HomeMy WebLinkAbout2009-expired permit application .
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C ITY of ORONO
��i�`,, �l�r Municipal Oftices
�.� .�yG Street Address: Mailing Address:
'�ji'EggOg' 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
March 23, 2009
Kevin Garnett
450 Orono Orchard Rd S
Wayzata, MN 55391
RE: Expired Building Permit Application for-3400 Fox Street, Orono, MN
Dear Mr. Garnett:
Enclosed you will find the original building permit application and plans for a Building Permit (for a
Remodeling Permit), that was submitted on 05/21/08.
This permit was never picked up and has since expired. Plan reviews expire after 180 days. We are
returning this application to you.
You may reapply for this permit at anytime. You will want to check with our Building Official to ensure
nothing has changed with in our code. A new application would have to be filled out at the time a
permit is re-submitted, along with any new documentation or fees that are now required.
If you have any questions, please feel free to contact Lyle Oman, our Building Official at 952-249-4600.
Permit Department/rd per lo
Telephone(952)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
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, Total Fee: $ ��79 3•�7" Date Received: ���`� �
Entered By: �j Permit#: �
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CITY OF ORONO - BUILDING PERMIT 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 R CONTRACTOR
JOB S�TE A���ss: 3��d o� s'r— z�P:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �� Ifyes, a special event permit is required with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be reguired un[ess applicant derrzonstrates
suff cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER• •
G//� ���N�_ PHONE: (home)
work)
MAILING ADDRESS: 3 y00 e� �i CITY: Q � ZIP:
Ge«�s,�e �. �
CONTRACTO�: �.�V � � HONE:
CONTACTPERSON: OBIL AGER: �j/�•�d •y �
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
. /�.�r
ARCHITECT/ENGINEER: �j��t„ ,��� pgp ;riS�i y�9�'v�1
MAILING DRESS: CITY./� , '
NAME: jL �J REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows) _�/'�
Any earth movement may re uire MCWD re iew and permits!
PR POSED WORK(describe in detai : � �
O �(
STORIES: __.�__ SQ.FEET OF EACH FLOOR ��C�
NO. OF BEDROOMS: � GARAGE STALLS: ATTAC ED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��, QO�_
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.
.
APPLICANT'S SIGNATURE: DATE: �
31
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. An individual asked to supply private or confidential data conceming 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 refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or property tax refund
instructions instead of on those forms.
Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shal I 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[hereafter 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 ofthe private or public data upon request by[he individual subject ofthe data. The responsible authority
may require the 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 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 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
conceming himsel£ To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 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)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individuaPs statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating[o
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 process this application or permit.
First Middle Last
Y.
Address
Ci1J' State Zip Phone
I understand my rights as stated above.
•
na ure
Reset Form 32
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BUILDING PERMIT APPLICANT: PROPERTY OWNER
,
I, � �i�r��f�JQ,�i�.P� , understand that the State of Minnesota requires
that all residential building contractors, remodelers and roofers obtain a state license
unless they qualify for a specific exemption from the licensing requirements. This license
requirement applies to owners of residential real estate who build or improve such
prcperty for purpcses of speculation or resale.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it. I hereby
claim to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on speculation ar for ,�sale and that the house for which I am
applying for this permit, located a�-..�'��f� ,��Q ��- , Orono, is the first
residential structure I have built or improved in the past 24 months. I also acknowledge
that because I do not have a state license, I forfeit any mechanic's lien rights to which I
may otherwise have been entitled under Minn. Stat. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting,remodeling, and/or roofing activity is a
misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. I further state that I understand that the filing of a false statement with the City
of Orono may also result in criminal prosecution and/ar civil penalties pursuant to
applicable city ordinances and/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Orono for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
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ame
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Date
For questions or information on contractor licensing, or to check the licensing status and
enforcement history of a particular contractor, call the Minnesota Department of Labor
and Industry, Construction Codes and Licensing Division, at (651) 284-5069. The Web
site is: www.doli.state.mn.us/contractor
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONL Y
ADDRESS OR LEGAL: 3y c�c� ►�x ST—
PID:
DESCRIPTION OF WORK: I�vv�� ip c_L n� s o�— c�..¢s s o s� ,<.�
ZONING REVIEW BY.• �(///� �DATEAPPROi�ED:Y�W~��_
BUILDING REi�IEW BY.• V DATEAPPROVED: S -Zz.-��
------_---_---___--------------------------
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes_� No
PLAN REVIEW Yes � No_ SEWER CO.NNECTION
STATE SURCH.ARGE Yes � No GiATER CONNECTION
INVESTIGATIOIV FEE Yes No �' PARK FEE
SAC Yes No � SITEINSPECTION
.�%zrmber of SAC Units OTHER (spec��
_����----�-��-----�---��-�---��-
ZONING CHECK LIST Zoning District: v �,
Fire Depar•tment: Post O�ce: School District:
Lot Area: Sq ft. ,9cres GG'idth Depth
Survey Submitted: Yes t�'o Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear-(Street): Left Side:
Adjacent Structures: Yf etla d:
Building Height� Def Hgt. Peak gt.
Lot Coverage:
Grading: StaffApprova!Date: By: Council Approval Date:
Septic: StaffApproval Date: B1�:
Zoning File: # Resolution: fr Resolution Date:
Sho�•eland Dist�•ict: iL/CGG'D Permit:
Avg. Setback: Bluff Setbac� Lot Coverage:
Existing Proposed
Hardcover: 0-?5'
7�-2.i 0'
?.i 0-.i 00'
�00-1000'
Har•dcove�• �a�•iance Reqzrired: 3'es �'o Date of Coarncil.9pproval:
REMARKS(i�r house):
33
BUILDING REVIEW CHECK LIST
UBC: (Z• 3 CONSTR UCTION T YPE: V�'`�
Sq Footage �Per Sq Ftg
Basement x =
1 st Floor x =
?nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Va[ue: $ I c�o,c�c�c� `�='
Inspections Required: Work Requirin;Separate Permits:
Site �Plumbing Fire
Hardcover Removal �1Llechanical W'ater Connection
Footing __Septic Sewe��Connection
�C Framing Fireplace Lawn Irrigation
O( Insulation (,Llasonry) Other
Yi'all Board (Mfg.) YG'ell(State Permit)
�Final Grading/Filling i�Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing h'ew
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
34