HomeMy WebLinkAbout2000-P02069 - addn/remodel/repair �
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' PERMIT
C�TY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: -n���;���....(-'o zo�5
Crystal Bay, Minnesota 55323 P21'1711t Typ2: Addition/Remodcl/Repair
612 249-4600
Date Issued: i�l`��o�>
SITE ADDRESS: lyso FoY�ageRa
LONG LAKL,MN 55356
PI D: o3-i i�-z3-i�-ooio
DESCRIPTION:
Proposed Use: Residential
UBC Occupancy: R3
Permit Class: Building
Construction Type: �
Permit Type: Addition/Renlodel/Repair
Census Code: �34
Permit Sub-type: Single Family
DETAILS:
Rcsolution#: N/A
Separate permits required fo Plumbing Mechanical Electrical(state permit)
NOTICES:
F E E S U M MA RY: Permit Fee: $ 1,217.75 V,�luation: $ l 40,000.0
Plan Review Fee: $ 791.63
State S«rcharge Fee: $ 70.00
SAC Fee: $ 0.00
Misc. Fees: $ 0.00
TOTAL FEE: $ 2,079.38
AP PLICANT: a��aerson wood�r�rc in� OWNE R: D s P�LPs �E D P�LPs
1438 85th St Nw 1950 FOX RIDGE RD
Buffalo, MN 55313 LONG LAKE MN 55356
THE UNDERSIGN�D I�REBY R�QLTI:STS PERMISS[ON TO MAKE THE REAL IMPROVFNIENTS SPECIFIED
�1ND AGI2EES TO DO AI,I. WORK IN STRIC"1'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF NIINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICAN'I'PERMITliE SIGNATU � ISSUEI B SIGNA�I�[J
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Today's Date: 1/l 9/00 Page 1
� Total Fee: $ ;,,�, �:�J'j'.� �' Date Received: I��-���,
Entered By: ��,,�' Permit#: {�(?,;�[;�� ;
CITY OF ORONO - BUILDING PERNIIT 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 ONTRACTO
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JOB SITE ADDRESS: i�� ���,[; ,y��� ZIP:
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NAME OF OWNER � l�L�� l:�.l,Gl� 1��� PHONE: (home)
(work)
MAILING ADDRESS: �,�j(� �}� ��� CITY:��� ZIP:�
CONTRACTOR. I V� �,'I��HONE:
CONTACT PERSON: � � BILE/PAG R: �Z �}� �,�-
MAILING ADDRESS: l4� 85'mST, �,�. �� 1(J ZIP: ��'
STATE LICENSE: # ��i(v�
ARCHITECT/ENGINEER: �� � � , 1� �� PHONE: �1,'� ��
MAILING ADDRESS• CITY: ZIP:
NAME: �(,��� �}�jl� REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
�v,J� �., �
PROPOSED WORK(describe in detai�: �(� 2 ��� ��(1 �X�I��i
�'�i�U`.�
STORIES: SQ. FEET OF EACH FLOOR: (���
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��O 4�
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 ce r ith the approved plan.
APPLICANT'S SIGNATURE �� DATE: I �Z
NOTE! Parade of Homes events require separate perntit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The 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. M individual asked to supply private or confidendal data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the coltecting state agency,political subdivision,or statewide
system;(b)whether he may refuse 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 identiry of other persons or endties authorized by sratc or federal law to receive the data.
This requirement shall not apply when an individual is asked[o supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individuaf income tax 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,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 private data and informed of its meaning,the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this secqon is pending or addirional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subjec[of the data.
The responsible authoriry may�equire the requesting person to pay the actual costs of making,certifying,and compiline the copies.
1fie responsible authoriry shall comply immediately, if possib(e,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 no[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 concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days eithe�: (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
ro be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disdosed data.
The determinadon of the responsible authoriry may be appealed pursuant to the pcovisions of the administrarive 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 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 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 rocess this application or pe �t.
ti-- �"�
First - Middle Last /
��_ � `�a I 1� l;\l.
A�����',� fl'1�"� 1� '�; 2�2�
��n,'' State Zip J Phone
I under my righ s st e�above.
�
Sig "re
6
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 19�O F o x �2��pc��. 2s�A�p
PID:
DESCRIPTION OF WORK: 2� ��2�, AAA ��no►�.J
--------------------------------------------- -----------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: �-r�, -vo
BUILDING REVIEW BY: DATE APPROVED: � . �� •�o
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes v No
PLAN REVIEW Yes v No SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZONIl�'G CHECK LIST Zoning District: 2(2 -� (3
Fire Department: ,v /GE Post Office: � School District: d2�s�c�
Lot Area: Sq.ft. /U� C/.�n�( Acres Width Depth
Survey Submitted: Yes _ � No Date of Survey: �{- 5 -Q(P
Proposed Setbacks: .
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
�o"b
Lot Coverage:
�
��, �� Grading: Staff Approval Date: By: Council Approval Date:
Q
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
. . . `
BUILDING REVIEW CHECK LIST
UBC: �Z� �j COtiSTRUCTION TYPE: �/I�I
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ ��1����o��
Inspections Required: Work Requiring Separate Permits:
Site OC Plumbing Fire
Hardcover Removal o( Mechanical Water Connection
Footing Septic Sewer Connection
9C Framing Fireplace Lawn Inigation
_�Insulation (Masonry) Other
�_Wall Board (Mfg.) Well (State Permit)
pC Final Grading/Filling _�Electrical (State Permit)
Other
REMARKS(IN HOUSE):
---------------------------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERl��:
8
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_ � Certificate of Surve� � SI, � Fi ,�;�� 4��p���u �� ,,,� ;
, :� •: �= -� ,' t for Biff Jones � ��;r�, _ ,, : —2�! sroRY ��p�n�o.�i
• • � of Lot 6, Block 1 , Fox idg�,, • ; ..- _._ �,` j
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I hereby certify that this is a true and correct representation of a survey of
the boundaries of Lot 6, Block 1 , Fox Ridge, �tne location of an existing house,
� and a propos?d addition. It does not purport to show other improvements or en-
croachmencs.
COFFIN & GRO(JQERG, INC.
Date : 4-n-86 a�%r�-��n erg -Cic.��(o.1��55
Scale: 1" - 40' Engineers & Land Surveyors
o : I ro�i marker Long Lake, P4i nnesota
� D..�AT.E-, TIME
CITY OF ORONO CALLED IN `� ' �'�
INSPECTION NO ICE SCHEDULED � ��
PERMIT NO. �a C � COMPLETED Z'Z a
ADDRESS s O �-� r`--�'
OWNER G�aiA���� CONTR. , ��°����4�
TELEPHONE NO. � p � �7���-
� DESCRIPTION ��/�'%ZZ°'����
LL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOPORDER POSTED.CALL INSPECTOR CITATION ISSUED
C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-460�
OwnerlContractor on site:
Inspector. ��'%/� ri-C ��-c/�S
White Copyllnspector'��-
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE � SCHEDULED �- "� ��
PERMIT NO. �� COMPLETED —' �-'� U
ADDRESS 1�� � � ���� I
OWNER CONTR. ��1/5G'�C�IC�
TELEPHON E NO. �� g -��� �C�I J
� DESCRIPTION -�\CR�+r'�v�m�v�a `�2MOaC.f
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� 2 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
Q
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUM8ING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: >> .;
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INSPECTOR WILL RETURN
C7 STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
C', INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContractor on site:
p ��/p _ ��
Ins ector. c�
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN -�� y�� c,
INSPECTION N TICE l9�'I SCHEDULED � a' �
PERMIT NO. COMPLETED 1 Z��� �L�s-�-�
ADDRESS ���C�i��� �� ��dl
OWNER CONTR. -��2�-��n�''J
TELEPHONE NO. ��� J�`��-z—
� DESCRIPTION - �el��a�.
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 4 WALL BD 12 WATER HOOK-UP 17 SITE INSPECTION
OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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V BEFORECOVERING PERMANENT
C'CORRECTUNSAFECONDITIONWITHIN HOURS. pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
C; INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS.
Cali for the next inspection 24 hours in advance. 249-460�
OwnerlContractor on site:
Inspector.� �-��-
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CtTY OF ORONO CALLED IN ���7 C��
INSPECTION�N T�IC; SCHEDULED � ��� �� ��
PERMIT NOY �-" � COMPLETED �� �—�� p' %�
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ADDRESS %`��--��U ' ���-�
OWNER CONTR. ,�i��2��
TELEPHONE NO. �D� �.� 71-�
� DESCRIPTION iP��_.,��J
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� 02 �� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
03 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 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
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 P�UMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� BEFORECOVERING PERMANENT
C.I CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN
INSPECTOR WILL RETURN
C STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cali for the next inspection 24 hours in advance. 249-46�0
Owner/Contra tor on site:
Inspector. ,/�'/G�� GL-�I
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN —T-
INSPECTION NOTICE SCHEDULED 3��5-��' � 'd�'
PERMIT NO. �' COMPLETED "` �-�� 5 • ��
ADDRESS I ��5 �-' �G'� �-�f�'1 T�� �-L:��
OWNER CONTR. �-�-����� C',�'CL�-�
TELEPHONE NO. ��� �'� �� (�"�� l
� DESCRIPTION
ly� Ot FOOTING 11 fv1ECHANICAL RI 18 EXCAV/GRADING/FILLING
��i 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMIVIENTS:
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INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
Cl INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-4600
Owner/Contractor on site:
Inspector,i����' �'� C �
White Copyllnspector's File Canary CopylSite Notice