HomeMy WebLinkAbout2002-P05169 - accessory structure PERMIT
CITY OF ORONO Permit ►vumber:
2750 Kel!ey Parkway - PO Box 66 P05169
Crystal Bay, Minnesota 55323 Permit Type: a��esso�-y sr�u��ures
(952) 249-4600 Date Issued: si2ii2oo2
SITE ADDRESS: 4675 Creekwood Tr
Maple Plain,MN 55359
PID: 30-118-23-33-0007
DESCRIPTION: UBC Occupancy R3
Construction Type V
Proposed Use: Residential
Permit Class: Building Census Code 328
Permit Type: Accessory Structures Permit Sub-type(s): Accessory Structure
DETAILS:
Approved per resolution#:
Separate permits required: rium�ing iviec;nanicai Eiecuicai�siaiej
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 153.25 Valuation: $ 8,000.00
Plan Review Fee: $ 99.58
State Surcharge Fee: $ 4.50
TOTAL FEE: $ 257.33
APPLICANT: Owner/self OWNER: D&K Biek
MN 4675 Creekwood Tr
Maple Plain MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK 1N SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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� AI�iP�:.ICANT PERMITEE SIGNATURE [SSliED BY S[GNATURE
Copies: 1-File(Si,enitures Reauired), 1-Applicant, 1-Monthlv Reports. 1-AssessinE. 1-Finance Page 1
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Total Fee: $ � � , � ��`, Date Received: � ��--�'�
Entered B � �� " `� �'�
y: ��, , Permit#: ��� � /G� y
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CITY OF ORONO ��LDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��� � �`°a'��'`°� r�`°`'Q ZIP: 5 5 3 S�j
p�o � �"i� SS 359
NAME OF OWNER: � -+ K�� g��k PHONE: (home) 9 5 z-`f 7� --�q oS
(work) 9 S z- ?�f-z- �-(�-7!0 7
MAILING ADDRESS: `-�'�75 C�u-k�-�a�! �r�-Q CITY: ZIP:
D h,*^o � M►� >`5 3 S�j
CONTRACTOR: 5-�-f (�� ��b�:-,q.�PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: JA s^n-s � � �7 �-e-� PHONE•
MAILING ADDRESS: �-��� ,G �l CITY: . ZIP:
NAME: ��c�d .••:, c�•5.} REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure�__
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �J A�•'� �a'��d�*� .
STORIES: � SQ. FEET OF EACH FLOOR: `-f'��i f t2
NO. OF BEDROOMS: -o - GARAGE STALLS: ATT. DJ k DET. N/h
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �sr�aa
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 plan.
APPLICANT'S SIGNATURE: �•-�C 4� DATE: � �9 �Oz
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
5
Sea 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 confidencial data concerning himself
shall be infortned of: (a)the purpose and inte�ed use of the requested data within the collecting state agency,polirical 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 confidendal dara;and(d)the idenary 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 invesagative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or�rooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual sha[I be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidentia(. 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 secaon is pending or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any,request made pursuant to this subdivision,or within five days
of the date of the 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 wichin 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
privare data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authority shall within 30 days either. (a)correct the dara 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 determinadon of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating
to contested cases.
DATA PRNACY 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 �ity 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 required to process this application or permit.
�� � ����
First Middle Last
�'�S7 S ��� T�
Address
O t�.ar�,o , M nt 5 5 3 s9 � s z.-�I-�� -�9 o s
City State Zip Phone
I understand my rights as stated above.
�����-d'�-
Signature
6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �-i(07 S ��,—L�.w u o� T(1-4�L
PID:
DESCRIPTION OF WORK: oo► �s,v
ZO.�iI�Ti G REVIEW BY: DATE APPROVED: S-i�-�'Z
BUII.DI�i 1G REV�W BY: DATE APPROVED; S-��• vz-
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER�I�IIT Yes �/' No
PLAi�t REVIEW Yes �' No SEWER CONNEC"ITON
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CH�CK LIST Zoning District: ro c� r�.s�l
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: �Vetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
�'�� Grading: Staff Approval Date: By: Council Approval Date:
�'�� Septic: Staff Approval Date: By:
�v Zoning File: # Resolution: # Resolution Date:
`l�
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
Y �
BUILDING REVIEW CHECK LIST
�C� � V CONSTRUCTION TYPE: vN
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor z =
Garage x =
z —
TOTAL
Fstimated Construction Value: $ (�,(�vp°"—
Inspections Required: `Vork Requiring Separate Permits:
Site �_Plumbing Fire
Hardcover Removal �_Mechanical Water Connection
do�•►� Septic Sewer Connection
_,Z[ Framing Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
Wall Board
—� (NIfB•) Well (State Permit)
_�C Final Grading/Filling �Electrical (State Permit)
Other
REl�Z��RKS(IN HOUSE):
-----------------------------------------------
REVIEW BY OTHERS: DAT`E:
Access: Existing New
Access Approval: Date By;
-------------------------------------------
REMARKS (TO BE NOTED ON PERivII'I'):
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO E SCHEDULED ���L2'= -���M
PERMIT NO. COMPLETED � Z
ADDRESS_ �7G�7 S— �e�w��� /fe�
OWNER CONTR. _Lxc,►i��c� C��'�f�
TELEPHONE NO. �-S� ���' ��7 bs
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� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q� IN ION 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
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/CONTRACTO TOMEETYOU:�S_NO
� C ENTS: �- G r � �G2c.•�'�1
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W� ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W �ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR
�CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContrac o�site:
Inspector.
White Copyllnspector's Ffie Canary Copy/Site Notice