HomeMy WebLinkAbout2008-00326 - addn/remodel/repair � � � CITY OF ORONO PERMIT 1v0.: 2008-00326
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1 U07/2008
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 : ADD[T[ON/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTI VITY : 434-RESIDENTIAL
VALUATION : $ 8,000.00
NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE)
RE STRUCTURE 1ST FLOOR FRAMING TO REMOVE LOAD BEARING WALL IN LOWER LEVEL-BASEMENT
APPLICANT PERMIT FEE SCHEDULE 162.25
L N SHANK BUILDERS PLAN REV[EW 105.46
1206 MISSISSIPPI DR.
CHAMPLIN, MN 55316- STATE SURCHARGE(VALUATION) 4.00
(763)286-1955 TOTAL 271.71
Minnesota State License#: 20595688
OWNER
GEORGE, DEVEAN
1285 FRENCH CREEK DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The 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 for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not speciYied 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 after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time tbr due cause. �
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Applicant Permitee Signature Date Issued y Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIB D ABOVE.
' � 'Total Fee: $ �7`• 7l DateReceived: /� ra�- �
Entered By: I��p� Permit#: apa 8-Gt�3a(o
CITY OF ORONO - BLIILDING 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 O CRj ON RACTOR
�—�
JOB SITE ADDRESS: � ZSS��'�;�r�l� C1z.� . .L�T� . zlP: �..��.-3`�`1
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � NO If yes, a special event perrriil is required with Police Department and Crty Council approval
60 days prior to the event. Shutile bus servtce will be re yuired unless applican!demonstrates
su„tficient on-site parking is available. Non permitted events wilJ not be allowed.
NAME OF OWNER: �U��� �',���� � PHONE: (home)CGI�-'�yS�j�37
(work) `'
MAILING ADDRESS: ��.�� �CI� C'/Z�CITY: �,�'00Ud ZIP: �r'S�7'�
L u �.�4 s f3 T��� C r.�-n��,,4�tt�
CONTRACTOR: L N sf-1�N k- /3GI! G-��1'�.s PHONE: ,�l,�3-����v--/`�S,i""
CONTACT PERSON: �.(,CC}l,S ��4/�/� MOBILE/PAGER: " ��
MAILING ADDRESS:f�b Co ,y/�/s�/i�P( DIZ • CITY: e�ANk j�C.l l� ZIP: .�.5�,,,3/�0
STATE LICENSE: # Zo S�'!Sco c�v° EXPIRATION DATE:__� -3/ - b q
ARCHITECT/ENGINEER: �'� � ��G jf'(���.�"u j� PHONE: 1�I Z- '�Z 3--�(�3 Z
MAILING ADDRESS: ��O � 1s1`; �hv• So • CITY: ��5. ZIP: �t `�
NAME: ���)C I�-�- ��'.c t, -�f"" REGISTRATION: # f�j �.S"
TYPE OF WORK: New Home Addition Aecessory Structure
Move Home Remodel/Alteration (ie: Siding,Windows) �_
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe irt detai�: j��-,�`�,�Gf�TI,-/K-E 7s� -f/h• �'�J� �/U L7
-��, ,��ttic o!� L-rs r�t� 1��'"���'/�l� G��L�. I N t_o�r�T�- L Et���-B� s�e��/ T-
STORIES: �... SQ.F''EET OF EACH FLOOR: ����
NO. OF BEDROOMS: _� GARAGE 5TALLS: ATTACHED� DETACHED a
ESTIMATED C�NSTRUCTION VALUATION(excluding land): $ �, d 6� � �a
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 ardinances and codes of the City and with the State Bui.lding
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: �--��''� � -���f�- DATE: j� � � � ""��
31
�Sec.1.3.U4 RIGHTS OF SUBJECTS OF DATA
Subd_ 1. Tti•pe of data. The rights of indi��idual on�vhom t�ie data is stored or to be stored s6a11 be as set forth in this section.
Subd.2. Information requn�ed to be given individuaL An indi�-idual asked to supply private or contidential data concerning}rimself shall Ue
informed uf: (a)the ptnpose an�i intended use of the requesteJ data�vithin the cuilecting state ugency,political sutxiivisiun,or statev�ide system;(U)
whether he may reYuse or is leg�il(y required to�upply the requc�ted dxta;(c j uny kno�vn cunseyuence tuising fivm his supplying or refiwing to supply
private ot confidential data;and(d)the identity of other persons ot eutr[ies authorized by state or federal lac��to recei��e the data. Thls requitement shall
not applv��hen an indi��idual is asked tn supply inves[igati���data,pucsuant to section 13 82,subdivision 5,to a law enforcement otlicer.
The conuiissioner uf revenue mav olaee the notice reauired uncler this subdivision in the individual income taa ui_pi'ODeitv tax refund
insiructions insteud of on thvse forms.
Subd.3. Access[o data by indi��iduai. Upon request to a responsible authority,an utdividua(shall be informed�vhether he is the subject of
storeci Sata on individuals,and w}iether it is classitied as public,private or conYidential. Upon}vs T'wtlier request,an individual�vho is the suUject oY'
stored private or public ciata on individuals shall be shown the data withuut anq ch:irge tu him and,ifhe desires,shall Ue infuimed of the content;znd
mesuiing of thut duta. After an inclividual has been sho�vn the private datn and infvimed of its menning.the ciata need not be disclused to him for sia
months thereafter unless a dispute or actiun pursuant[o this section is pending or additional data un the individual has been collected or created. The
responsible authorin�shall provide copies of the priv2te or public d2ta upc�n request by the individual subject of the data. The tesponsible authority
may require the requestii�peison to pa} the actual costs ofmaking,cettifying,and compi(ing the wpies.
The res��onsible authorit}'shall comply ucuneciiately,ifpossible,w�ith any request made putsuant to this subdivisiun,or Hithin Yive days of
the ciute of the request,excluding Saturdays,Sundays�nd legal holiciuys_if icnmediate compliance is not pua�ible. If he cunnd comply tvith the request
���itlun that time,he shall so infonn the v�di��idual,and may have au additiunal five days v�ithui�vhich to complV Nifli[he request,excluding Saturdays,
Sundays and legal holidays
Subd.4. I'��ocedm�e��hen data is not accwate or complete. An inJividual may contest the acctuacy or completeness oCpuUlic or pri��ate ciata
con�erning himself. To exercise this right,un individual sha12 notitj�in wiiting the responsiUle authoiity desciiUing the nnhu�e oY the clisagreement. The
responsible authority shall within 30 da}�s either: (a)conect the data Yound to be inaccurate ur iucomplete and attempt[o noti'ty past recipieuts uf
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the indi�7dua1 that he believes the data to be conect. Data in
dispute shall be disclosed onl}�if the individuaPs statc.ycnent of disagreement is included�uith the disclosed data.
T1ie detemunation of the responsible authority may be appealecl p�u�suant to the provisions of the administrative procedure act relating to
contesfed c:ases.
DATA PRIVACY ADVI50RY
In accordanee with M.S. 13.04,Subd.2,"Rights of subj ects of data",we would like to informyou thatyour 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 norified 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 federai 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 ful] name is required to process this application or permit.
First Middle Last
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naa�ss
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City C-� ��,��"��� }� � State ��� �� ZiP _���ii�` Phoee � CN 3 � ��cl�' "
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I understand my rights as stated above.
I�-1 ,�".S�'
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Signature
Reset Form 32
�Jct 14•08 09:47a Lucas Brand Co, 7632861955
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ I,�'�.S ��C'^.C"l-t � rP� � �(:
PID:
DESCRIPTION OF WORK: _ fzcrYw�.-z (�,,..,,�/; �:v�L, ,�L _ �,r�--���
ZONING REVIEW BY.• f� DATEAPPROVED: �
B UILDING REVIEW BY.• DATE.APPROT�ED: i�•LS-O�
FEES TO BE CHARGED: Misc. Fees Calculated By.• ��
PERMIT Yes_� No
PLAN REVIEW Yes_� No SEWER CONNECTION
STATE SURCHARGE Yes_� No N�ATER CONNECTION
INVESTIGATION FEE Yes No_�� PARK FEE
SAC I es No_� SITEINSPECTION
Number of SAC Units OTHER (s pec�)
ZONING CHECK LIST Zoning District: /�/O G/ti3.n/ �
Fire De artment: v
P Post Off ce: School District:
Lot Area: Sq ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wetla d: �
Building Height: Def.Hgt. Peak gt.
Lot Coverage:
Grading: StaffApproval Date: B}�' � Council Appi•oval Date:
Septic: StaffApproval Date: I D"�"l'(J�3 By: (.��j^
Zoning File: # Resolution: # Resolution Date:
Shoreland District: MCWD Permit
Avg. Setback: BluffSetback. LotCoverage.�
Existing Proposed
Hardcover: 0-75'
75-250'
250-�00'
500-1000'
Hardcover Y'ariance Required: 3'es No Date of Council App��oval:
RElYLARKS(in house):
33
BUILDING RET'IEW CHECIC LIST
UBC: /� � � CONSTRUCTIONTYPE: ��
Sg Footage $Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ U+Q O(7 �
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
�_Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
YG'all Board (Mfg.) YG'ell(State Permit)
_�Final Grading/Filling Electrical(State Permit)
Other
REMARKS(INHOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
34