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Home My WebLink About2007-P11174 - addn/remodel/repair PERMIT �lTi' OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p11174 Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair (952) 249-4600 Date Issued: 9/13/2007 SITE ADDRESS: 80 Cygnet Pl Unit# Long Lake,MN 55356 PID: 04-117-23-22-0017 DESCRIPTION: UBC Occupancy R3 Construction Type VN 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: NOTICES/REMARKS: Kitchen Re-Model,Remove Old Kitchen&Replace FEE SUMMARY: Permit Fee: $ 461.95 Valuation: $ 32,000.00 Plan Review Fee: $ 300.27 State Surcharge Fee: $ 16.00 Misc.Fee: TOTAL FEE: $ 7�g,22 APPLICANT: Owner/Self OWNER: Mr. &Mrs. Smith � 80 Cygnet Pl 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 ORDWANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. i � � � ,L� .%� (.�� __.; � t � � APPLICANT�E�MIT E S ATURE�` '" ISS E BY SIGNATURE Copies: ]-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 � �� j 1 Total Fee: $ 779 7 L. 1�\ Date Received: ("� 1 � � �� Entered By: Permit#: (� �-'� -C% 1 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: � ZIp� �^.�� 3.�� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes, a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be reguired unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. NAME OF OWNER: �v( �i/"�C.�/ `S(,�,� � 't`� PHONE: (home) �tj,z-�O�gt��z (work) �l�'a0! ",$czL� $ MAILING ADDRESS: CITY: �/rj�a ZIP: �,��,�'L CONTRACTOR: (-� PHONE: _�'Jj�-�0��9�� CONTACT PERSON: p MOBILE/PAGER C�,- ac7!-3�.F9� MAILING ADDRESS: G�✓� �.�7'�' j'�(. CITY: �/-��, ZIP: , .r3.r6 STATE LICENSE: # -- EXPIRATION DATE: ARCHITECT/ENGINEER: ��1,� /'1' �v� PHONE: �,��- �j j��c� ?O? 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! P OPOSED WO (dre/scrirbe in detain: (�(�, -��P y �-P `//N-U �(� � - � l/C,l �I' � �►" P — P�' Q c STORIES: �_ SQ.FEET OF EACH FLOOR: � (� �-� NO. OF BEDROOMS: 3 GARAGE STALLS: ATTACHED� DETACHED_ ESTIMATED CONSTRUCTION VALUATION(excluding land): $��} z• �. o0 I hereby apply for a building permit and 1 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' t to start ' ut a permit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: �—zG � G� 31 � �CHEC�K p�F' i�IST FOR ISSUANCE O�F' �E�'l�LITS FOR OFFICE USE ONL� C.�f i ;— �� /) �� DD�tESS ORLE�AL: `� � e . PID: �C��P � < n�. �,,� ��;-�r�,w�� lc�✓/� 9�"�l� ESC��7�� OF WORK: /1Q,�'1•, ..,� �,.�r--_�--------- ' j/ a� �-------- --------`______�__-------------pATE APPROVED //16'1 �O�,�G REVIE�V SY: DAT'E APPROVED; �- g - � . -- �ULLDING REVT.EtiV BY: . � ---=-----------------------=------------------------------- �`EES TO BE C�-T�GEA� Misc, Fees Calculated Sy: PERNLIT Yes ✓� No _ PLAN REVIE`V � Yes ,/� No SE�VER C�i�INECTION No tiVATER CONNECTION STATE SURCHARGE �-'eS � ,�o � pA�{ FEE INVESTIGATION FEE Ye5 No —�- SITEINSPECTION S1�C �es er af SAC�Units OTHER (specify) Numb ----------------------- ------------------------------------------------------ ------ ZO! � Cr CIiE.CK LIST Zoaiag District: N.C-_ � Post Office; Schaol District: � Fite Dep�e�� . Acres ' Widch Dep� L,oc Area; Sq.ft. . Survey Submi[ted: Yes �o Date of Sunrey: Proposed Setbacks: Q � Side: � Front(Lake;; �� Rear (S�reet): Lefc Sid . rPnt Cln r� r , ��/atl�r tj: �r��ja„�.... 1_:ll_Z"; Pea�Hgt. Euil�lin� Hei�t: DeF. H�t. . Lot Covera�e: GradLng: Staft Approval Dace: By; Counc� Approval Date: ' Septic: S�af: Aporova! Date: +' " � ��' �'`f� Zoc�.n�' F��le: �`______----- Resolut�.oa: n Resolutioe Da:e: Sherel�ld Dlst:ic�: g�,,`F:ce�.ba k: L,:��Coverz;e: A��. Se`•�pac'";: p;op�se�' �ts��a� �-I Z CC 0`�P r•, G-'!�� _._------ ----- 7�-2�� ------ __---- '7;u-��s.: — ---------- ��-....,., ----- J. ��r1 , ��.� V. L.V'..--... . _ -� —' ra-r.�.�,'Z.' '�ar,_,:.° .,_::.�'.i2,_. 12: . �^,,�,1T�� /yn �I �.1;``� y'�' k . _.. . ___ $UILDING REVIE�Y CHECK LIST UBC: 2•Z ' CONSTRUCTION TYPE: _y N Sq FootaQe $ Per Sq Ftg Baseraent . ,. x _ . ls[ Floor x � _ � . 2nd Flaor x = . Gara�e x = z = TOTAL Estimated Coastructioa Value: $ 3Z,Ooo °i—' Inspections Required: tiYork Requiring Separate Permits: 5 ite Plumbing Fire Hardcover Removal Mechanical Water Coanection Footing � Septic 5ewer Coanection ' �_Framiao Fireplace Lawn Irrigation yc I�u�ativa (ivl,�soary) O�her �Vall Soatd (Mfg.} Weli (Stace Permit) � F�� G�adi�g/Filling Eieccrical (State Pettnit) OCher RENIARKS (IN HOUSE): " - -- --- - ---------------------------------------------------------------------------------------------------- REVIE'�V �X OTHERS: �A�; Access; Ezisting New Access Approval: �atz &y; -------------------- RE1�IA..RKS (TO EE NOT`ED QN PER.�.tiII1�}: � �: Sec13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shal I be as set forth in this section. Subd.2. [nformation required to be given individuaL An individual asked to supply private 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 legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing 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 shall 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 required under this subdivision in the individual income ta�c or propertv ta�c refund instructions instead of on those forms. Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuRher 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 hlm 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 of the private or public data upon request by the individual subject of the data. The responsible authonty may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authonty 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. [fhe cannot comply with the request within that time,he shal I 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 individua]may contest the accwacy or completeness of publ ic or private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describingthe nature ofthe disagreement. The responsible authority shall within 30 days either (a)correct the data 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 determination of the responsible authority may be appealed pursuant to the provisions of the 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: l. 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 Address C��y te Zip Phone I understand my rights as stated ove. S ature Reset Form 32 / L� / �j (�� 1 E TIME � CITY60F ORONO CALLED IN � INSPECTION NO ICE �L SCHEDULED � PERMIT NO. �l�l 7/ COMPLETED ADDRESS �� -� OWNER � CONTR. TELEPHONE N0. S� �"� 7" — �7`�"�"J � DESCRIPTION ^Tli � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRA G/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHOREM/ETLANDS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q�INAL ❑ SEWER HOOK-UP ❑ PROGFESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING Rf ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL � ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: ¢ W a � � � �1 rNA ( � � A-l I f E'lv� ,' �� o � � r------- W � Q ti Z W � W � � GW�WORK SATISFACTORY:PROCEED r PROJECT COMPLETE � ❑CORRECT WORK&PROCEED I UE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR RE�NSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. �; pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ IIVSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-4600 OwnerlContractor on site: Inspector. ,c� o .c White Copyllnspector's File Canary Copy/Site Notice