HomeMy WebLinkAbout2007-P11161 - pool , •
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P11161
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249-4600 Date Issued:
6/28/2007
SITE ADDRESS:_ 860 Farest Arms La Unit#
Mound, MN 55364
P��� 07-117-23-12-0006
DESCRIPTION: UBC Occupancy U1
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Permit T e: Accessory Structures Permit Sub-type(s): Pool-Outdoors-Above Grc
YP
DETAILS:
Approved perresolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 125.25 Valuation: $ 6,000.00
Plan Review Fee: $ 81.41
State Surcharge Fee: $ 3.00
TOTAL FEE: $ 209.66
APPLICANT: OWNER: Owner/Self
MN
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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PUCANT PERMITEE SIGNATURIi ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, I-Monthly Reports, 1-Assessing,(If Septic, l-Septic) Page 1
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Total Fee: $_ ���:l,Q� Date Received: (p � -��
Entered By: (_��/1 Permit#: /�j �j�p I
CITY OF ORONO - 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� CONTRACTOR
JOB SITE ADDRESS: ��'/�c r=�iL�'"Si"-�.L<��S !-�.�v - ZIP: �,'s' .3�S/
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS �NO If yes, a special event permit is reguired with Police Department and City Council approval
60 days prior to the event. Shuttle bus service wi[l be required unless applicant demonstrates
sufficient on-site parking is available. No�permitted events will not be allowed
i
NAME OF O WNER: ,,�i9✓' S t���F_<v,S r,s ,°1/� PHONE: (home) �,�-2-S�T z • 7 9.s'�,
,
(work) 9,s-z-, �s, - s J �S
MAILINGADDRESS: ,�Eo i'z;,��-sTq�1«,.c , ITY: �m��« � ZIP: ,�<s 3�>Y
_�-
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure �
Move Home Remodel/Alteration (ie: Sidin�, Windows)
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detai�: ���;�<< �i3c�-�� �k'r �'iz�
/-�.='c L
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEllROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �,�c�c=c; � �^
I hereby apply for a building permit and 1 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 pennit and wark is not to start without a permit;and that the work will be
in accordance with the approved plan. �
APPLICANT'S SIGNATURE: - �--�ATE: L��S- �?�
31
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Sec.13.04 RIGHTS OF SL�BJECTS OF DATA
Subd. I. Type of data. The righu 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 himselfshall be
informed of. (a)the purpose and intended use of the requested data within the col lectin�state agency,pol itical subdivision,or statewide system;(b)
whether he may refLse 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 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 data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propertv 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 whe[her it is dassified 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. After an individual has been shown the pricate 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 of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made putsuant to this subdivision,or within five days of
the date ofthe request,excluding Saturdays,Sundays and legal holidays,ifimmediate compliance is not possible. Ifhe 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 publ ic or private data
conceming 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 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 da[a.
The determination ofthe responsible authority may be appealed pursuant[o 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 of data",we would like to inform you that your request
for a pern�it 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 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. 13.04 (available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
��1� �S �-,,,�-
First Middle Last
Address
City State Zip Phone
I understa y ri hts as stated ab ve.
�� c�—� '
Si�natu
Reset L'orm 32
��Cg pF'�' i.IST FOR ISSUANCE OF �'E��'�ITS
FOR OFFICE USE ONLY�
�p�2ESS ORLEGAL: 5�� ���e S'� f1 �'✓�► S
P�D: od) .
�pESC��� OF WORK: we- r
______-------
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ZOYI�TG REVIEW BY: ^--------_____.___ pATE APPR.OVED: Z
$YTII.�DING REV��'V $Y: DATE APPROVED; G-Z£3-o�
` ` Misc. Fees Calculated By:
�`EES TO BE C�IARGEA: YeS ✓ No
PER��T SE�VER C��TNECTION
PLAN ��Eti� � Yes ✓ No
No tiVATE.R CONNECTION
STATE SURCHARGE YeS ✓ No ✓ ���{ pEE
INVESTIGATION FEE Z'eS No � SITEINSPECTION
SAC Yes
OTHER (specify)
Number of SAC�Uruts _. _________________________
-----------------------
----------------------------
----------,---
�,OYTs�IG CTTF�CK LIST Zoaing Distric�: �-� �
Fire Dep�ent:
Post Office: School District: � �
�c prea: Sq.ft.
Ac�es W idth Depth
�o Date of Su�vey:
Survey Submitted: Yes . 95
Proposed Setbacks`. � �' �
Froa[�" r1 C1 F��tt Side: �'C)+ ,
rnin. s2�hsu,t.. 35�,.,,�.5� �0 / �' �`�
P.ear(Street): �k.�f/h� �Side: �, � �
Sv - 75/'� ��
( 1VPrl��: ✓�� ,.(. bAc�G
r'`�'3CP�f Srnir���r2�: ��8 oLc�lcl�-
� �!c cic.
Suildin�Hei�t: DeE, �-Igt. __ �'e�`�'��� I D 3�,
�P�p NJ
Lot Covera�e: �1�G1
g Co�cL Approval Date: '
GradLng: Scaff Approval Date: y�
i.�.{�
Szp�ic; S�afE Approvai D2te: � � �y'
7oaing F��le: ��__ Resotutioa: R _ Resolutio� Da:e:
1�lS�R+'� o��o� /10� �n �'IGrQ�/,Yk pl
Shorzlzr!d Distric�: ��Coverage:
AvQ. Setbac'�_: B!uf;SetSack:
� �.csti.eo Proposed
H�eco��er: G-7�'
��-2��'
2�`u-��1V
�Ct�-i�fi��:
�. �.,- �;` '- - o` Co�.=__ .",�_-- =`
�;,.�`��.;z- -�;�z,�:.e -��u.:z�. . � � --�- - -
L'T'�L`�.�-�� fLn h,'���:
1.
$UII�DING REVIE�V CHECK LIST
�C: U � CONSTRUCTION TYPE: �(�
Sq Footage $ Per Sq Ftg
Basemeat . ,. x _ .
lst Floor x � _ . '
2nd Floor x _ � .
Garage x _
z =
TOTAL
Estimated Construction yalue: $ � ��p o�
Inspections Required: �York Requiring Separate Permits:
5'tte Plumbing Fire
Hardcover Removal Mechanical Water Coanectioa
Footing � Septic 5ewer Coanectio❑
� Framing Fireplace Lawn Irrigation
LasuiaCiou (Niasoary) Ocher
1�Va11 Board (ivlgg.) Well (State Permit)
X Final _�Grad�u�/Fi11inQ Eleccrical (State PeRnitl
C[her
R.EI1'IARKS (IN HDITSE): ' -- --
--- -- - ------------------------------------------------------------------------------------------------
REVIE'4V $Y OTHERS: �A�:
Access: Existing New �
Access Approvai: Date &y.
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RE`'LA.RKS �'T'O EE NOTED O�I PFRtiTI'I�}:
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