWORK: � Z' x J7 ' n�� � hCL�,-�- ZONING REVIEW BY.• � DATEAPPROVED. J(� /'�5 Gi��� BUILDING REVIEW BY.• DATEAPPROVED. —� FEES TO BE CHARGED: Misc. Fees Calculated By: ��yN� �� PERMIT Fes ✓" No PLAN REVIEW I es ✓°' No SEWER CONNECTION STATE SURCHARGE Fes � No uATER CONNECTION INVESTIGATION FEE Y'es No_� PARK FEE SAC Yes No �/' SITEINSPECTION Number of SAC Units OTHER (spec�) �_��____�___���_�___��_�________�__�_��_��r_�� ��_�___��_____��__�__��_���___�__� ZONING CHECK LIST Zoning Disti-ict: l��� Fire Departnzent: _ Post Off ce: School District: Lot Area: Sg ft. Acres W'idth Depth Survev Submitted: }'es �� 1Vo Date of Sz�rvey: f�1.,� �V' Proposed Setbacks: q Front(Lake): _{�� � Right Side: 0� i , Rear(St�•eet): � � Left Side: � � \ .4djacent Structures: � Wetland: Building Keight: Def. Hgt. � /�— Peak Hgt. Lot Coverage: _� Grading: StaffApprova[Date: Bt: Council Approval Date: Septic: StaffApproval Date: �(� � ������ Bl�,� Zoning File: # Resolution: # Resolution Date: Shoreland District: �L�CG['D Permit: .4vg. Setback: B1uffSetback: LotCoverage: Fxisting Proposed Hardcover: 0-%.i' i�-��0' ?.i 0-�00' .i 00-1000' Hardcover I'ariance Requir•ed: Y"es No Date ofCouncil.9pproval: REM.9RIiS(in house): 33 B UILDING REVIEH'CHECK LIST L%BC: l9—1 CONSTRUCTIO�'TYPE: \(A� Sq Footage ,�Per Sq Ftg Basement x = Ist Floor z = 2nd Floor x = Garage x = x = TOTAL _ Estimated Construction Value: S ( ?�d�c7� Inspections Required: Work Reqc�irins Separatc Permits: Site Plumbing Fire Hardcover Removal �Llechanica/ Y�'ater Connection �Footing Septic Sewei•Connection _�Framing Fireplace Lawn Irrigation Insulation (�Liasonry) Other W"all Board (Mfg.) G�"ell(State Permit) �LFinal Grading;F'illing _�Electrical(State Permit) __Other REMARKS(INHOUSE): REVIEW BY OTHERS: DATE: Access: Existing N'ew Access Approval.• Date By: REM.ARIiS (TO BE NOTED ON PERMIT): 34 � � . . . � � �. � t . : , : , � t � —,�—s�..;._�_ -""'-�"' -��_�--i � I I � � � � 1 j ! ' I � j + � � 1 I F � � ' �i i 1 � ( I ' � �� I ' � ' ' • � � I I � i � �. 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