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2008-P11917 - addn/remodel/repair
' ' � PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: P11917 Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair (952) 249-4600 Date Issued: 3/13/2008 SITE ADDRESS: 2255 French Creek Cir Unit# Wayzata, MN 55391 PID: 10-117-23-32-0006 DESCRIPTION: Proposcd Usc: Residential Census Code 434 Pcrmit Class: Building Pcnnit Type: Addirion/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair D ETAI LS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 574.25 Valuation: $ 40,000.00 State Surcharge Fee: $ 20.00 TOTAL FEE: $ 594.25 APPLICANT: Nieters Creative Const Inc. OWNER: James&Brenda Broucek 14745 NW 225th Ave 2255 French Creek Cir Elk River,MN 55330 Wayzata,MN 55391 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 BU(LDING CODE REQUIREMENTS. APPLI NT PER;�IITBE SIGNATURE ISSUED BY SIGNATURE � Copies: 1-File(Signatures Requirect), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 , , � / //�,y� Total Fee: $ �� � ��J Date Received: .3 ..3 jJ ��'�" ` Entered By: Permit#: / ,� CITY OF ORONO - BUILDING PERMIT APPLICATION 5S I�� + / All information must be submitted in full before plan review will be started. � (please pYint all information) ------------------------------------------------------------------------------------------------------------------------ ,�--—..__ ._� THE APPLICANT IS: (circ[e one) OWNER OR ONTRACTOR �-----� JOB SITE ADDRESS: � �-`� S �-2r �t c� � L���,1� L,����/,� ZIP: J��5 _��1 ( Will this be a Parade of Homes, Remodelers Showcase Home or other llisplay Home? ❑ YeS � NO 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. NAME OF OWNER: J��� a- �i���� � �,�,i,t,� ���� PHONE: (home) `�S�- - a= 7 3 - ��t C<., 1 (work) MAILING ADDRESS: z 2 5 � �=�rz�,��C-�-� C.✓7�:.�CITY: L�e"L-v�-.c ZIP: ��a � CONTRACTOR:�: Il, r.,�-C�,) �n-�.2�.t.;.:� (,�G �ti� ��...L-�.��IONE: 4 l�--- �`� 4� ll=� � CONTACT PERSON: 'i .�,���,� �.� ,�,�[.�•2� MOBILE/PAGER: MAILING ADDRESS: (d 7 � ��' �-�5 f�� .��c�, /l��.CITY: Cl �-��i�L�.:.��, ZIP: �5-,5 � 3 i, STATE LICENSE: # .� t9L'>E�Q !G��: EXPIRATION DATE: -3 - 3 l � Z�e �', ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Altecation (ie: Siding, Windows) C. Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detai�: 2.�, �rZ�, �1.�l s'�v-� S�2 � �-:--{/-� �,r% ��'{-(JL �' t�i I il�i.^s � STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $__� G �uv . G� 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: �1'�`� DATE: �� � � � �� ", 31 Sec.13.04 RIGHTS OF SUBJECTS OF llATA 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 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 leeally 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 o[her 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�,[o a law enforcement officer. The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income tax or propertv tax refund instructions mstead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,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 informed 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 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 shal I 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,ifimmediate compliance is notpossible. Ifhe 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,exdudine 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 himself. 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 either (a)correct the data found to be inaccurate or incomplete and attempt to no[ify past recipienLs 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 individual's statement of disagreement is included with the disclosed data. The determination of the responsible authorit��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 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: ]. The information you furnish will be used to detern�ine your qualification for the permit or license requested. 2. 1'ou 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. ]3.04(available upon request)to review private data on yourself. 6. Your full name is required to process this app(ication or permit. First Middle Last Address City State Zip Phone I understand;p�p-xights as stated above. ,`�� Signaturc Reset Form 32 , . ,_ , . _ �', -. , ' � � � � , ., . , . � . . '. c— �p� "'� _ }� . : _.�... . _.___. _ . . . _. _ _ - --. .. _ ` .r - , _ �— �-..�. r . , .. . � � � e+ ' _ , # • . . .. , ! ' . .. �' - ' � � t � j_- . •, . . - _ � f./���,f' . ' . .. � ... . � .. 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C� TELEPHONENO. /S2 �7.3 ���/ � DESCRIPTION ���� � /"�� ���� � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING � ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS Q ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z � WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE � SEPTIC MAINT. ❑ COMPLAINT Q ❑ DEMO-F�NAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � j �C��P b�J�U'� � �� l � � 1'�I� 0 � `-�h �-�� r�� �. �3Q ��«�.�, �.�� ° � s�y K� �c�'�'���v r' ,L�� � �) QG- v � �e �F-�c_ 4z�' c� 1 �F-L►''� z � � � � �' � �JeS—f f3� ��v�.� w � W � � d W� �Q(ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED '� ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR W{LL RETURN ❑ CITATION ISSUED 0 STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 forthe next inspection 24 hours in advance. (952� 249-46�� OwnerlContractor on site: Inspector. ,�fi—f' /..� _ White Copyllnspector's File Canary CopylSite Notice