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Home My WebLink About2003-P06951 - addn/remodel/repair PERMIT C�T'Y OF ORONO Permit ►vumber: 2750 Kelley Parkway - PO Box 66 P06951 Crystal Bay, Minnesota 55323 PeCCTIIt Type: Addition/RemodeURepair (952) 249-4600 Date Issued: ioi2si2oo3 SITE ADDRESS: 1153 Elmwood Ave Mound,MN 55364 P I D: 07-117-23-14-0069 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Pernut Class: Building Census Code 434 Pernut Type: Addition/Remodel/Repair Pernut Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: � Separate pernuts required: vmer-�j NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 83.25 Valuation: $ 2>500.00 State Surcharge Fee: $ 1.75 TOTAL FEE: $ 85.00 APPLICANT: Owner/Self OWNER: Scott Pearson �v THE UNDERSIGNED HEREBY REQUESI'S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. —� �, � - . _ ',_� i� � �� ^�� . - � � APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Sienitures Required), 1-Anplicant, 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1 i r � Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all infor»tation) ------------------------------------------------------ ------�--------;�-----------:�==_---------------------- ------ THE APPLICANT IS: (circle one) � OWNERIOR CONT�ACTOI�J JOB SITE ADDRESS: � � �� . �� ti i -� � % ZIP: � � .�. �', Will this be a P rade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Non permitted events will not be allowed. NAME OF O`VNER: � �� i �' �: I7'1; PHONE: (home)-_- ; - � � � ` ��O (work) MAILING ADDRESS: � e �: � r,��,(j�'�� (��/� CITY: ' � ; (�� ZIP: � "- ' "� r � CONTRACTOR: _ I ,)f, ? ��r ; �,� PHONE: _ ' - � �'�!� �; v J CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration�_ Land Alteration PROPOSED WORK(des ibe in detai�: �' 1: .} ti ;.�";' �� ' '- ; !, � 4 ; ' . � �� - i �, � l ''� (% ��} j�� ,1 ' ��- 9;r rr�/r �� ; , j ( r � I�,"�i r 'r�� ' _ _ � ,�(�� STORIES: � SQ. FEET OF EACH FLOOR � �� 1.� � �`� NO. OF BEDROOMS: ; GARAGE STALLS: ATT. DET. ,_, �,r ESTIMATED CONSTRUCTION VALUATION (excluding land): $ `��r��-�i'j'��` �� ,��%J �� 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. � 'i APPLICANT'S SIGNATURE: ��St.�, v�� ;� DATE: �. � � ' � � , � 1 Sec.13.04 RIGHTS OF StiBJECTS OF DATA ' Subd.1. Type of data. The rights of individual on Nhom the data is stored or to be stored shall be u set forth in this section. Subd.2. Information required to be given individual. .an indi�idual asked to supply private or confidential data concerning himself shall be in[ormed of: (a)the purpose and intended use ot the requested dita within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requestrd data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity o(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 datL pursaant to section 13.82,subdivision 5,to a Iaw enforcement officer. The commissioner of revenue mav olace the notice re�uired aader this subdivision in the indicidual income tax or orooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. tipon request tu n responsible authority,an individual shall be informed whether he is the subject of stored data on individuais,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 wit6oat any charge to him and,if he desires,shall be informed o[the content and meaning of that data. After an individual has been shown the prirate 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 secoon is pending or additional data on the indi�idaal has been collected or created. The responsible authority shall provide copies of the private or public dita upon request by the individual subject oCthe da[a. The responsible authority may require the requesting person to pay the actual costs of making,certifyins.and compiling the copies. The responsible authority shall comply immediately,if possible.w ith any request made pursuant to this subdivision,or within Tive days of the date of the request,excluding Saturdays,Sundays and legal holida�s,i(immediate compliance is not possible. I[he cannot comply with the request within that time,he shall so inform the individual,and may have an addi000al 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 complae. An individual may contest the accuracy or completeness of public or private data concerning himselL To esercise this right,an individual shall nodh-in wrimng the responsible authority describine the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data foond to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individuil;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 o[disa�reement 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 PRIV�CY ADVISORY In accordance�r�ith NI.S.13.04,Subd.2,"Righu of subjects of data",we would like to inform you that your request for a permit or license from the City of Orono or an��of its departments may require}•ou 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 ma�•require that the City den�•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 actio� to approve, some information may become public. 5. You have certain rights under M.S. 13.0� (a�-ailable upon request) to re�-ie��•private data on yourself. 6. Your full name is required to process this application or permit. �� ,_ ,�� fi � � ;- ��r� � F�rst Middle Last '� l S 3 � L C 5� ��f' �'�,�� l� � Address �� 1 1 I �V �� ,�i_J�� C�4' State Zip Phone I understand my rights as stated above. . �- � �� 5�� "�_' S�gnature " � ' CHECK OFF LIST FOR ISSUANCE OF PERMITS ' FOR OFFICE USE ONLY A.DDRESS OR LEGAL: /� S 3 L=Z�,.��.m, �P �}-.�-v PID: DESCRIPTIO�T OF WORK: ,(Z4su i s� 1= t�u d R sv s�—'�^--. ZOrZ�tG REVIEW BY: ,V DATE APPROVED: BUII..DING REVIE`V BY: DATE APPROVED; �v-t$-�� FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes c� No PLAN REVIE� Yes No c� SEWER CONNECTION STATE SURCHARGE Yes � No WATER CONNECITON INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTION Number of SAC�Units OTHER (specify) ZONING CH�CK LIST Zoning District: �/� C E�yS� Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres idth Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front (Lzke): Right Side: Rear (Street): I,eft Side: Adjacent Structures: Wetlan : Building Hei;h[: Def. Hgt. Peal:H t. Lot Covera�e: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # solution Date: Shoreland District: Avg. Setback: Bluff Setback: L.ot Coverage: Ezisting Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS (in house): 7 BUII,DING REVIEW CI-�Cg LIST �C' �' 3 CONSIRUCTION TYpE: �/lJ _ Sq Footage S Per Sq Ftg Basement x _ lst F7oor x _ 2ad Floor z Gara?e x — z = TOTAL Estimated Construction Value: S Z�SOc9 `�`� Inspections Required: �Vorb Requiring Separate Permits: S ite Pl�bing Fire Hazdcover Removal Me;';:anical Water Connection Footing ` Septic Sewer Connection _�Framing Fir�lace Lawn Ircigation Insulation (1�iasonry) Other Wall Board (�1fg.) Well (State Permit) —�F�� CT�g��l�g Electrical (State Permit) Other RE�1IA.RI�S(I�i 1 HOUSE): _---_____------------------------------------------ REYIEW BY OTHERS: DATE: Access: Existing ��, Access Approval: Date By: ------------------------------------------------------- RF��IARKS (TO BE NOTED ON PERI�II'1�: 8 s�f- � D T TIM E CITY OF ORONO CALLED IN �� INSPECTION �C�� / SCHEDULED lD� :DO PERMIT NO. COMPLETED ADDRESS �``S3 ��W��- OWNER CONTR. � TELEPHONE N0. �� Z��-- -3 Dd C� � � DESCRIPTION l� 0� FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING �RAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 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 � 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 � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � a C.f.c,S S � �"' i � � O a � O � W � Q � Z W � W � � � d W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CAIL INSPECTOR ❑CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call forthe next inspection 24 hours in advance. (g52) 249-4600 Owner/Contrac�o ite: Inspector. � White CopyllnspectoPs File Canary CopylSite Notice