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2006-P09778 - shed
PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 Po9778 Crystal gay, Minnesota 55323 Permit Type: Accessory Structures (952) 249-4600 Date Issued: 4/24/2006 SITE ADDRESS: 2905 Fox St Unit# Long Lake, MN 55356 P��� 04-117-23-34-0007 DESCRIPTION: UBC Occupancy U1 Construction Type VN Proposed Use: Residential Census Code 328 Permit Class: Building Permit T e: Accessory Structures Permit Sub-typc(s): Shed YP DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: 8'x 12'Garden Shed FEE SUMMARY: Pernut Fee: $ 181.25 valuation: $ 10,000.00 Plan Review Fee: $ 117.81 State Surcharge Fee: $ 5.00 TOTAL FEE: $ 304.06 APPLICANT: Landmark Design, Inc. OWNER: Mark&Carol Engebretson 4045 Watertown Road 2905 Fox St Orono,MN 55359 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPL[ANCE WITH ALL CITY OF ORONO ORD[NANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. ---1 � APP ICA T PERMITEE S GNATURE SSUED BY SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 � f Total Fee: $ Date Received: % �� � � / � Entered By: Permit#: �/�� / /`;>j�, .i_ CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all informatio�e) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle one) OWNER OR C��ONTRACTO� JOB SITE ADDRESS: ��(�' � �"� ST��-, C�`�C� ZIP: S��j C.O Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes, a special event per•rnit t�s required with Police Department ar�cf City Council approval 60 days prior to the event. Shuttle bus service wil!be r•equired unless applicant de�nonstrates strfficient on-site parking is available. iVon-periTzitted events�vill not be allolved. NAMEOFOWNER: �`^ ' � ������IPHONE: (home) �'� z' �"�� � �'� (work) (Q t2 � ��i �(o MAILING ADDRESS: Z 1'Q� ��� S 1 CITY: �%�'��� ZIP: 3� CONTRACTOR: �����-S��`�- I ti-�C- PHONE: ��'� ���' -�'�'�� CONTACT PERSON: � �1 MOBILE/PAGER: �v t 2, '7 Z3 -��`�� MAILING ADDRESS: �4 I,�c,. � � CITY: Glz-GNC) ZIP: S j 3S� STATE L�C�ENSE: # �`j C�j. EXPIRATION DATE: i���11� i k c�}}- ARCffiTECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure � Move Home Remodel/Alteration (ie: Siding, Windows) Any earth movement may require MCWD review and permits ! PROPOSED WORK(describe in detai�: C����� �,s�.c� � x � Z� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 1 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 confonnance 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• �lC� � DATE: q- - Z- I � Cv 31 � � Scc.13A4 RIGHTS OF SUBJECTS OF DATA Subd. l. 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. An individual asked to supply private or contidential dataconceming himselfshall 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 legally required to supply the requested data;(c)any known consequence arising from his supplying or refusine to supply private or contidential data;and(d)the identity ofother persons or entities aud�orized by state or federal law to receive the data.This requirementshall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a la�m�enforcement officer. The commissioner of revenue mav�lace the notice required under this subdivision in the individual income tar or prooertv tax refund instructions instead of on those forms. Subd,3. Access to data by individual. Upon request to a responsible authorit��,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuRher 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 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 authoriry shall provide copies of tlle private or public data upon request by the individual subject of the data. The responsible authority may require dte 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 pursuant to this subdivision,or wi[hin tive days of d1e date of the request,excluding Saturdays,Sundays and legal hol idays,if immediate compliance is not possible. [f he cannot comply with[he request within that time,he shall so inform the individual,and may have an additional frve days widiin 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 contes[the accuracy or completeness of public or private data concerning himsel£ 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 eidiec (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 disdosed only ifthe individual's statement of disagreement is inciuded with[he disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions ofthe 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 pennit 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 wili be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may rec�uire 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 rec�uested 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. First �'liddle Lxst Address Citti� State Zip Phonc i understand my rights as stated above. � ���.. � Signxture Reset Form 3� � CHECK OFF i�IST FOR ISSUANCE O�' PERIVIIT5 . FOR OFFICE USE ONLY ADARESS OR LEGAL: 2� �5 �x 5� PID: DESCRIP�!'ION OF WORK: _�g���,� s�� --- ------------ --------------------- ZOV�IG REVIEVV BY: DATE APPROVED: L/-Zy-O� BULLDI�i IG REVIE�V BY: DAT'E APPROVED: y- 2�/-o� FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes f No PLAN REVIE`V � Yes ✓ No SE�zTER CO�INECTTON STATE SURCHARGE Yes � No `VATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTION Number of SAC Units OTHER (specify) ------------------------------------------------------------------------ ZONIti'G CHT,�CK LIST Zoning District: Fire Departm.enC Post Office: _ School District: Lot Area: Sq.ft. Acres Wid4h Depth Survey Submitted: Yes No�_ Date of Survey: iN�� ���0`� Proposed Setbacks: Fro� (Lake): �-(0 a� � Right Side: �I� � ± R�r (Street): 3� r Left Side: `�Sb �� Adjacen[Structures: 9�� � Wetland: �I �� i � � Building Hei�t: Def. Hgt. 5•S — Peal:Hgt. 1 I Lot Covera�e: N/� Grading: Staff Approval Date: � By: Council Approval Date: Septic: Staff Approval Date: � BY� Zonin� File: � — Resolucioa: # Resolution Date: Shoreland District: /�'v Avg. Secback: Bluff Setback: L.oc Cove�a�e: Etisting Proposed Hardcover: 0-75' 75-250' 2�0-500' S0a-1000' Hardcover Variance Required: Yes No Date of Council Approval: RE:�L4RKS (in house): � � BUILDING REVIEtiY CHECK LIST UBC: U —� CONSTRUCTION TYPE: �/`� Sq Footage $ Per Sq Ftg Basement x = lst Floor z = 2nd Floor x _ Garage z _ x = TOTAL Estimated Construction Value: $_ ���pp0°`� Inspections Required: tiYork Requiring Separate Permits: S ite Plumbing Fire Hazdcover Removal Mechanical Water Connection �_Footing � Septic Sewer Connection � Framing Fireplace Lawn Inigation Insulation (Masonry) Other Wall Board (Mfg.) Well (State Permit) � F�� Grading/FIlling Elecuical (State Permit) O cher REi��iRKS (IN HOUSE)• ~ ---------------------------------------------------------------------------------------------------------------- REVIE`V BY OTHERS: DATE: Access: Ezisting New Access Approval: Date gy; -- ------------------------------ REI�IARKS (TO SE NOTED ON PER.il�1IT�: 8 g.w'y,( .�� .m '- - - ' t .. .� ..,.. ,y0t�. T' ... . .j :�... <"" """iF`� : �, .. , - : .-. . . .,,�, .... �s; . .r �s/ . � � .J 1! a d •�..d; „�' et.-ii✓ v„�,�' ..t� f jY`, j�:. � , . , . � ,� � �� . . � w � _� � �� � , a � � ' a �. . �� N " " ' �t +,�`,�-�' .n !>;� � .r� "�� � �5�� �.�� �t-: �� �,: � P j�'�i' .i. Y�,� . . � . m.. .i�. . ��, . � . . 4} ` 4 ! .. ,. ,.. . ..� .� .. .� . . „ ;. +� t9 r�,� - , , • ;°.:�.—____-_------•---_.-_-r...:.:. <:"� �ad; ��" ,�. ! 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