HomeMy WebLinkAbout2005-P09232 - addn/remodel/repair � . PERMIT
CITY OF ORONO Permit ►vumber:
2750 Kelley Parkway - PO Box 66 P09232
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
9/30/2005
SITE ADDRESS: 35 Crystal Creek Rd Unit#
Long Lake,MN 55356
PID: 33-118-23-33-0002
DESCRIPTION:
Proposed Use: Residential 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: Electrical(state)
NOTICES/REMARKS:
Frame Basement
FEE SUMMARY: Pernut Fee: $ 181.25 valuation: $ 10,000.00
Plan Review Fee: $ 117.81
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 304.06
APPLICANT: Roncor Construction OWNER: Steven&Anne Koehler
10470 Lyndale Ave S- 11 E 35 Crystal Creek Rd
Bloomington,MN 55420 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 ORD[NANCES AND STATE OF
MINNESOTA BUILDING COD REQUIREMENTS.
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APPLI ANT PERM[ EE SIGNATURE ISSUED BY SIGNATURL
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, I-Septic) Page 1
Total Fee: $ l��•�� Date Received: 9 a�-o-�
�ntered By: � Permit#: A�9a3�
�,�;'� CITY OF ORONO - BUILDING PERMIT APPLICATION
f��� �
�cu�,���a� All information must be submitted in full before plan review will bc started.
� (please priizt nll information)
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THE APPLICANT IS: (circle one) OWNER OR ONTRACTO
�---------
JOB siTE avn�ss: �5 ����Izu� C���- �'c�. zlr:
Will this be�yPQarade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes IN No lf��es, n special event perinit is regzrired ivith Police Department and Ciry Coa�nci[npprovnl
CJ 60 days prior to the e>>ent. Shuttle bz�s service will fie required tualess applicant den�onstr•ates
sufficient on-site parking is crnnilnble. Non-pern�iited events tivill not be nlloived.
NAME OF OWNER: �S�"(�G/�t'�.�1/l�,/��� PHONE: (home)
� (work)
MAILING ADDRESS: �_���� ��x'I� CITY: ���1!�;��'Yl.�-1�- IP:
CONTRACTOR: /'C.�Y�(�N (�G�✓lS�t�1 ,�'� PHONE:Cf SZ ��l�'(�� �S1 �
CONTACT P�RSON: ��yLC� v���c�^{� MOBILE/PAGER:
MAILINGADDRESS: %U7�(� L�-,i'it�PC ,�VrS.(1�ITY: ��l�i'1 ZIP: s5`l��-(7
STA'I'E LICENSE: # /,�L Z 3 3"7 EXPIRATION DATE: �5 � �
AI2CHITFCT/ENGINEER: � PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Acce�,sory Structure
Move Home Remodel/Alteration �`�
PROPOSFD WORK(describe in detai�: %yi�iyu �JG��1e-���
STORIES: SQ.FEE'I'OF EACH FLOOR:
NO. OF BEDROOMS: GARAG� STALLS: ATTACHED DETACHED
CS'I'IIVIATED CONS'I'RUCTION VAi.UA'i'ION(excluding land): $ l0��-
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 pcnnit and work is not to start without a permit;and that the work will be
in accordance with the approved plan. �
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APPLICANT'S SIGNATiJRE: ��`��Z'� � DATE: ��
31
Sec.13.04 RIGHTS OF SUI3JECTS OF DATA
Subd. 1. "1'ype of data. '�he rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. ]nfonnation required to be given individual.An individual asked to supply private or contidential dataconceming himselfshall be
infonned o1'. (a)the purpose and intended use of tlie requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legal ly required to supply the requested data;(c)any known consequence arising irom his supplying or refusing to supply
private or contidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. l'his requirement shall
not apply when an individual is askcd to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
"Che commissioner of revenue mav place the notice required under this subdivision in the individual income ta�or propertv tak refimd
instructions instead of on those fonns.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is lhe subjectof
stored data on individuals,and whethcr it is classified as public,private or contidential. Upon his tLrther 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 ot'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 sis
mon[hs thereafter unless a dispute or action pursuant to this section is pending or additional data on the individuai has been collected or created. The
responsible authoriq�shall providc copies of the private or public data upon request by the individual subject of the data. The responsible authority
may rcquire the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,�vith any requcst made pursuant to[his subdivision,or within tive days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possiblc. If he ca�mot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within wllich to comply�vith Uie reyuest,e�cluding Saturdays,
Sundays and Icgal holidays.
Subd.4. Procedure when data is not accurate or comple[e. An individual may contest the accuracy or completeness of puUlic or private data
concerning himsel f. To exercise this right,an individual shall notify in writing the responsible authority describing tl�e naWre ofthe disagreement.The
responsible aulhority shall within 30 days either (a)correct the data found to be inaccurate or incomplete and attempt lo notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify[he individual tha[he bel ieves 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.
��he detennination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating[o
contested eases.
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:
l. The infonnation you furnish will be used to detennine 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 pennit 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 117iddle Last
r�ddress
City Statc "Lip Phonc
I understand my rights as stated above.
SignNture
�2
CHECK OFF LIST FOR ISSUA1�tCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 S C 2 ys r19� c�c�
PID:
DESCRIPTION OF WORK: �,q s�,�,-.o„�F �-hw�./�
ZO.VI�1i G REV�W BY: ��/� DATE APPROVED:
BUiLD�G RE'VIEW BY: � DATE APPROVED: s• 3� •� c
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes �/ No S�VER CO�INECTION
STATE SURCHARGE Yes _� No WATERCO�tNECTION
INVESTIGATION FEE Yes No ✓' PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONI�IG CH�CK LIST Zoning District: �s,� G_��.•�G
_ �
Fire Department: Post Office: School District:
Lot Area: Sc.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Si :
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Covera�e:
Gradina: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Av�. Setback: Bluff Set ck: L.ot Co��erage:
E�istin� Proposed
�
Hardcover: 0-7�'
7�-2�0'
2�0-SOQ'
500-100a'
Hardcover Variance Required: Yes No Date of Council Approval:
gtEI�qARhS (in house):
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BUILDING REVIE`V CHECK LIST
�C� �' S CONSTRUCTION TYPE: V y�/
Sq Foocage $ Per Sq Ftg
Basement � _
lst Floor z _
2nd Floor z _
Garage R =
R -
TOTAL
Estimated Construction Value: $ /0,�o v �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Foo[ing � Septic Sewer Connection
� Framing Fireplace Lawn Inigation
Insulation (IVlasonry) Other
_�Wall Board (Mfg.) Well (State Permit)
���� Grading/Filling _�Electrical (State Permit)
Other
RENIARKS (IN HOUSE): - ---- -��--
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RE'VIE`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By;
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REI�IARKS (TO BE NOTED ON PER�bII'I'):
8
��� DATE TIME �
CITY OF ORONO CALLED IN
INSPECTION N IC SCHEDULED )0"� ����
PERMIT NO. � COMPLETED
ADDRESS � S C�c� S�� �Cy �
OWNER CONTR. � U h� C�/'
TELEPHONE NO. �T� �� � �.�� I I �G'�� �OU PS� �
� DESCRIPTION
l� 01 F NG 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
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/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED C"i PROJECTCOMPLETE
� ❑ CORRECT WORK&PROCEED 1- ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. ;� pHOTOTAKEN
INSPECTOR WlLL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ext inspection 24 hours in advance. (952� 249-4600
OwnerlContra �site:
Inspector. � '
White Copyllnspector's F�e Canary CopylSite Notice
N
done
Cod4
Af ALLIfl-ME-5
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IM,, E IN" -9
THE: DRAM BY:
RONCOR CONSTRUCTION Koehler Erin Nimmer
DATE:
10740 Lyndale Avenue S., #°11E ESIDENGE: 9/19105
Bloomington, MN 55420 35 Crystal Greek Rd.
Tel. (952) 888-5578 Fax (952) 888-0755 Orno, MN 55336 5HEET #1 1 of 1