HomeMy WebLinkAbout2000-P02276 - single family � PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po22�6
Crystal Bay, Minnesota 55323 Pe►'mit Type: User Defined
(612) 249-4600 Date Issued: 4il��oo
SITE ADDRESS: 224o Fox st
LONG LAKE, MN 55356
P I D: 03-117-23-32-0009
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 8,000.00
TOTAL FEE: $ 50.00
APPLICANT: JAMEs Joxtvsorr OWNER: J R&H L JOHNSON
2240 FOX ST 2240 FOX ST
LONG LAKE, MN 55356 LONG LAKE MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPEC[FIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUILDING CODE REQUTREMENTS.
LICANT P,R E SI NATURG U D BY SIGNATURE �y
Copies: City, Applicant,Assessor, Finance Page 1
� . ,
. � ��
� Total Fee: $ �G'� Date Received: 3/3i�b o
Entered By: � Permit#: �p 7�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
-------------------------------------------------------- -- - -----------------------------------------------
THE APPLICANT IS: (circle one) OWN �'OR CONTRACTOR
��� �'�, x S���`�'
JOB SITE ADDRESS: ZIP: ��S<3 S�,
NAME OF OWNER: :,��-✓vl� � cJOti�vSo�� PHONE: (home) ¢7.3-5��}�
(work)
1VLAILING ADDRESS: �a�� ,�X ����'`fCITY: Lo+vC.-, �,4-i�;� ZIP: SS 3 S(
�
CONTRACTOR: ��� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: /�I/�}- PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration�_
PROPOSED WORK(describe in detai�: �`,«-�,u� �2 t U��.v��' T�-�-�2�-t Low .42�.
TO �cc�s� r3�-e.<< � �- F'�o ��`��a 5�E �+-,--r-,4.�c-� DET�L S
.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTINIATED CONSTRUCTION VALUATION (excluding land): $ �1�
C'�3ST i3�."2�'�t„ � cY� oc�c�'
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.
t
APPLICANT'S SIGNATURE: `� , DATE:/'�,9���f� 3� ��D
NOTE! Parade o Homes ev ts require separate permit approval by Police Department and
City Council 60 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 riehts 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 hunself
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 leeally required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or co�denrial data;and(d)the identiry of other persons or entiries authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked ro supply investieative 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 prooertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsibie authoriry, 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 infornted of its meaning,the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been
collected or creared. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authoriry 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 infornt 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[he accuracy or completeness of public or
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incompiete data,including recipients named by the individual;or(b)notify the individuai 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 disclosed data.
The determinadon of the responsible authoriry 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 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 pemut 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.
J�m�s P� ��� J��-����.�
First Middle Last
vZ��-i O �i� s i�F�i`
Address
L...o�� L��C� ,��✓ ss 3 �� 4�.�-s9��
Ciry State Zip Phone
I understand my rights as stated above.
�n� �
Signa
6
.' ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2 2�o c= c�x s-��,`.T
PID:
DESCRIPTION OF WORK: �.�rv✓� ►'�,��r�,a-T� ( �JJ►z�v�.�,.�r�H �.sx�rz r n o•��
__ —__�� �-----------------------------------------y----
ZO�iIl�'G REVIEW BY: � CQ�w.�,.-- DATE APPROVED: ��- o0
BUILDING REVIEW BY:� DATE APPROVED: N/a
— — ------- --------------------------------- ------ -
FEES TO BE CHARGED: �,,��'o?'a`��� Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes No SEWER COiVNECfION
STATE SURCHARGE Yes No WATERCONNEC'TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONIiv'G CH�CK LIST Zoning District: i� � C rf.��-�
Fire Department: Post O ice: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes o Date of Survey:
Proposed Setbacks:
Front(Lake): t Side:
Rear(Street): ft Side:
Adjacent Structures: LVetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: _�(- 1 `t - n� By: �•(� . Council Approval Date:
Septic: Staff Approval Date: --- By: —
Zoning File: # Resolution: Resolution Date:
Shoreland District:
Avg. Setback: Blu f Setback: Lot Coverage:
Ezi ting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARI�S (in house):
7
BUILDING REVIEW CHECK LIST
�C� CONSTRUCTION T'YPE: —
Sq Footage $ Per Sq Ftg
Basemen[ x =
lst Floor x =
2nd Floor z =
Garage x =
x =
TOTAL
Estimated Construction Value: $
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection -
Framing Fireplace Lawn Inigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_�F�� Grading/Filling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DAT'E:
Access: Ezisting New
Access Approval: Date By:
RENIARKS (TO BE NOTED ON PERitiII'1�:
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SKETCH PLAN FOR ��T�-,�-cE-��r,�,�; q
J1M JOHNS�N �u «� ��� ��r� �--
OF LOT 4, BLOCK 1 , "� '
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�A�PPROVED�tXt��ew �.-x�,�n o,�
� A�PPROVEfl WITH i�EV�101VS
0 DISAPP OYE�
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DATE_— ��r_�y -oa
.
I hereby certify that this su�vey was prepaed by me or unde� my �irect sup�- scA�E
C�P`�6� � CROf�BBRC, II� Yision, and that i am a duly registered Civil Engineer and Land Surveyor tnder 1 "_�00'
��� ����,� � �� the laws of the State of Minnesota. DATE
4�2 TAWIRApc AVEt�IE LONG 11ri� I�l 55356 2/2/00
JOB N0.
' 612-413-4141 00-026
Mark S. Gronber Minnesota License Number 12755
- 00-026