HomeMy WebLinkAbout2007-P11016 - entrance monuments PERMIT
CITY CaF ORONO
Permit Number:
2750 .�Iley Farkway- PO Box 66 P11016
Crysta Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249-4600 Date Issued:
5/22/2007
SITE ADDRESS: 3320 Fox St Unit#
Long Lake,MN 55356
P��� OS-117-23-44-0009
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Permit T e: Accessory Structures Permit Sub-type(s): Entrance Monuments
YP
DETAILS:
Approved perresolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
Front Entry Monument&Gate
FEE SUMMARY: Pemut Fee: $ g3.25 valuation: $ 3,000.00
Plan Review Fee: $ 54.11
State Surcharge Fee: $ 1.50
TOTAL FEE: $ 138.86
APPLICANT: Water Street Homes LLC OWNER: Gregory&Cynthia Haugen
464 2nd Street#105 3320 Fox St
Excelsior,MN 55331 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISS[ON TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDfNANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE �' ISS ED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, l-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ � Date Received: � � I ���
Entered By: o, ) Permit#: c-;� / �i k'' /r. �
CITY OF ORONO - BUILDING PERMIT APPLTCATION
All information must be submitted in full before plan review will be started.
(please print all infor�natio�i)
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THE APPLICANT IS: (circle one) OWNER OR ONTRACTO
JOB SITE ADDRESS: 3'3'�c7 f-oaz �vT_ ZIP. �'jS 3��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ No If yes, a specral event per�mit is requrr•ed ivlth Police Department a�zd City Coa�ncil approva(
60 days prior to the event. Shuttle bus service wi!!be required unless applicant dernonstr•ates
sa fficierzt on-site parking rs available. Non-pe�•��aitted events wil!not be allowed
NAME OF OWNER: C'-�ie� # C,�c<<, I���c�,,, PHONE: (home)
(work)
MAILING ADDRESS: 33� t CITY: p2v�� ZIP: �5��
in;� 7��?
CONTRACTOR: ►.�o���. -��r I-�i,.+,.�s PHONE: �'Sz- y7y- ��60
CONTACTPERSON: (�r:,,,a z��- MOBILE/PAGER: [.olZ ZZi _�,�'S'
MAILING ADDRESS: �-{��/ � Sr CITY: ,�ls,o� ZIP.�S 3
STATE LICENSE: # 2.� 3�O�b(P EXPIRATION DATE: �,3-og
ARCHITECT/ENGINEER: PHONE:
NIAILING 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 !
PROPOSEDWORK(describeindetain: �'io.�} ;�.,���,, w.e,�r,w,�..�- i- Gn,�e,
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding landj: � 3CXx�""'
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�vith the ordinances and codes of the City and with the State Building
Code;that[understand this is not a permit and�vork is not to start without a pennit;and that the�vork will be
in accordance�vith the approved plan.
APPLICANT'SSIGNATURE: DATE: S-(8-�7
31
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
SuUd. 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. Infonnation required to be given individual. An individual asked to supply private orconfidential data conceming himselfshall be
informed of: (a)die purpose and inrended 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 refusing to supply
private or confidential data;and(d)the identity ofother persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to suppiy investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement ofticer.
The commissioner oF revenue mayplace the notice required under this subdivision in the individual income tax or properry 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 infonned whether he is the subject of
stored data on individuals,aitd��hether it is classitied as public,private or contidential. Upon his fuRher request,an individual who is the subject of
stored private or public data on individuals shall be showii the data without any charge to him and,if he desires,shall be informed ofthe content and
meaning of that data. After an individual has been shown the private data and infonned 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[he private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actuai costs of making,certifying,and compiling the copies.
The responsible authority shall coinply immediately,ifpossible,with any request made pursuant to this subdivision,or within five days of
the date ofthe 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 inform the individual,and may have an additionaf 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 N�is right,an individual shall notify in wTitingthe responsible authority describing the nature ofthe disagreement. The
responsible authority shall wid�in 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)notity 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 data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administra[ive procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2,"Rights of subjects ofdata",we would(ike to info�-�n 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 detennine 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, son�e 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.
� t�J ,j 1-} :t f�TEYJf�
First �1(iddle L:�s!
_ ���/ Z�r� �T. '►� I� '
Address �
�xc�l s�o� n,��•1 ✓�-�„ � �33� � `35z- y7y-G�GD
Citr' State Zip Phone
I unclerstand mv rights as stated above.
Signaturc
Reset Form 32
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CHECK OFF LIST FOR ISSUANCE OF PER111ITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3 3'� Fo n 5 T"
PID:
DESCRIPTION OF�VORK: QN�/L1-r�C.2 /l�o�ti /v`�o�"S f 6/9 T?�S
----------------------------------------- ---- ------------------------------------------------------------------------
ZONING REVIEW BY: DATEAPPROVED: j-2 z cs7
BUILDING REVIEW BY: DATEAPPROT�ED: s=ZZ-�
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FEES TO BE CHARGED: Nlisc. Fees Calcz�lated 13y:
PERMIT Yes �/ No
PLAN RE vIEW Yes_,L/ No SEWER CONNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Y'es No � PARK FEE
SAC Yes No � SITE INSPECTION
1�'iusibe��of SAC Unils OTHER (specify)
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ZONING CHECK LIST 7_o�7i��g Disrricr: •
Fire Department: Post Office: School District:
Lat:lrea: Sq.ft. .4cres Yf%idth Depth
Stu•vey Submitted: 3`es X- No Date of Siu•vey: �•ZZ-o�'
Proposed Setbacks:
Front (Lalce): 3� � Rigllt Side:
Renr(Street): Gefl Side:
Adjacent Strt�cttu•es: ll�etla��d
�
13irildii�g Herght: Def. H�t. Penk Hgt. v
Lo�Coverage: N !/a'
Grading: St�rff.dpp��oval Date: C// .� Bv: Council,�1ppr•oti�a!Date:
Sep�rc: Stnff.=lpproval Date: � �y
Zor�ing File: � �" Resolution: � Resolu�ion Date:
Shoreland District: �r!5 ��ICGb"D Per•irrit:
,4ug. Setback:� BluffS'etback: LotCoverage:
Exrstii:g Proposed
Hnrdcover: 0-7�'
7i-7i�' v---
(�.�- ?so-son'
soa�ono�
f(a�dcover F arinnce Required }'es :�'o Date of Couiuil.�lpprovn!
RE�YI,4RKS(i�r hocrse):
33
1
B UILDING REVIEW CHECK LIST
UBC: N�14 CONSTRUCTION TYPE: '
Sg Footnge �'Per Sq Ftg
Bnsenae��t Y —
Ist Flcor c —
1ad Floor � —
Garage z =
x =
TOT,�L
Estirnater!Co�:structio�t Value: $ �,000
a�
litspections Required: 66'or•k Reqiiirirtg Sepnrnte Perntits:
Site Phu�Tbrng Fire
Hardcover•Renroval rllechni�ical ' Y�nter•Caznection
_�Footing Septic Server Connection
Fran�ing Fireplczce Lrnvn L�rigation
Insulatiora (�1�lasoniy) Other
G!'all Board (�i-lfg.) YYell(State Per•r�tid)
C Final Grncling-'Filling oLElectr•ical(State Permit)
Other
REI�IARKS(INHOUSE):
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RE VIE ti�B Y O THERS: DA TE:
Access: Existi��g New
Access Approval: Date By:
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REtYiARKS (TO BE NOTED ON PER'VIIT):
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