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Home My WebLink About2005-P08990 - addn above an existing deck PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 Po8990 Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair (952) 249-4600 Date Issued: 8/9/2005 SITE ADDRESS: 884 Dakota Ave Unit# Long Lake,MN 55356 P�� 26-118-23-33-0020 , DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair DETAI LS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: Addition above an existing deck FEE SUMMARY: Permit Fee: $ 69.25 valuation: $ 2,000.00 Plan Review Fee: $ 45A1 State Surcharge Fee: $ 1.00 TOTAL FEE: $ 115.26 APPLICANT: Jerid Adickes Construction OWNER: Benway&Gasner P.O.Box 92 884 Dakota Ave Montrose,MN 55363 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 ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. a � � / f// `��j�'� � '��t_`�_L_ � ,�i')/1/l � � � i� �� j APPLICAN PERMIT E SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 : � . �o �� Total Fee: $ � �CJ � Date Received: �� Entered By: I!_ /;' -/ _ , , �< � ��/ `=� Permit#• �/z/ /a�� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print al[information) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle one) OWNER OR ONTRACTO JOB SITE ADDRESS: ��" �� ✓�Jl��}� ,F�v�� u,%� ZIP: S.�� 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 sufficient on-site parking is available. Non-permitted events will not be allowed. NANIE OF OWNER: ,,C L,'{/� ��SSnC✓ PHONE: (home) /1 (work) ;'<� �iti�-66�0 MAILING ADDRESS: ��/ �ii KU�'� �1��C CITY: ��- ZIP: !�,35� CONTRACTOR: r_j'✓�-� A C� .�G�K!� �,�,-,�� , PHONE: �iE� s'�� `�p-.��;� CONTACT PERSON: ��; MOBILE/PAGER: MAILING ADDRESS: �� T,�,C, ;'�� CITY: /�;�,;��,:<.�; ZIP: S'�.�E�� STATE LICENSE: # �-,s��j�i�s.z EXPIRATION DATE: C%�; ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home Remodel/Alteration ,�i PROPOSED WORK(describe in detai�: -�!�„✓� �n (.ts:�;�.:-�, C✓c��.�� ve. rvtih�b �� v� ; n�� - n��>�� .- �—�ll� r�. � ��r �� ' �l.t �-�.� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � �� 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: DATE: � �% �� 31 Sec.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 confidential data conceming himself shall be informed o£ (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 ofother 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 imestigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax orQropertv 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 infortned whether he is the subject of stored data on individuals,and whether it is classified 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. Afrer 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 of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs ofmaking,ceRifying,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 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 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 ofpublic or private data concerning himself To exercise this right,an individual shall notify in writing the responsible authority describing the 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 ihat 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 disdosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act rela[ing 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 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. L.i.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. �7�,�,•d J��cs ,qcJ,�kc; First Vliddle Last L��}� ?t�f ��1. N Address Qe�C�no /'".'�.1 SJ3�� 6;�-� 3p'��7� City State Zip Phone I understand my rights as stated above. Signature 32 ' CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: f�4�`( �iq�c o� A ve PID: DESCRIPTION OF WORK: �200 o�..�n L,--,�,s 4 �Oe � ZO�G RE'V�`V BY: DATE APPROVED: �- �• o� BUII.,DING REVIEW BY: DAT'E APPROVED: g -y- o� FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes ✓' No PLAN REVIEW Yes � No SE`VER CO�TNECTION STATE SURCHARGE Yes �/ No WATER CONNEC'ITON INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC Units OTHER (specify) ---------------------------------------------------------------------------------------------------------------------- ZO�tI�1G CH�CK LIST Zoning District: /«�(-{i,qrN� — �EC.k �-�P/�P9 10-I o-�� Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres Width Depch Survey Submitted: Yes _� I�10 Date of Survey: � Proposed Setbacks: Fron[ (Lake): Right Si : Rear (Stree[): Left Side: Adjacent Structures: Wetland: Buildin� Hei�ht: Def. Hgt. Peak Hgt. Lot Covera�e: Grading: Staff Approval Date: By• Council Approval Date: Septic: Staff Approval Date: y: Zoning File: # Resolution: # Resolution Date: Shoreland District: Av�. Setback: Bluff Set ack: L.otCoverage: Existina Proposed ..7 Hardcover: 0-75' 7�-2�0' 2�0-SGO' 540-1OC�' Hardcover Variance Required: Yes No Da�e of Council Approval: RE�L4RKS (in house): BUILDING REVIEW CHECK LIST UBC: (z� 3 CONS'I'RUCTION TYPE: �(r� Sq Foo[age $ Per Sq Ftg Basement x = lst Floor x _ 2nd Ftoor R = Garage z = R = TOTAL Estimated Construction Value: $ 2�pp0 � Inspections Required: �Vork Requiring Separate Permits: Site Plumbing Fire Ha�dcover Removal Mecharucal Water Connection Foa[ing ` Septic Sewer Connection pc Framing Fireplace Lawn Inigation Insulation (Masonry) Ocher Wall Board (Mfg.) Well (State Permit) —�F�� Grading/Filling Electrical (State Permit) O[her REI�IARKS (IV HOUSE): - --�---- ---------------------------------------------------------------------------------------------------------------- REVIE`V BY OTHERS: DATE: Access: Existing New Access Approval: Date gy: -------------------------------------------------------------------------------------------------------------------- RE�IARKS (TO BE NOTED ON PERiVII'I�: 8 �� i . �� ✓ DATE/� TIME CITY OF ORONO CALLED IN /D"/rT '��' INSPECTION NOTIC C�/, SCHEDULED U-/ -U "� �'�' (l"�•-� PERMIT NO. � � ` v COMPLETED I��'.�r�� ADDRESS�7 ��'�c'��— ��'� OWNER ��z.(� G-c� S,/I.Ci CONTR. T r�`<.(�,��.'t/C�� :��,!". TELEPHONE N0. QL�I/�i" `�To� � �� "r'l�v (o � DESCRIPTION ilG��— l� 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 5 FINAL 14 SEWER HOOK-UP 06 PROGRESS � MO-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 � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � w a o > �'� a � 0 � W � Q � z W � W � j d W� ❑WORK SATISFACTORY:PROCEED ROJECT COMP�ETE W ❑CORRECT WORK&PROCEED f: I SUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR RE�NSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR 7 CITATION ISSUED ❑ INSPECTION REQUtRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-4600 OwnerlContractor on site: Inspector. �,_/ /"'`� . f�� White Copyllnspector's File Canary CopylSite Notice � � � ��<� � DATE � TIME CITY OF ORONO CALLED IN -`�^�' '�� INSPECTION NOTICE SCHEDULED � �-�� ` PERMIT NO. ��g'��(C� COMPLETED ADDRESS ��`1 / J�.-�'-t� �� - OWNER CONTR. .1Q�� 1cI i�'�S Cr�1��s'f� `/. TELEPHONE NO. 7� .� �iS'�J dc� 7L� _ ,� � DESCRIPTION�C� �n • ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING AMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS 0.�3.aA1 TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 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 COMPIJ{INT v 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 � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � j � o /��K � C � �� .. a � 0 � W � Q � Z W � W � j d W ORK SATISFACTORY:PROCEED i_i PROJECT COMPLETE � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. r; pHOTOTAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-460� OwnerlContractor on site: r Inspector. �.t� ��:.� White Copyllnspector's File Canary CopylSite Notice