HomeMy WebLinkAbout2004-P08077 - addn remodel repair � PERMIT
C I TY O F O RO N O Permit Number:
` 2750 Kelley Parkway - PO Box 66 Poso��
Crystal Bay, Minnesota 55323 Pel'CYllt Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: i2is�2oo4
SITE ADDRESS: 3051 Farview Lane
Long Lake,MN 55356
PID: 04-117-23-33-0009
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required: Yiumbing Eiecincai�siaiej
NOTICES/REMARKS:
--�----�----
FEE SUMMARY: Pernut Fee: $ 542.75 Valuation• $ 40,000.00
Plan Review Fee: $ 352.83
State Surcharge Fee: $ 20.50
TOTAL FEE: $ 916.08
APPLICANT: Owner/Self OWNER: David&Francine Delaney
� 3051 Farview Lane
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.
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A A EE GN TU � � ISSUED BY SIGNA URE
Conies: 1-File(Si�nitures Repuired), 1-Applicant, 1-Monthlv Revorts, 1-Assessine, 1-Finance Page 1
r
Total Fee: $ L'��D •C�0 Date Received: �� +��—D 7"'
Entered By: � � Permit#• �Q08O77
�,�,�- � ��I��o�(
CITY OF ORONO - BU�LDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) WNE OR CONTRACTOR
JOB SITE ADDRESS: jQ J� �{�,�2,,\/� � (/u ��r,� ZIP: >>3 J�1
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes � NO If ye.r,a special event permit is required with Police Depariment and City Council approval
60 days prior to the event. Shuttle bus service will he required unless applicant demonstrates
sufficient on-site parking is available. Non-permitted events will not fie allowed.
NAME OF OWNER�' l � � `"��.J�'-1�" PHONE: (home)`�>�-y�3-3i� I
(work) '"t S z- � 1 � `Q 1 i l +�
MAILING ADDRESS: �`��1 �'1����GJ C--?J CITY: �j���'� ZIP: r� � �
CONTRACTOR: �,�(t�,. PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATTON DATE:
ARCHITECT/ENGINEER: _ ��%-� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration �_
PROPOSED WORK(describe in detai�: ��)C�:� C�t�� 'c�
STORIES: � SQ.FEET OF EACH FLOOR: ��-'c�r
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: l�j ' 7" �`I
31
Sec.13.04 RIGHTS OF SUBdECTS OF DATA
Subd.1. Type of data. The ri�;hts 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 concerning hirnself shall be
informed of: (a)the purpose and intended use of the requested data within[he collecting state agency,political subdivision,or statewide system;(b)
whether he may iefuse 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 penons or entities authorized by state or federal law to receive the data.This requirement shall
aot apply when an i�dividual is asked to supply investigative data,pursuant[o section 13.82,subdivision 5,to a law enforcement officer.
'I'he commissioner of revenue may_place the notice rec�uired under this subdivision in the individual in ome t�x or�rooertv tax refund
instruc[ions instead of on those forms.
Subd.3. Access to data by individual.Upon reques[to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classi£ied as public,private or confideneaL 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 chazge[o him and,if he des'ves,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 m him for six
months thereafter unless a dispute or action pursuant to this sec[ion is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or public da[a upon request by the individual subjec[of[he da[a. The responsible au[hority
may require the requesting pe�son m pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pu�suant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if irnmediate 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,e�ccluding 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 himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either. (a)correc[[he 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 ac[relaung to
con[ested 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 pernut 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
p ub lic.
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.
���.i�,�� �,,�p'�, �C1-,�����/
First Middle Last
��4� ���� ���� �ti
Address �
�Zr�.ti� �ti� �; 3 ;�� > >� Z y� ,� -z,�<� �
City State Zip Phone
I understand my righ d above.
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� ure
32
CHECK OFF LIST FOR ISSUANCE OF PEIZ�tiIXTS
FOR OFFICE USE ONL Y
ADDRESS OR LEGAL: �C�5 � Fi9lt'v��w �►^'p
PID:
DESCRIPTIO:VOFYl�ORK: K�Tc/�e�✓ �'L`"'�L
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Z0�V7NGREf/IEt�BY: ! r D.-4TEAPPROVED: Ja •i� -o y
B UILDING RE VIE YV B : DA TE APPR 0 6'ED: �o -�4 -�Y
--------------------------
FEES TO BE CHARGED: / 1�'Iisc. Fees Calcc�l��ted By:
PER�titIT �`eS J ��o
PLAN RL I/IE GV Yes ✓ �Vo SE LVER COtV�VECTION
STATE SURCH.4RGE Yes _L�� �Vo tiVATER COtWECTIO�V
INVESTIGATIOIV FEE Yes tVo PARK FEE
SAC Yes �Vo SITE NSPECTION
�Vun�ber• of SAC U��its OTHER (specify)
--------------------------------------------------------------------------------------------------------------
TONING CHECh'LIST Zaning Districc: �J o Gc-�-��C�.Q
ti
Fire Deparhraerrt: Post Office: School District: _____
Lot,�(rea: Sq.Jt. Acres GYidth Depth
Swve}�Subrrtitted: Yes No Date of Stuvey:
Proposed Setbacks:
Fro��r(Lalce): Riglat Side.
Reai•(Street): Left Side:
Adjacerzt StrucUu•es: Yt�etla� :
Buildir�g Heiglit: Def. Hgt. Peak gt.
Lot Coverage:
G,�adi,�g: Scaff,4pprovc�f Date: y: Cocuicil Appraval Date:
Septic: Stnff,�tpprovaf Date: BY�
Zoning File: # Resolutia�: # Resoltttion Date:
i
Shoreland Dish•ict:
Avg. Setback: Bluff etbadc: LotCovel•age:
E�istir g Proposed
Hardcover: 0-7�'
75-2.i 0'
250-500'
500-1000'
ffardcover i�ariance Required: Yes No Date of Co�utcil Approval.•
RE1tiIARXS(in house):
31
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C� C�A TIME /
CITY OF ORONO CALLED IN I ��
INSPECTION TICE SCHEDULED �a'd /�j.'�
PERMIT NO. COMPLETED �� ��
ADDRESS 0 � ��
OWNER CONTR.
TELEPHONE NO. �a ^ I —D l �v°''�-
� DESCRIPTION �� - ���`�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FO�LOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W f�WORK SATISFACTORY:PROCEED �PROJECT COMPLETE
W�❑CORRECT WORK&PROCEED ^ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WlLL RETURN
!7 CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 24J-4600
OwnerlContract o s' :
Inspector.
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