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Home My WebLink About2005-P08380 - addn/remodel/repair CITY OF ORONO PERMIT 2750 Kelle;��Parkway - PO Box 66 Permit Number: Pos3so Cryst�l,B�y, ivlinnesota 55323 Permit Type: Additio�xemoael�Repa�T (952) 249-4600 Date Issued: 2is�2oos SITE ADDRESS: 4051 Highwood Rd Mound,MN 55364 P I D: 07-117-23-44-0076 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Permit Class: Building Census Code 434 Pernut Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: 3066 Separate permits required: i'iumoing iviecnanicai ruepiace Eieciricai�siaiej NOTICES/REMARKS: �_, �.- -- . „_. -- � r--n----- -r�-�---.,�--- n----�-� .::::: -..... :::�:.:�::� -- -- - ......,. �....�..�...,..�-, .�....,..�. .,�.,., �..�� ...... . .... ... ...... FEE SUMMARY: PernutFee: $ 1,189.75 Valuation: $ 135,000.00 Plan Review Fee: $ 791.63 State Surcharge Fee: $ 70.50 TOTAL FEE: $ 2,051.88 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. ��u.G�t� �'�l /f� �--2 G' / � i C�'��l C r �'1 �� APPLICANT NERMITEE SIGNATURE ISSU D BY S[GNATURE Copies: 1-File(Sienitures Re�uired), 1-Applicant, 1-Monthlv Reports, 1-Assessme. 1-Finance Page 1 4 \�: � � .� t j.1 t� ) I_l Total Fee: $ '^ � � , , „ ;�, Date Received: � -2 �-U=� Entered By: ;�,��T,. ' _� � � ,�,�; � 1 � Permit#: ,:��;?�,��=c� ,-� y . 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 R CONTRACTOR JOB sITE anv�ss: y c S 1 1�� .�,��\ �u�� C��>�._�, vt��: Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes � NO /f yes, a specia!event permit is required with Police Department and City Counci(approva/ 60 days prior to the event. Shuttle bus service wi/1 be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. NAME OF OWNER: �v.��,�.W�� A.�.��.� ` �\�� PHONE: (home)'��3 S�`�-`�'l3� (work) �l 1 �l� a� a'S MAILING ADDRESS: I�� `t�S�� A�� CITY: ��.`�� ZIP: S S`f�� CONTRACTOR: 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 dej�tai�: �`�� °� s��`-.�� s��` `�� e«s� ��c��o.� ('< �.:.��c e.�C- �t.�-1 lc. � \`ev�ic^ E` a�tiC� `��'` �cL.+��' \Ev�c\ �^�- �.�-�-1��_�. � ' ��\� � �.��`�i�oor - �bC, STORIES: •� SQ.FEET OF EACH FLOOR 0'�t l�� - ` NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED DETACHED� ESTIMATED CONSTRUCTION VALUATION(excluding land): $ !��O�'�C �� 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: �`��'�l�� 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. L 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 concerning himself shall 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 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 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 ofthe 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 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 authoriry shall provide copies of the private or public data upon request by the individual subject of the daca. The responsible authoriry may require the requesting person to pay the actual cosu of making certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the 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 Iegal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement.The responsible authority shali within 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inacwrate 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 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. yV�\\\\clV.�� \\C��JJi� ��.l.�J't First Middle Last tL�-�� 9t� ��•� \`' . Address ��w.�.��__ �`'�,4� S S �1�.�. ''l��-S��`t-`l'13� City State Zip Phone I understand my rights as stated above. ��-ti �� C(►-�-�---� Signature 32 � ' CHECK OFF LIST FOR ISSUA1vCE OF PER1ti.tITS FOR OFFICE USE ONLY ADDRESSORLEGAL: yo5l hll6Hwoo0 �� PID: DESCRIPTIO.�OF YI�OR.K: Z•v� rr��i R-/�.o�n �� -OQe� -------------------------------------- ------ -------�------------------------------------- ZOtVIlYG RE vIE GV B Y: D.ATE APPROVED: z - �- a � BUILDING RET�EW BY, DATEAPPR06'ED: z• �-o � -------------------------------- FEES TO BE CHt1RGED: 1L'Iisc. Fees Calct�lated By: PERILIIT Yes ✓ No PLAN RE I�IE yV Yes � �Vo SEWER GO�V�VEGTION ST.�TE SURCH4RGE Yes �/ tVo tiT�ATER CO�WECTION INVESTIG,4TIO�V P.EE Yes No �/ PftRK FEE 5.�.C Y"es No � SITE NSPECTIO�V 1Vcunber af SAC Units OTHER (specify) ------------------------------------------------------------------------------------------------ ZO�VING CHECh'LIST Zar�i�tJ Disti•ict: G2• /� Fire Deparhrterrt: Post Office: Sdiool Dist��ict: _.. Lot.�{ren: Sqf'r. 2Z,'Z�� Acres •,� Y�idth 9(��oHu� DepN� Suivey Subntitted: Yes�C_ No Date af Scuvey: Proposed Setbacks: Froru(Lalce): 5s Right Side: W y'3 Renr(Streei): 1$•(o Left 5ide: E 2t{• � Adjncent Sn•uctiu•es: N/A Gf/etln�id: N�fr Building Height: Def. Hgt. D. �C Peak Kgt. Got Coverage: � �S�`"r G,•acting: Scaff.4pprovccl Date: /�/� By: CourTcil r{pp�roval Date: Septic: Staff,�lpp�•oti�al Date: /� �� BY� Zonirtg File: # 6�-�06 6 Resofutiat: # Resolution Dnte: /2• /3 - � / Slioreland Dish•ict: �./�P5 Avg. Setbnck: �,►� Bluff 5etback: �� Lot Cove1•age: /S• Y E�istin,� Pr•oposecf Hccr•dcover: 0-7�' � z•c. �2•� 75-250' ��^ Z50-500' 500-1000' Harcfcover Yariartce Reqtieired: Yes_ C No Date of Co�utcil Approval: / 2-i 3� o`( RE1l�lARKS(i�t Itouse): 31 ,. , . . < . �'. , , BUILDI[VG RET/IETY CHECIi LIST UBC: t�• � CONSTRUCTION TYPE: �JN _ Sq Faota,�z .�Pe�•Sg Fc,� Base�neru � _ !st Floor• .� _ 3nd Floa• .1 = GarcJe s = .c = TOTAL Estiiriated Coiistr•t�ctioic Y`a(ue; ,5 I 35,OW �� Inspectiores Required: 6P"ork Requiri��;Separate Perncits: Sile pC Pl�u,ibir�g Fire Hardcover Reirioval � rLlechani:cal GYctter Connecfion • Footing Septic Seu�er•Corv�ection X Framir�g oC Fireplace Lawn !t•�•igation _�C /�ucdatio,� ('��Iaso�trl) Otlier• _� GY"a!1 Board ot (A�Ifg.) G�ell('State Peri�tit) oc Final Gradiiig/Filling o� Electrical(Stare Per»iit) Other P.E1tiiAR1';S(IN HO USE): ------------------------------------------------------------------------------------------------------------------------ RE fflE tT�B Y OTHERS: DATE: .dccess: Existiilj rVe�+� ,=tccess�(pproval: Date B��: ------------------------------------------------------------------------------------------------------------------------ RE!'�I�RIiS (TO BE NOTED OtV PEIt�tiIIT): 32 DATE TIME ✓ CITY OF ORONO CALLED IN INSPECTION TI SCHEDULED PERMIT NO. O c�CU conn LETED � ADDRESS � L''� e OWN ER CONTR. TELEPHONE NO. � DESCRIPTION LL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP �TE INSPECTION Q OS FINAL 14 SEWER HOOK-UP 06 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 FINA� 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMM�NTS: � .-- �— � • % :� 0 — .' c� � ` l ' . �i - � � � � �— (�� E'�'1��' l 1:.�� 1r�- l �� L� u��'i o ' � w � ,��= l . Q � �. �.� � �,�:? (� � � � i � � r � a W ❑WORK SATISFACTORY:PROCEED f i PROJECT COMPLETE � ❑CORRECT WORK&PROCEED I 1 ISSUE CERTIFICATE OF OCCUPANCY W O ,�ORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED � STOP ORDER POSTED.CALL INSPECTOR C; INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952) 249-46QQ OwnerlContra ite: Inspector. White Copyllnspector's Fil Canary CopylSite Notice % � �� DATE TIME CITY OF ORONO CALLED IN 7'jZ '� INSPECTION NOT C SCHEDULED '7-/S�-U.S� i C'�J:�o�Z� PERMIT NO. ��v COMPLETED ADDRESS yO.> � ��/ �I h�,J�,`Q� '�� OWNER /r��-C� CONTR. 0�:�.�-� TELEPHONE NO. �� l� �� 77L�'C...� � DESCRIPTION /��C C�/'I � � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q � 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 0 N 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 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 � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � , � � �i � � � '�t�t � � o � 4 � � � 0 � W � Q � 2 W � W � � d � ❑W KSATISFACTORY:PROCEED f� PROJECTCOMPLETE W ORRECT WORK&PROCEED I ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ Owner/Contracto n ite: Inspector. White Copyllnspector's Fi e Canary CopylSite Notice �-7 �TJEJ TIME " CITY OF ORONO CALLED IN ! `— INSPECTION I E SCHEDULED / �� PERMIT NO. �_ COMPLETED ADDRESS OWNER CONTR. Q��r�� TELEPHONE NO. �.O�Z Z`1'7 77�� DESCRIPTION {yl.S�t IUyL � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q O5 FINAL 14 SEWER HOOK-UP O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINA� 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � w - a � � O �. � O � W � Q � Z W � W � � d W� WORK SATISFACTORY:PROCEED f� PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT 0 CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED C INSPECTION REQUtRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �952� 249-46QQ OwnerlContrac site: Inspector. White Copyllnspector File Canary CopylSite Notice �� TE � TIME ITY OF ORONO CALLE iN INSPECTION NOTIC Cq��SCHEDULED � �� PERMIT NO. l� ��"c MPLETED . ADDRESS U�� OWNER�� k�� CONTR. TELEPHONE NO. C� (�(�� DESCRIPTION �I I �.�..� �„�R��• ty� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q OS FINAL 14 SEWER HOOK-UP 06 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 YO YES_NO � COMMENTS: ` � W a � �'\ �� ` �\ O � � O � W � � 3 Q z 5 [�Z W � W � � a W WORK SATISFACTORY:PROCEED PROJECT COMPLETE � ❑ CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY W � ❑ CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CQRRECTUNSAFECONDITIONWITHIN HOURS. �; pHOTOTAKEN INSPECTOR WILL RETtJRN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cal1 for the next inspection 24 hours in advance. (952� 249-46�� OwnerlContractor � site: Inspector. White Copyllnspector' File Canary CopylSite Notice