HomeMy WebLinkAbout2007-P00569 - addn/remodel/repair PERMIT
�ITY OF ORONO
Permit Number:
?750 *elley Parkway- PO Box 66 P11569
,rystal Bay, Minnesota 55323 Permit Type:
Addition/Remodel/Repair
(952) 249-4600 Date Issued: 10/16/2007
SITE ADDRESS: 1995 Fox Ridge Rd Unit#
Long Lake,MN 55356
P��� 03-117-23-13-0005
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Remove support wall and replace
FEE SUMMARY: Permit Fee: $ 54.00 valuation: $ 1,500.00
State Surcharge Fee: $ 0.75
TOTAL FEE: $ 54.75
APPLICANT: Owner/Self OWNER: Thomas 7 Kieley
M� 1995 Fox Ridge Rd
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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APPLICANT PERMITEE SIGNATURE SS ED BY SIGNATURF
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, l-Assessing,(If Septic, 1-Septic) Page 1
' Total Fee: $ DateReoeived: 10-!Z a7
Entered By: Permit#. Q �l (09
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must besubmitted in full b�Foreplan reviewwill bestarted.
(pleaseprintall information)
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TH E APPL I CANT I� (arde one) 9�IVNER bR CONTRACTOR
JOBSITEADDRESS I ��� � / '�'� �� U��e- �4� ZIP: � `I TS�
Will thisbea Paradeof Homes, RemodelersShawcaseHomeor other Display Home?
❑Ye.S �NO Ifyes,aspeaal�errtpermitisrec�iredwithPoliceDepartm�tandCityCanalapproval
60 days prior to the eu�rt. 9xktle busservioewi I I be requi red unless�pl icant demonstrates
suffi a ent ars te parld ng i s awai I abl e Non-permi tted events wi I I not be al I o�uued.
NAMEOFOWNER: ��I�^^�+' �� K� ���7 PHONE: (hor�e �� � 3�'�Z
. � (W��^I -�7J—jv� 3
MAILINGADDRES� � � � � �`'� (����CITY: ����� ZIP: 5 s ��c
CONTRACTOR: I�� U�'''�`' PHONE: �l� - ��1-3cc ��
CONTACT PER90N: M OBI L E/PAGER:
MAI L I NG ADDRES� r�-- CITY: ZI P
—a,
STATE L I CENSE: # EXPI RATI ON DATE:
ARCHITECT/ENGI NEER: PHONE:
M AI L I NG ADDRES� CI TY: ZI P:
NAM E: REGI STRATI ON: #
TYPE OF WORK: New Home Addition Aooessory Structure
Move Home Rerriodel/Altaati on(i e Sidi ng,Wi ndaws) �_
Boz f bsui npwt nt ou nbz sf r vj sf N�CE sf vy f x boe qf snj ut "
PROPOSED WORK (d�cribein detail): (�� �u�- i ( Fr c � .� ��,�•� _�'�`�
c;�� �:- ;�,�< t „� �. j ).,, x �y'' �v L - r,;�,� �.,....
� � 1�l'
STORI ES: �_ 9Q.FEET OF EACH FLOOR: I 3 � �
NO. OF BEDROOMS Y GARAGE STALLS ATTACHED � DETACHED
ESTI MATED CONSTRUCTI ON VAL UATI ON(e�cduding land): $ �5�'�' r✓
I hereby applY for a building permit and I adcnowledgeth�theinforrrr�tion aboveisoorripleteand accxarate;
th�the work wi I I be i n oonforma�oe with the ordi nances a�d cales of the City axi with the State Bui I di ng
Cod�that I urxierstand thi s i s nat a permit and work is r�ot to start without a permit;and th�thework wi I I be
i n accorclaioe with the appraved pl an.
APPLICANT'SSIGNATURE: /��i� �� ��7 DATE: ��lY �� ` � .�
.
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�'� ��'�,� � _ �j�`� � ��i '" X I�- �(��
l'�L L �' i, �s�y
� � Sec.13.04 RIGHTSOF SUBJECTSOF DATA
�d.1. Type of dafa The rights d i ndividual on whom the data is stored or to be stored shal I be�set forth in this sec�on.
SLbd.2. Ir�formationrequiredtobegivenir�vidual.Anir�d'ividualaslcedtosupplYprivateoroadidakialdataoaioarrnghirr�selfshallbe
iMortnedof: (�theptxposea�dirtaideduseofthereqi�teddahawithintheodledingststeagawy,polititxlsdx6vison,orstatewides�stem;(b)
whether he ma�r reFuseor islegally reqiired to�pply therecpiested d�(c)arry known oonsequaioeaisng from t�ssupplyir�g or r�us ng to supply
privateoroaifideitiaid2t�ax1(cntheidattityofotl�pesonsorenfitiesaAtnrized6ylateorfederallanrtorecevethedata Thisreqiirernentstrall
not�ply when an in�vidual is�lced to supply investig�ive data,pur�ant to saction 13.82,s�dvision 5,to a law eiforoar�ert�oer.
The corrmiss+oner d reverxie mav daoe thenotice reaired tx�this sibdvison in the indvitival ir�cometac or oraoatv tac reFtmd
i nstructions i rutead of on Uiose forms
SLbd.3.Aooesstod�abyindvi�al. Uponreqt�esttoare�auidearthority,aiindvidualshallbeinfortrierfwhethaheisthe�jectof
storeddataonindviduals,aidwhetheritisdasafiedaspublic,privateoroonFidartial. Uponhisfurtharec�est,anindviduaiwhoisthesibjedoF
stored priv�eor public data on ir�viduals shall be�own thedatawithout any diageto him and,if hede�i res,9rall be infortned o�theco�ent and
rrieaningo(th�data Aftaanindvidualhasbeenstqwntheprivatedataandinforrriedofitsmearrng,thedafaneednotbedisdosedtohimforsix
monthsthereeftauNessadsputeoractionpirsia�ttothissectionispaicfir�oraddtionald�aontheindvidualtrdsbeencdlededorcreeted. The
respaisblea�thaitysMallprovidecapiesoftheprivateorpublicd�auponrequestbytheir�d'ividualsubjectofthed�a Therespa�sibleauthority
rr�requi re the reqi�e5ti ng pason to pey the actuai oosts d rrnki rig.oertifYi n8,a�d carpil i ng the oopies.
Theres�onsWeaithority shall oortply irtrnedately,if possid�with ary rec��x,t rt�ade pu�uard to this�vison,orwitFanfiveda�rsoi
thedateof the reque3,ecdud ng Sahrdays,SLndaysand fegal hol ida�s,if irmiedateoort�lianeisnot possde If hecariot oorrply with therecµ�est
within th�time,hesh�l so inform theindvidual,and ma�havean addtiaial fiveda�swithin which t000mply with thereq��est,ecdudng Saturdays,
S�x�daysand legal hdidays
SLbd.4. PYooed�rewhe�dataisnot aoar�eor oomplete An indvidual rrra�omtest theaoarac�r or oortplete�essof qblica privatedafa
�ninghi►r�self.ToecacisethisrigM,aiir�vidualshall notifyinwritingtherespor�.sbleaAhoritydesrridrgtheretureaFtheasagearent.The
responsiWe aRhority sMall within 30 dayseither: (�oorrect thedata fand to be inaoauateor iraarpleteand attenpt to notify past recipiQntsof
inaa�rateorinoon�letedata,indudngrecipartsnanedbytheindvidual;ar(b)notifytheindvidualthathebelievesthedatatobecorrect.Datain
di�ute�all be disdosed oNy if the ir�vidual's statanait of�sa�rear�t is induded witfi the�sdosed�ata
Thedetamir�ation d therespor�sible aithority may be�peeled p�rsva�t to the provisionsd theadministrativeprooed�react r�aati ng to
oontested cases
DATA PRIVACY ADVI90RY
I n a000rdaioewith M.S 13.04,SLbd.2,"RightsaF subjectsoF data�',wewa.ild liketo infam you that your request
for a permi t or 1 i cense from the Ci ty of Orono or ary of i ts departmaits may req�re you to f�xni sh arta n pri vate or
oonfidential irrformation.
You are r�tified that:
1. The ir�formation you furr�sh will be used to d�amine your qualification for the permit or license
rec��ested.
2. You may reFuseto supply data but refusal may requirettrat theCity deny thepermit or licens�
3. The inFormation may be stiared with other local, state or federal agaicies to the extent nec�say to
prooess the permi t or I i ce�e.
4. If yau requested pemit or Iicense requiresCouxil action to approv�some inFormation may beoorr�e
p�l i c.
5. You have certan rigtrts under M.S. 13.04(avalable upon request)to reviaiv private data on yourself.
6. Yau ful I nar�e i s requi red to prooess thi s appl i cati on or perrrit.
-�h�.�.„ ; -:1� l�, t��--,
Fi rst M iddle Last
/ �'�`�� ��� /�� ��,c— c'���'
Addre�
f�-%� ,�.v �� `�`3 � ��l-�'�'�� 3 z
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City State Zip Phone
I understand my rightsasstated above
, �.?� �.�� %
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Signature '
Sf tf�C�e� 32
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: l�i 5 S F c�X 2��p�, �'��
PID:
DESCRIPTION OF WORK: ���,o�Q��
ZONING REVIEW BY.• �� W�Y� �DATEAPPROVED.�Y�________
BUILDING REi�IEW BY.• DATEAPPROT�ED: ►d -�v-crt
FEES TO BE CHARGED: Misc. Fees Calculated ByW�� � � '�_�_____
PERMIT Yes ,/ No
PLAN REVIEW Yes No �/ SEWER CONNECTION
STATE SURCHARGE Yes� No� WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (spec�)
�------�----�----��----�--��-
ZONING CHECK LIST Zoning District: JV 0 C I-f'+'4r�/�
Fi�•e Department: Post Offtce: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes 1�'o Date of Survey:
Proposed Setbacks:
Fronl(Lake): Right Side:
Rear(Street): Left Side:
Adjaceni Structures: Wetlan :
Building Height: Def Hgt. Peak H�t.
,
Lot Coverage:
Grading: StaffApproval Date: By: Council Approval Date:
Septic: Staff Approval Date: Bj,:
�
Zoning File: #1 Resolution: # R�solution Date:
Shoreland Dist�-ict: M�'WD Per•mit:
Avg. Setback.• Bluff'Setback: j Lot Coverage:
Existing ' Proposed
Hardcover: 0-75' �
1
75-250' '�
250-500' �
500-1000' �
Hardcovei• Variance Required. Yes No I Date of Council Approval:
I
REMARKS(in house):_ �
i
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/
B UILDING REVIEW CHECIC LIST
UBC: R' 3 CONSTRUCTION TYPE: V�
Sg Footage $Per Sq Ftg
Basement x =
1 st Floor z =
2nd Floor x =
Garage x =
x =
TOTAL
00
Estimated Construction Value: $ �.�v� —
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical YYater Connection
Footing Septic Sewer Connection
rC Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
_ Wall Board (Mfg.) Well(State Permit)
oC Final Grading/Filling Electrical(State Permit)
Other
REMARKS(INHOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval.� Date By:
REMARKS (TO BE NOTED ONPERMIT):
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