HomeMy WebLinkAbout2007-P11347 - re-side PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11347
Crystal Qay, Minnesota 55323 Permit Type: Minor Alterations
(��2�) 249-4600 Date Issued:
8/16/2007
SITE ADDRESS: 1920 Fagerness Pt Rd Unit#
Wayzata, MN 55391
PID: 17-117-23-23-0031
DESCRIPTION:
Proposed Use: Residential Census Code O/S-Building
Permit Class: Building
Permit Type:
Minor Alterations Permit Sub-type(s): Building-Re-Side
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 111.25 valuation: $ 5,000.00
State Surcharge Fee: $ 2.50
TOTAL FEE: $ 113.75
APPLICANT: TBH Builders&Remodelrs Inc. OWNER: Bruce&Camille Curtiss
9710 234th Lane NE 1920 Fagerness Pt Rd
Stacy,MN 55079 Wayzata MN 55391
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.
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APPLICANT PE M E IGNATURE IS '�D BY SIGNATURE
Copies: I-File(Signatures Reguired), 1-Applicant, l-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
' Total Fee: $ � Date Received:
� Entered By: Permit#:
CITY OF OR�NO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � �'I'Zo �,�4,E'Yl- ZIP:
f�-��-�: i`�
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Ye5 �No If yes, a specia!event permit is required with Police Department and Ciry Counci!approval
60 days prior to the event. Shzrttle baas service will be required unless applicant demonstrates
sufficient on-site parking is availab[e. Non permrtted events will not be allowed.
C;LrLC. ��2- 2Z.� � ��80
NAME OF OWNER: ,dts� `� C c�e.j s S PHONE: (home)
(work)
MAILING ADDRESS: I�'ZD �sG�G_i2-a�SS �t'i CITY: �n ,;_, � ZIP:
CONTRACTOR: �p�� �g;l�y.���c���.�y..�,�r�f?t,� i►�►C�HONE: (��z-7�-l-)�--(v�`�
CONTACT PERSON:-�j�� �,�G�i g�� MOBILE/PAGER: �
MAILING ADDRESS: �� t n 2 3�{-� �.i.� lJ t CITY: S i�.� ZIP: 5 So'J�
STATE LICENSE: # Z o 3 �,5'3�{- � EXPIRATION DATE: 3 -2� _�.,�
ARCHITECT/ENGINEER: - PHONE:
MAILING ADDRES5: �—'- CITY: ZIP:
NAME: ��---� REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows) G
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detain: �'ow�,��-e�-i� S�O:,J G,� S�isrz,�Fr�
_�`��-_ rw�� 0 l.J r-J �.N-
STORIES: Z SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(ezcluding land): $ '�p d�
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 SIGNATU� DATE: -� 6(v�-p�
31
" Sec.13.04 RIGHTS OF SUBJECCS OF DATA
, Subd. 1. Type of data. "I7ie 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 pdvate or confidential data conceming 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 refuse or is]egally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confi�ential 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 imestigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mayplace the notice required under this subdivision in the individuai income ta�c or orooercv 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,private or confidential. Upon his further request,an individual who is the subject of
stored pmate or public data on individuals shall be shown the data without any chazge 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 six
months thereafter unless a dispute or action pursuant to this section is pending or additional data on the i�dividual 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 of making,certifying,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 of public or private data
conceming himsel£ To exercise this right,an individual shal I notify in writing the responsible authority descnbing the nature of the 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
inacc�rate 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 individuaPs statement of disagreement is included with the disclosed data.
The determination ofthe 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 ofdata",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 e7ctent 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.
� G-1-'Eht C� �pin�.t�1z� �-�-Gr�v(12C��-/�
First Middle Last
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Address
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City State Zip Phone
I und�rstand my rights as state above.
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Signat e
Reset Form 32
���� DAT TIME �
CITY OF ORONO ALLED IN �b /�
INSPECTION N IC SCHEDULED /D-ZZ-07
PERMIT N0. l��� COMPLETED
ADDRESS �g� ,��R�'� �f �-
OWNER CONTR. /�� l�-d
TELEPHONE NO. ,��--Ll �l o�- �7"� ��d �
� DESCRIPTION �1�� —SC���
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
� ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
O ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL
Z�LL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTiC INSTALL. ❑ FOLLOW-UP
� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
v ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOF TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED O�PROJECT COMPLETE
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W ❑ CORRECT WORK R PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN � CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIOtJ REQUIRED.CALI TO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (J52� 249-46��
Owner/Contra o s e:
Inspector. '
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