HomeMy WebLinkAbout2005-P08876 - attached deck PERMIT
CITY �F ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P08876
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
7/5/2005
SITE ADDRESS: 3720 Jacobs Mill Rd Uuit#
Long Lake,MN 55356
P��� 32-118-23-24-0008
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Pario 13x16 concrete with deck footing for l 1x14 deck above patio
FEE SUMMARY: Permit Fee: $ 69.25 Valuation: $ 2,000.00
Plan Review Fee: $ 45.01
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 115.26
APPLICANT: Owner/Self OWNER: Gregory&Wendy Carlson
MN 521 Willow Dr.N.#203
Long Lake,MN 55356
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.
, � �%�
APPLI T PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ Date Received: = (p-v�o7��
Entered By: � �-yr�= , Permit#: p 7�O
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pf•i�it all inforniation)
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THE APPLICANT IS: (circle one) OWl\TEI�R CONTRACTOR
�_...
JOB SITE ADDRESS: 3701-� ,-�a��s ��d�( /�� - z�: S���w
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �NO If yes, a special event permit is r•equired with Police Department and City Council approval
60 days prior to ihe event. Shuttle bzrs service will be required unless applicanl demoi�strates
sz ff caent ai-site par�ing is available. Non permitted events will not be allowed.
/`+ �` (c��tO �7�3�5F3�-�?s�
NAME OF OWNER: (�Z I�Q �.{z f/`�SE'�� PHONE: (honle) RJ`�o�`T7 oZ9/g
� (work)_�S l-3%7-?�o�
MAITL,ING ADDRESS: �j7c��' c�G���S d���� f� CITY: (�jv�iL�b ZI]P: �53��0
� ��r�-PHONE��`�„2�G, �' 7D7
CONTRACTOR: `'�v+i�} � A��� I�'o � � � �l
CONTACT PERSON: Lc�nv� !2 MOBILE/PAGER: �,��-�z��-O��
MAILING ADDRESS: ,g-o c `� CITY: L'%�cL�f o ZLP; '_>'�;;;Z�
STATE LICENSE: #���} .o. 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�: �j,�-�o ��3'�/(o� � ��a1�t�CyP%� r.,����1
.
c e�.��-�,�� -J-icui �c-v I ( u l�' C��f'��� a/����t- ,Oi;�.-�t% ,
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land}: $ o'�E��'C�
I hereby apply for a building pernut 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: rO ',��D5r
31
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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.
5ubd.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 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 daca;and(d)the identity of other persons or entities authorized by state or federai law to receive the data.This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.32,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav nlace the notice required under this subdivision in the individual income taY o�ro�ertv tax refund
instn.tetions instead of on those forms.
Subd.3. Access to data by individuaL Upon request to a responsi6le authority,an individuzl shall be informed n�hether 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. After an individual has been shown the privafe 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 collec[ed or created. The
responsible authority shall provide copies of the pnvate or public data upon request by the individual subject of the data. The responsible authonty
may require the requesting person to pay[he actual costs of making,certifying,and compiling the copies.
The responsiole au[hority shall comply immediately,if possible,with any request made pursuant to[his subdivision,onvithin five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply wi[h the request
within that time,he shall so inform the individual,and may have an additional five days wi[hin which to compty with the request,exctuding Sacucdays,
Sundays and legal holidays.
Subd.4. Procedure�vhen data is noc accurate or complete. An individual may contest che accuracy or completeness of public or piivate data
conceming himsel£To exercise this right,an individual shall no:ify in wiiting the respon;ible authonty describing the nature of the disagreement. The
responsible authoriry shall within 30 days eithec (a)con�ect the data found to be inaccurate or incomple[e and attempt to notify past recipients of
inaccuratc or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data ie
dispute shall be disclosed onfy if the indiv;dual's statement of disagreement is included with the disclosed data.
The determination of[he responsible authority may be appealed pursuant to the provisions of the administrative procedure act rela[ing to
contested cases.
DATA PRIVACY'ADVISORY
In accordance with M.S. 13.04,5ubd.2,"Rights of subj ects 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 deternune your qualification for the pem�i; or license
requested.
2. You may refuse to supply data,but refusal may require that the City deny the permit or Iicense.
3. The information may be shared with other local, state or federal agencies to the extent necessary to
process the pernlit or license.
4. If your requested permit o:license requires Council action to approve, some infomiation may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to revie`v private data on yourself.
6. Your full name is required to process this application or p�nnit.
�' �o��—l�il�,� ��� �1.���
First Middle Last
3�a-�� �1�c�l�s G1it�-Cl ���.
Address
c����u z 1�L1,� ,��3��r� ��a- �7��l�i
C�ty State Zip Phone
I understand my rights as stated above.
Signature
32
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFTCE USE ONLY
ADDRESS OR LEGAL: 3�2 0 -�r�c,o6s Wt,��
PID:
DESCRIPTION OF WORK: ip rc.��
ZO.�tPli G RE'VIEW BY: � ' DATE APPROVED: �•z g -o S
BUII.DING REVIEW BY. DATE APPROVED: b•t ts-o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓� No
PLAN REVIEW � Yes �' No SEWER CO�iNECTION
STATE SURCHARGE Yes � No WATER CONNEC"TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�TING CHE.CK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes gc_ No Date of Survey: o,.r �=�� �
Proposed Setbacks:
Front(Lake): ��3 t Right Side: 1`t3� �
Rear (Street): y?,o` '� Left Side: l b�� t
Ad;acent Structures: �-��t.�--7 Wetland: N ir9
Buildin� Height: Def. Hgt. — Peak Hgt. '�
Lot Coverage: —
Grading: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: "— By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: �J J
Avg. Setback: Bluff Setback: I.ot Coverage:
E�isting Proposed
Hazdcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RE�iA.RKS (in house):
�
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BUILDING REYIEtiV CHECK LIST
�C� - �'� CONSTRUCTION TYPE: �A�
Sq Footage $Per Sq Ftg
Basement x _ .
1st Floor x _
2nd floor x _
Garage x =
z -
TOTAL
Estimated Construction Value: $ Z�pa� ��
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
K Footing ' Septic Sewer Connection
�C Framing Fireplace Lawn Irrigation
-�lstion (Masonry) Other
Wall Boazd (Mfg.) WeU (State Permit)
/� F�� Grading/Filling Electrical (State Permit)
Other
RENIARKS(1N HOUSE): .
------- ---- -------------------------------------
REV�W BY OTHERS: DATE:
;
Access: Ezisting New
Access Approval: Date gy;
------------------------------------
RE�IARKS (TO BE NOTED ON PERiI�IIT�:
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i�c"{�THIS�'I�fd S�T ON �fi�h,T,�LL�l�
GvDAT� TIME
CITY OF ORONO c� �
INSPECTION N IC SCHEDULED - �
PERMIT NO. � COMPLETED
ADDRESS 37� v��� ��� �
OWNER C�� _CONTR.
TELEPHONE NO._ 9'S2 T 73 a 9/9
� DESCRIPTION ��� /�
ly TING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� FRAMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
y
Q 03 INSU f 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 06 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
Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
c�., COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� CORRECT WORK E�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL{NSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-46�0
OwnerlC r n site:
Inspector. -
White Copyllnspector's File Canary CopylSite Notice
CE
RTIFICATE �� ��J��E� FOR �
LOT 2 �LOCK 19 J�CO�� MiLL �
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Lot 2, Blnck 1 , JACOBS MILL �
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