HomeMy WebLinkAbout2005-P08614 - addn/remodel/repair CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Pog614
Crystal Bay, Mirinesota 55323 P@Cflllt Type: Addition/Remodel/Repair
(952) 249-4�00 Date Issued: 4i2�izoos
SITE ADDRESS: 4051 Highwood Rd
Mound,MN 55364
PID: 07-117-23-44-0076
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addirion/Remodel/Repair Permit Sub-type(s): Building Undefined
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: PermitFee: $ 111.25 Valuation: $ 5,000.00
State Surcharge Fee: $ 3.00
TOTAL FEE: $ 114.25
APPLICANT: Owner/Self � OWNER: Anita Rouse
MN 16220 48th Ave N
Plymouth, MN 55446
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 BUILDING CODE REQUIREMENTS.
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APPL[CAN"C PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitur�es Renuired), 1-Applicant, 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
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...
Total Fee: $ ��T . �-S Date Received: /�- ��.%'�' �`�
Entered By: _ Permit#: � _ ��'�--CC)
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all i��for»zation)
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THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: �.�S � L����,�.�,���� �����.O���� ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ �TO If yes,a special event permit is required with Police Depaf�tment and City Council approval '��
60 days prior to the event. Shuttle bus se�vice will be reqzrired unless applicant demonstrates �
sufficient on-site parking zs available. Non�ernzitted events will no!be allawed.
NAME OF OWNER: �-1 <�,��a,���_��t (➢���Se PHONE: (home) 'Z 63-1 e��Y�,3�
(wark) �t���S 11�1�� 5
MAILING ADDRESS: �i�aaG �-�,�t l.� �.��- 1J CITY: ��y v�����. ZIP: S'S�i4�
CONTRACTOR: S�.w.�- PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration �_
PROPOSED WORK(describe in detai�: ��.._� � ow�c�=����. �,`�,�,z� -..�k���
t�.�`� �� ��� _`s�
STORIES: � SQ.FEET OF EACH FLOOR `z� - a3 t o �-.�--`�� �
NO. OF BEDROOMS: 3 GARAGE STALLS: ATTACHED DETACHED 3
ESTIiVIATED CONSTRUCTION VALUATION(excluding land): $ ��b� v � ��� �t���y'�8�4 l
�D`t��>!�O`�
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; o��O b��
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 pertnit and work is not to start without a permit;and that the work will be bK,��,�
in accordance with the approved plan.
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APPLICANT'S SIGNATURE: G����-- � /��-- DATE: �I �S��S��
31
.�
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. l. Type of data. The rights of individual on whom the data is storcd or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individuaL An individual asked ro supply private or confidential data conceming himselfshal]be
informed of: (a)the purpose and intended use of the requested data�vithin the collecting state agency,political subdivision,or s[atewide 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 federaf 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�lace the notice required under this subdivision in the individual income tax or propertv 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 infocmed whether he is the subjec[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 pub(ic 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 of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual cos[s 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 of the request,exduding Saturdays,Sundays and legal holidays,if immedia[e 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 cotnpleteness ofpublic or private data
concerning himsel£ To exercise this right,an individual shall notify in wiiting the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)conect 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 individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed ptu•suant 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 inforcn you that your request
for a permit or license from the City of Orono or any of its departments may require you to fumish 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 rec�uest)to review private data on yourself.
6. Your full name is required to process this application or permit.
W ,�,��at.� �o��'�'� ��`ti5�
First Middle Last
��a10 �,� �� ���e �
Address
��� w�.�-���� ("�� S.`S `t`� (� `l�3- S��-��3�
City State Zip Phone
I understand my rights as stated above.
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Signature
32
CHECK OFF LIST FOR ISSUANCE OF PERMITS
. FOR OFFICE USE ONLY
ADL�RESS OR LEGAL: y 0 S 1 N t�t-1 W oo�J �Zo�
PID:
DESCRIPTION OF WORK: uP�A�:_oRit,�,v,,9�c. �,� � f���a� vn/D/1'72 fN �+N���`'�:
------���__�_—______�_�r��_____------------------------------------------------------------ �-+u.>S--P
ZOr`IYG RE'VIE`V BY: DATE APPROVED: y�Z J-o S
BUILDING REVIE`V BY: �� �Q�..w.._ DATE APPROVED: y- Z, _bs
�.
FEES TO BE CHA.RGED: Misc. Fees Calculated By:
PERNIIT Yes � No
PLAN REVIEW Yes No �/ SEWER CONIVECI'ION
STATE SURCHARGE Yes r/ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZO�IIIIG CH�CK LIST Zoning District: �p C H�4�v�c,f>
Fire Department: Post O�ce: School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Stree[): Left Side:
Ad;acent Structures: `Vetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Covera�e:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning F:le: # Resol ion: # Resolution Date:
Shoreland District:
Av'. Setback: Bluff Se[back: L.ot Coverage:
Ezisting Proposed
Hardcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REVLARKS (in house): D o,� ��0 5�,� g �v��..�.a�,o..� ,r c...�s ��•�.�� � 6� i.-•i
�od/C C v^.�� n� C i rz Go�-�ra( /'f%1�✓lJ /���v rnv� ��✓v /��s /��i���'J
/
7
BUILDING REVIE`V CHECK LIST
�C� �" 3 CONSTRUCTION TYPE: VN
Sq Foota�e $Per Sq Ftg
Basement x =
lst Floor z _
2nd F1oor x _
Garage z =
z —
TOTAL
Estimated Construction Value: $ S'o�o "='
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�( Footing ` Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insula[ion (Masonry) Ocher
Wall Boud (Mfg.) Well (State Perm.it)
—�F�� Grading/Filling Electrical (State Permit)
Other
RENIARKS (I�i 1 HOUSE):
- -------------------------------------------
REV�W BY OTHERS: DAT'E:
Access: Ezisting New
Access Approvai: Date gy:
-- -----------------------------------------------
REI�IARKS (TO BE NOTED ON PERitiiI'I�:
8
,� �7
✓� - /
� DATE�; ��,���-�j TIME
CITY OF ORONp CAL ED IN
INSPECTION N TI SCHEDULED ==������
PERMIT NO. connP�ErE�'� ` / ��
ADDRESS ��S� / ��`� '�
OWNER � CONTR.
TELEPHONE NO.�i���Cy' �o� � O�� � — ��CC'�_
� DESCRIPTION ✓ G?D! �
� 01 FOOTING 11 MECHANICAL RI 18 E CAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W r�WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED '-; ISSUE CERTIFICATE OF OCCUPANCY
W
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-46��
OwnerlContract r i .
Inspector.
White Copyllnspector's File Canary CopylSite Notice