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Home My WebLink About2004-P06944 - addn/remodel/repair � PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Po6�44 Crystal Bay, Minnesota 55323 P@C1711t Type: Addition/Remodel/Repair (952) 249-4600 Date Issued: 2i19i2oo4 SITE ADDRESS: 770 Dickey Lake Dr Long Lake,MN 55356 P��: 27-118-23-33-0010 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: riumoing iviec:nanicai rirepiace Eiec;uicai�s�aiej NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 593.25 Valuation: $ 44,335.90 Plan Review Fee: $ 385.68 State Surcharge Fee: $ 22.7p TOTAL FEE: $ 1,001.63 APPLICANT: ��'ner/Self OWNER: Charles&Jill Leukuma MN 770 Dickey Lake Dr Long Lake MN 55356 TI�UNDERSIGNED HEItFBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMEIv'TS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SI'ATE OF MINNESOTA BUILDING CODE REQUIRFMENTS. �- j - J � � L.-, ?��C.!/.�'�d/ APPLICANT P RMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Sienitures Renuired), 1-Applicant 1-Monthlv Reports, 1-Assessine. 1-Finance Page 1 � Total Fee: $_�, �;(�� ( � �� ' Date Received: � ��' �� ' �� - Entered By: �� Permit#: ,�� ,`�G 9 y�f ��n �_� I C; � �i �C'�� ` \ CITY OF ORONO - BUILDING PERMIT APPLICATION ,�' �' ��J � � � �� '� All information must be'submitted in full before plan review will be started. �� ' �; �� • � � ; (please pr�r:t all information) ` \------------'-"----------�^= -�i �-�� - e--.j�--��-�^=�--L-ti��---L-'�-=---------------------------------------------------- \ THE APPLICANT IS: (circle�o�ne) OWNER OR CONTRACTOR JOB SITE ADDRESS: � � � � �% � � " ZIP: � 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 City Coa�ncil approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: PHONE: (home) - - �" � � ._� (work) � ,� _, MAILING ADDRESS: CITY: ZIP: CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # �a... -,-�.. ARCHITECT/ENGINEER: � ��, �� - � �� PHONE: �� MAILING ADDRESS: CITY: ` ZIP: ' - , NAME: ' � �� ; , ; , � � REGISTRATION # TYPE OF WORK: New Additi � � T�,% Remo� �� -" r �� .►�P �2 PROPOSED `VORK(desa ,�/��, � �� (�(�� (� �`��/�-� �- � sTo2uEs: � �`,`�.1`�` , , � - - NO. OF BEDROOMS: _ � �� ,� �- � � �'� �_ � `� L� �`J � _i'� ��-�,��, ' � ,� �. ESTIMATED CONSTRU� �(�� ,�:� � �� (;-�n , � �,� 1 ` �\ ) 1 � / � `_� ; � C�� . � I hereby apply for a building pe /" � '� �" � ~`�' he work will be in conformance � -�� :�� ' ,�` '� , y� � t I understand this is not a permit � , � ith the approved plan. APPLICANT'S SIGNATURE: - DATE: Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. T}pe of data. The rights o[individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Informatioo required to be given individual. An iodi�idual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may re[use or is legally required to suppiy 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 indi�idual is asked to supply investigative data,pursvant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the notice reouired under this subdivision in the individual income taY or orooertv tax 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,pri�ate or rnnfidentiaL Upon his further request,an individual who is the subject of stored private or public data on individuals shali be shown the data w ithout 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 sis months thereaRer unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authorih shall pro�ide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requestin;person to pay the actual costs of making,certif�-ing,and compiling the copies. The responsible authority shall comply immediately,i[possible,with any request made pursuant to this subdivision,or within five days of the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so ioform the individual,and may have an additional fi�e days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. :�n individual may contest the accuracy or completeness of public or private data concerning himself. To esercise this right,an individual shall notify in w ritiog the responsible authority describing the nature of the disagreement. The responsible authoriri 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 indicidual;or(b)notify the individual that he believes the data to be correct. Data in ' dispute shall be disclosed only�it 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. '�I DATA PRI�:-�CY ADVISORY � In accordance with�i.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. I'4 I You are notified that: � 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You ma`� 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�-our requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.0-� (a�-ailable 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�h� State Zip Phone I understand my�rights as stated aboce. � Signature � 4 . � � CHECK OFF LIST FOR ISSUAIVCE OF PERiv1ITS FOR OFFICE USE ONLY ADDRESSORLEGAL: ��l (� (�11C_KC`� LJ-��c� �piZ�V � PID: DESCRIPT'ION OF WORK: �4 p(J i �� ZONING REVIEW BY: DATE APPROVED: ��-3�-03 BUII.DING REVIEW BY: DATE APPROVED: r o - �r- o � FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes ,/' No pLAN REVIEW Yes �' No SEWER CONNECTION STATE SURCHARGE Yes ./ No WATER CONiVECIION INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC Units OTHER (specify) ZOti�Il�1G CHECK LIST Zoning Districr. Fire Department: Post O�ce: School District: Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes � No Date of Survey: �- �5� �� Proposed Setbacks: � Front (Lake): (67 �= Right Side: 35 � r Rear (Street): Z34 ` � Left Side: I ��, � Adjacent Structures: /�'�7?lGYf�-� Wetland: N �/� Building Hei�ht: Def. Hgt. /U� C�-/�y,( Peal:Hgt. � Lot Covera�e: O�k Grading: Staff Approval Date: � By: Council Approval Date: Septic: Staff Approval Date: — By: Zoning File: # '-' Resolution: # Resolution Date: Shoreland District: /vv Av�. Setback: Bluff Setback: I.ot Coverage: Existing Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Appro�•al: REMARKS (in house): 7 . � . • BUILDING REVIEW CHECK LIST �� a ' 3 CONSTRUCTION TY'PE: �l 1�l Sq Footage $ Per Sq Ftg Basement z = � Q�,60 t -B 1st Floor �?�1,� 3�= Y2� x Lt4.Z� — �� 2nd Floor �Y x 3 v = K� R �{�(.2� = t '{j� b D( •f� Garage (�7x yb = 3 22 x_ z2• �S = �� 3Z.3 R c TOTAL Estimated Construction Value: $_ �{�� ,3 3,5�j (� Inspections Required: Work Requiring Separate Permits: Site _�plumbing Fire Hardcover Removal _�c Mechanical Water Connection _ Cg_Footing Septic Sewer Connection a Framing � Fire lace _�Insulation P Lawn Inigation Wall Board (M�o�) Other --�- � (Mfg.) Well (State Permit) � F�� Grading/Filling a Electrical (State Perm.it) Other REMARKS(IN HOUSE): � � - ------------------------ ----------- --------- REVIEW BY OTHERS: DATE: Access: Existin� New Access Approval: Date gy: ��----------------------- ---------- ---------- RENIARKS (TO BE NOTED ON PERI�fIT�: . 8 �� [ V � L� TE�,S/� TIME ✓ CITY OF ORONO CALLED IN `r � INSPECTION NOTI ,/ SCHEDULED /C� O �./Y'i _ PERMIT N0. �' Y- COMPLETED i ADDRESS Z� �'l`�' ;- �.. � OWNER��/ �I CONTR. TELEPHONE N0. G��--�:� " � l�' 7�C�� , � DESCRIPTION - �� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIILING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z04 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 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP ? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PIUMBING FINAL �{ 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:�YES_NO � COM�NTS: 4 w� � ' 1� j � �� `� O � � O � W � Q � Z W � W � � � �KSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CA�L INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the�ext inspection 24 hours in advance. (952) 249-4600 Owner/Contracto site: Inspector. � l, 'l/4�i1 , White Copyllnspector'9 File Canary Copy/Slte Nodce � .� v T TIME CITY OF ORONO CALLED IN � �� '�--�,�� INSPECTION NOjICE // SCHEDULED � D /i .�� PERMIT NO._,l��L��y4 COMPLETED ADDRESS ( � ��L . OWNER ��- CONTR. TELEPHONE N0. , �.,`��- y��v — �L/�� DESCRIPTION �?/L2,y I�7 ��i � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS h 03 INSULATION 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 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL � OWNERICONTRACTOR TO MEEf YOU:�YES_NO � COMMENTS: � W 0. � � O >. � `` O � W - � Q � Z W � W � � d W � WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED �STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �gSZ� Z49-46�� OwnerlContr � te: Inspector. � E- White Copyllnspector's File Canary Copy/Site Notice CC - y �� DATE TIME � CITY OF ORONO �(rl ��y CALLED IN --7/i�'/� INSPECTION NO ICE scHEou�Eo 7�/�C.zS �. CCi PERMIT NO. " COMPLETED ADDRESS � \ �% OWNER �' CONTR. TELEPHON NO. �� `-Z— � DESCRIPTION ��n� C`—' �Q�UL �f�t�C'� l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � Q 03 INSULATION 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 COMPIAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP ? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL � 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU: YES_NO • � COMMENTS: ��E ��'�'�n �� W V�`��t �1�1 � a � � 0 � � 0 � w � Q � z w � W � � GW �ORK SATISFACTORY:PROCEED �I PROJECT COMPLETE � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY W 0 U CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� Z49-46�� OwnerlContr $ite: Inspector. ��;�, I White Copyllnspector's Fil Canary CopylSite Notice M - - 200. // a , ,, N _ - - - S�8 Do"¢3'E 0 � � X.o z�.o I � k • . — __. __ � K/.9Z7.7 , ;x , ��.0�i /��y o�d c�/i-oi�o � ,� I 9 - �osP��i�,< ��'� , i ro � I I � � I � ; � I � ' � I ► � - , , � � i� � i , - � ,� . �'�� '�� ; � � ,�, i , , �� w-� , . � ��y�.�� ; , � ; I --, , , � � . ; � � � � � � I �, ! � ' � � � � ' I p I r,oz;.g � , � � <: «�: � :,, 6�,. ,� ! � I � .�iozs.9 �t�1ie� 1 r � �, 6'"� � � � �� V` °� /eZf> i�.e � � N � lo V o � -----x,era.s ..._� ' ,o:Z.9 � N G�z�� . X! �/1�� ZG.33 0 ` xioz4.z _ '� � ' r tJ �.i 7 j LL � �� ' 3� 35�0 /7 ��,il�� ;—��7• � � �"1 �__.,_— �NG' �� \Q I �� OSG�� oUS �n —'�) v i _ � \ \ `"`:� 14 I N� I � � x�o pi�.-�\\ \ •3\ ` io.o ?4�/7 �° �, I Z=, o =z.� � --.o- ----- \e'1 -��,�"� /oZ3.¢R' Xl�tl, � �/OL.¢> s� � , b ` ' `�6 x�� °_ �, � I ' x,ez,. ��, �.`��,� �f�' OF QR�l�Q ; ' 8 x,ozZ.� � ; :� �1�� :�N 4��ING �I.AN � I � j ; ' ��'� ' � + '`�� 1rJrJ, ;�a,�s � I � , i , ; I � i- i ��w�,,.,�� ;;;��J �ru;�;� �a �r+��r�r..Ar �`� '•.y� •wllr'Y ) � . , � ��--_� �,t�h�i�.4��,-�,�.,�.. � I 1 � I –.�� y j' I — � i � ��► I '��` _ _. � � -�'`°3 , � � I j � Q ..._ ___ ---......�.- � � I ( I\I � � � � I ' � \ � I E ' I � I � I ' � I � � I i � ; j h� � i /� I I i I � I N' ^' ' l� � I,k�;r.�. i o i ° ' — — �-- .—� — � � L�)T�-' , � '�� xio�e.4 � — — — — — �� ' i ; _ i � - - _ � � � �O.// SB7�59'S/E — - - .-'��o,�.s � — � --- �— � � ------ ; � -------- i ---- � n�.Z3 0 ------- ---_ ------- --- ' ----- i i o 2 1.q � . I - — —-- I —_ -- xioiq 8 � KEY----- L.AKE--- _ DR1=__-_ -- - —_- -_ — -- �e��r Denot I �- x �00 . 0 Denot ( (100 .0 ) Denot Denot ' Propo �� '�� 4!�� -� ._ t� -2� �� a�� i�`. �:�i .. ;�;� id corrfCt representation of � survey of Fi{e No. Isnd end of the location of ifl build�ngs, ��3� ac�+ments, if any, from or on said land. � d�o} _,,�.OriL �9 � Book - Page i � -- r �