HomeMy WebLinkAbout2004-P07202 -addn/remodel/repair r ! PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�2o2
Crystal Bay, Minnesota 55323 P2C1711t Typ2: Addition/RemodeURepair
(952) 249-4600 Date Issued: 2i6i2ooa
SITE ADDRESS: 870 Hunt Farm Rd
Long I.alce,MN 55356
PID: 30-118-23-44-0004
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Buildin Census Code 434
Permit Class: g
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate pemuts required: ruepiace Eiec;mc;ai�s�aiej
NOTICES/REMARKS:
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FEE SUMMARY: PermitFee: $ 265.25 Valuation: $ 15,500.00
Plan Review Fee: $ 172.38
State Surcharge Fee: $ 8.25
TOTAL FEE: $ 445.88
APPLICANT' Richard Heine Remodeling Repairs OWNER' Denni&Bridget Armbruster
� 11610 47th.Avenue North � 870 Hunt Farm Rd
Plymouth,MN 55442 Long Lake,MN 55356
THE UNDERSIGNID HIItEBY REQUESTS PE[tMISSION TO MAKE THE REAL IlVIPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPI,IANCE WITH ALL CTTY OF ORONO ORDINANCFS AND SfATE OF
MINNESOTA BUII.DING CODE REQUIItEIVIII�iTS.
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A LICANTP MITEESIGNATURE ISSUEDBYSIGNATURE
Conies: 1-File(SiQnitures Reauiredl. 1-Apnlicant, 1-Monthlv Renorts. 1-Assessine, 1-Finance Page 1
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/-, c-� <.
Total Fee: $ �7 �5 � ", �`>
Date Received:���-���)��
Entered By: ;�.L? Permit#: /��t 7�p.�
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan revie��- will be started.
(please print all inforjnation)
THE APPLICANT IS: (circle one) O`VNER OR CO1V'TR�CTOR
JOB SITE ADDRESS: � �Z'' ����/',1�v``/��—� ��� ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ,� No If yes, a special event permit is reqt�ired with Police Department and City
Council approval 60 days prior to the event. _ti'on permitted events will not
be allotived.
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NANIE OF O`VNER: � C��t►� �S ,�/�/�'�/-�/'`i1s<z��HO\"E: (home) 7��- ��� DI��_�
r � � (work)
NIAILING ADDRESS: d 7� l�✓�v�-f,�►�� /W CITY: C.����!'z� ZIP:
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CONTRACTOR: ��� ���n�^� e� t. �,� PHO\�E: C3--��3—/.s"G G
CONTACT PERSON: C �-C NIO ILE/P�GER: � ��(�` � �
MAILING ADDRESS: //��( ��ydj /��' N' � CITY: / L /�(� �p� ZIP: e���.
STATE LICENSE: # �GO�.��'�/, �
ARCHITECT/ENGINEER: ��g+-,,.-�-� PHO\-E:
MAILING ADDRESS: CITY: ZIP:
NA1�IE: REGISTRATION #
TYPE OF`VORK: New Accessory Structure
Addition Niove
RemodeVAlteration c� Land Alteration
PROPOSED WORK(describe in detai�: � �N � � �i, %iN `ti,� � �
S� r � /�it,t
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROONIS: � GARAGE STALLS: ATT. DET.
L.N° C�ANSe �d. .
ESTI�IATED CONSTRUCTIO�' VALUATION (excluding land): $ /��i�'Z
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 �i-ith the ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and wrar-k-is,not to start w-ithout a permit; and that the�-ork«zll be in accordance«zth
the approved plan. w �
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APPLICANT'S SIGNAT . '--� D�TE: � �!��
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on w6om the data is stored or to be stored shall be as set fort6 In this section.
Subd.2. Information required to be given(ndividual. ,�1n indi�-idual asked w supply private or confidential data concerning himself shall be
informed o[: (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 ls legally required to supply the requested data;(c)aoy known consequeace arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities aut6orized by state or federal law to receive the data.This reqairement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdlvision 5,to a law enforcement ofticer.
The commissioner of revenue ma lace the notice r uired under thls subdivision (n the individual inrnme tax or ro e tac refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an Indlvidual shall be informed whet6er 6e is the subjeM of
stored data on Individuals,and whether it is classifed as pubiic,pricate or coniidential. Upon 6is further request,an Individuai who Lt t6e subject of
stored private or publ(c data on Individuals shall be shown the data without aay charge to him and,Ii he desires,shall be(nformed of t6e content and
meaning of that data. After an individual6as beea shown the private data and informed of its meaning,the data need not be disclosed to hIm for slx
mooths thereafter unless a dispute or aMion pursuant to this sectfon is pending or additional data on the individual has been coilected or ereated. The
responslble authority shall provide copies of t6e private or public data upon request b}•the indlvidual subject of the data.The responsible authority may
require the requesting person to pay the actual costs of making,certifyiog,and compiling the copies.
The responsible authority shail compiy immediately,lf pouible,wlth any request made pursuant to t6is subdlvision,or within 6ve days of the
date of the request,excluding Saturdays,Sundays and legai holidays,if immediate compliance is not possible.If he cannot rnmply with the request within
that time,he shall so inform the indlvldual,and may have an additional five days within whic6 to comply with the request,excludine Saturdays,Sundays
and lega16o8days.
Subd.4. Procedure when data is not accurate or complete.An individual may contest the accuracy or completeness of public or private data
concerning himselC. To exercise th(s right,an(nd(vldual shall notify in wrihng the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past rectpients of
inaccurate or inrnmplete data,including recipients named by the individual;or(b)nodfy 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 admiutstrative procedure act relating to
contested cases.
DATA PRIVACY AD�ZSORY
In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that�-our 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�•our 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 estent necessarv 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 bI.S.13.04(a�•ailable upon request)to revie�-private data on�ourself.
Your full name is required to process this application or permit.
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Last
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Address
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��ty � State
Z�P Phone
I u rst d y r' hts as stated above.
Signature /
� "' - CHECK OFF LIST FOR ISSUANCE OF PE&11ITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �7 u �-i v n,r�-�q R� (�r4�
PID: �
DESCRIPTIONOFWORK Lp`,.��2 �...v�.� (LE.rv►.o4E�
ZOIVING REVIEW BY.• N I fA DATE APPRO ti�D:
BUILDING REVIEWBY.• DATE APPROVED: Z -3-O Y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLANREVIEW Yes ,/ No SEWER CONNECIION
STATE SURCHARGE Yes� No �VATER CONNEC�70N
INVESTIGATION FEE Yes No ✓ PARK FEE
SAC Yes No �/ SITE INSPECTIOti
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning Districz: /v o CKAnIG�
Fire Depanment: Post Office: School District:
Lot Area: Sq ft. Acres Width Deptlz
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Lefi Side:
Adjacent Structures: erland:
Building Height: Def. Hgt. eak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Dcre:
Septic: Staff Approval Date: 8��: —�,o C�n�,� iN # or �,�/LODu^S
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac�: Lot Coverage_
Existing Proposed
Hardcover: 4-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Appr�ti�al:
REMARKS(in house):
32
. � .
BUILDING REVIEW CHECK LIST
UBC.• 2• 3 CONSTRUCTION TYPE: �/N
Sq Footage $Per Sq Ftg
Basement X
Ist Floor x
2nd Floor x
Gnrage X =
x
TOTAL
Estimated Construction Value: $ I S.S dp �=
Inspections Required.• Work Requiring Separate Permils:
Site Plumbing Fire
Hardcover Removal Mechanical
Water Connection
Footing Septic Sewer Connection
_�Framing __ZC Fireplace L,awn Irrigation
_�Insulation � (Mason
�_ Wall Board ��"vrslv� O�_
(Mf8•) Well (State Permit)
d Final Grading/Filling _ � Electrica! (State Permit)
Other
— --------------------________ ----------
REMARKS(IN HO USE): �� �M`
------------------------ ---------------
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date
BY:
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REMARKS (TO BE NOTED ON PERMIT); r
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''1 D/►� O� TIME
CITY OF ORONO CALLED IN �` �
INSPECTION N I E SCHEDULED �� �Q 0
PERMIT NO. ZOZ COMPLETED
ADDRESS �57� 1-I(�r11- ��r rY� �.
OWNER CONTR. � � C-�c 5 (��Vl o�,
TELEPHONE NO. 7 CP� o��CP ����
� DESCRIPTION
ty 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WEfLANDS
y 03 ION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 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
v 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
c��, COMMENTS:
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� WORKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W O CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (952) 249-46��
Owner/Co r o s e:
Inspector.
White CopyMspector's Fi Canary CopylSite Notice
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DATE TIME
CITY OF ORONO CALLED IN �/
INSPECTION N TICE SCHEDULED _3 �.3/-D�-I� //:30
PERMIT N0. 72O Z— COMPLETED
ADDRESS 8 7� f�"�� �=�d��''1- ��
OWNER CONTR. ��C�C- �f.vn.e����.
TELEPHONE N0. 7�3 2��0 g g 70
� DESCRIPTION ��� ' � �-P
� Ot 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CAII INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIflED.CALLTO ARRANGE ACCESS.
Call for the next i pection 24 hours in advance. (g52) 249-46��
OwnedConUac r sit :
Inspector.
White Copylinspector's File Canary CopylSite Notice
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