HomeMy WebLinkAbout2008-00460 - addn/remodel/repair � CITY OF ORONO PERMIT NO.: 2008-00460
� 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: OU07/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 1285 FRENCH CREEK DR
PIN : 10-117-23-32-0007
LEGAL DESC : FRENCH CREEK
: LOT 008 BLOCK 001
PERMIT TYPE : ADDITION/ REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 6,000.00
NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,M�CHANICAL, ELEC"1RICAL(S1'ATE)
DGMO CLOSET WALLS,BUILD NEW WALLS, DRYWALL INSUI.A"['ION.
RF,MODEL 2ND FLOOR
APPLICANT PERMIT FEE SCHEDULE 132.75
MELCO REMODELING PLAN REVIEW 86.29
3320 JEWEL LANE N
PLYMOUTH, MN 55447- STATE SURCHARGE(VALUATION) 3.00
(6l2)598-6338 TOTAL 222.04
Minnesota State License#: 20630510
OWNER
GEORGE, DEVEAN
1285 FRENCH CREEK DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
f ihe work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission tor additional or related work which requires separate
permits. All provisions of laws and ordinances govcrning this type of work
shall be compied with whether or no[specitied herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This pennit may be
revoked�any time for due ause. i � .
� t - �— �,
1
/ / ��� l�� / /
Applicant Permitee ignature Dale Issucd By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� G y,o
�
►�
Total Fee: $ aZ a.Q DateReceived: � ,�./�d8
Entered By: Permit#: 00 -�� ` (00
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
, ,, L
JOB SITE ADDRESS: j � � T �- � �-� G �X.K �Z ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS � NO If yes, 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 demonsti-ates
sufficient on-site parking is available. Non-permitted events N�ill not be allowed
NAME OF OWNER: I,1 Q V�- J� Ca �J 'L� PHONE: (home)
�1 �-, (work)
MAILING ADDRESS: I r���� F�k V�-�ti �ti�l� D�CITY: (�7�G'�ti� ZIP:
,
CONTRACTOR: (.(.i � I Q. C� �' �hF� PHONE: �I� �J ��.���
CONTACT PERSON: S 1 �.� I ,�u(/ MOBILE/PAGER:
MaiLiNG ann�ss: 33�-0 ��e-�rrel ��, eITY: �I�„�;����, ziP•��7
STATE LICENSE: # d,O� 3�'S � EXPIRATION DATE:
ARCHITECT/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�Qs�T l�/�t l/ S , ��L���lf l.k f,t/
�,�ti1S. D"� �� �a /r ► ����U�►�� '
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �,(�l�/�% ��
I hereby apply for a building permit and I acknowledge that the infonnation above is complete and accurate;
that the wark will be in conformance with the ordinances and codes of the City and with the State Building
Code;that 1 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: � �J/�J�
31
�
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. l. Type of data. The righu 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 himself shall be
informed of. (a)the purpose a�d intended use ofthe 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 may olace the notice required under this subdivision in the individual income tax or propert�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 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. Afrer 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 authority shall provide copies of the private or public data upon request b��the individual subject of the 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 tive days of
the date ofthe request,excluding Sat�rdays,Sundays and legal holidays,if immediate compl iance 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 himsef£ To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The
responsible authority shall within 30 days eithec (a)correct the data found to be inaecurate 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 individual's statement of disagreement is included with the disdosed data.
The determination of the responsible authority 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 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.
� (c��/ � �I.�.�' �C� I�
First Middle Last
3'�j � �].2 IX/,�� L� �
Address
P �� w����- 6,�/1 �/ � �9�7
City State Zip Phone
I understand my rights as stated above.
r���
Signature
Reset Form 32
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �Z $S r�2..=r►c-t�t ��� ,/�2
PID:
DESCRIPTION OF WORIi: �?.0 w�.�r��,.� Z�„�Q o 2
ZONING REVIEi�'BY.• (4 DATEAPPROVED.W_Yr��_�_
BUILDING RE[�IEW BY: w—_ DATEAPPROVED: �- s - d°t
FEES TO BE CKARGED: Misc. Fees Calculated By: � � M �� w
PERMIT Yes r/� No
PLAN REVIEW Yes �/ No SEWER CO.NNECTION
STATE SURCH.ARGE Yes �/ No u'ATER C01�7VECTION
IIVVESTIGATION FEE �'es No_� PARK FEE
SAC �'es No �/ SITEII`'SPECTION
Number of SAC linits OTHER (spec�)
________________----------------------________
ZONING CHECK LIST Zoning District NU c t�,P
Fire Department: Post O�ce: School Districr:
Lot Area: Sq.ft. Acres YG'idth Depth
Sw•vey Submitted. Yes No Date of Su�vey:
Proposed Setbacks:
Front(Lake): Rig Side:
Rear-(Street): Left ' e:
Adjacenl Structw-es: N'etland.
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading. Staff,4pproval Date: By: Council App�•oval Date:
Septic: Staff�ipproval Date:Nc1 ��*ti^'�� i� B��: ��,
-�'o r �c3c:��o.v�S
Zoning File: # Resolutia�: Y Resolutior�Date:
Shoreland District: A�1CYI�D Pernlit:
Avg. Setback: BlarffSe ck: LotCoverage:
Fa ist ing Proposed
Hardcover: 0-'�'
?5-'�0'
'�0-�DO'
.i00-1000'
Hardcover 1 ariance Reqz�ir•ed: I'es N Date of Coin�cil,9pproval:
REMARfiS(in hnuse):
�
bE
�t.lIL1l2I3d�IO Q3.LON 3g O.l) S.Y?I ti'W3?I
�i� aznQ :jvno.rddy�ssa��y
n�a_,� But�srr3 :ssa��y
�3.L b'Q �S?I3H.l O�I S.413Ir13?I
�(3S110H 1�II�SX?I i�'I��X
.�ar�10
(�tcu,�ad a1n1S)ln��at�a13 � Suill?.��8utpn.r� Inui� �a
(lrauaad�1n�S)11?�f ('�.�LY) p.�noff Iln.�i
.�ay�� (�uosny�r) uot�njnsul �c
uor�n��aal unw7 a�njda.�:,� �uiwn.��-�
uoc��auuo�.�anlas �t�das �ut�oo�
uot��aua{o�.raln,� fn�tuny�ay�� �nnou�ay.rano�p.roH
a.rr� Suzqzunld�— a1?S
:s1?Zuaad alv.�ndas Lin�rnba�.yro,� :paa�nba�suor7�adsul
po ppQ � $ :an�n� uo�l�n.rpsuo�pa�nura�s�
76'.LO.L
— x
= x a�n.rb�
— X aoo�.�pUz
— .r .rool,�Js j
= x �uacuasn�
�a,�bs.�ad$ aanloo,�bs
(..�7� �3dd.L;VOLL.�l1?LLSNO,� -Z,t �.�Si�
.LSl7 A.�,�H��H3I�13?I JNIQ7711 g