HomeMy WebLinkAbout2004-P07242 - addn/rremodel/repair 4
� PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�242
Crystal Bay, Minnesota 55323 Permit Type: Aaa�t�o�Remoaevxepa�r
(952) 249-4600 Date Issued: 3iioi2oo4
SITE ADDRESS: 3155 Jamestown Rd
I,ong L,ake,MN 55356
PID: 28-118-23-33-0012
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Buildin Census Code 434
Permit Class: g
Perniit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate pemuts required: riumoing
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 492.25 Valuation: $ 35,000.00
Plan Review Fee: $ 319.98
State Surcharge Fee: $ 18.00
TOTAL FEE: $ 830.23
APPLICANT: Master Care Home Repair Service OWNER: Ian Gatehouse
14975 Highland Trail 3155 Jamestown Rd
Minnetonka,MN 55345 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.
;,,/ ,.% . ,.
� ` ` � � � � `-�/�%'( v `�✓ L�-
AP ICANT PERMITEE SIGNATURE / ISSUED BY SIGNATURE
Cooies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
G� �-/�/a�
Total Fee: $ �3D,2 3 Date Received: Z-19-D�
Entered By: �� -' _ Permit #: �-� 72�2
�,
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please prinf all information)
THE APPLICANT IS: (circ%one) OVVNER OR CONTRACTOR
,,
JOB SITE ADDRESS: :; j t�`� �j.�-,�,��yt��...:• �., (—> ZIP: _5 �_� _�>S �
NAME OF OWNER: =.L��.i �=>�-i� ln�.�s�>� PHONE: (home) �I:�=? - ��ti-��? 1
(work)
MAILING ADDRESS: �'���; �1 R +�nE�i->> ��� �� CITY: Lc,r.,;��_:,�.� ZIP: ���� �,
CONTRACTOR: �'lrr�� �-.� � PHONE: �>> -��� - a y��a_
CONTACT PERSON: �F�� r1 �-_aa= � MOBILE/PAGER: �;��- �� ; - ti-, �,�
MAILING ADDRESS: �a-��a i-},!hi .,�:�i;_,�, ,_.... CITY: (�; .�.,�;- ,--,.�r .,ZIP: �ti�►
STATE LICENSE: # =���`�
ARCHITECT/ENGINEER: � PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New �ddition Accessory Structure
-----------
Move RemodeVAlteration_� Land Alteration
PROPOSED WORK (descrrbe in detai�: ���:f r,+�-�,E-,„„ �e r,.,r, �,�� ;,_
STORIES: ;. SQ. FEET OF EACH FLOOR:
N0. OF BEDROOMS: �_ GARr1GE STALLS: ATT. DET. �
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 3 r�, c�>c��
I hereby apply for a building permit and I acl:nowledge that the information above is complete and
accurate; that the work will be in conformance ���ith 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�vill be in accordance with the approved plan.
�1
APPLICANT'S SIGNATURE: � -�,,� �--�� DATE: �� � `� /� `I
NOTE.� Parade of Homes events require separate permit approval byPolrce Departmenf and City
Counci/60 days prior to the event. No�permilted events will nof be allocied.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. 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 supph private or confidential data concerning himself shall be
intormed 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 legall}• 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 identin•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 imestigati�e data,pursuant to section I 3.82,subd'nision 5,to a law enforcement officer.
The commissioner of re�enue ma�� place the notice reauired under this subdi�ision in the individual income tax or propertv ta�c refund
instructions instead of on those forms.
Subd. 3. Access to data by indi�idual. l�pon request to a responsible authorih�, an individual shall be informed whether he is the subject
of stored data on individuals, and ���hether it is classi(ied as public, pri�ate or confidential. l:pon his iurther request, an individual who is the subject of
stored private or public data on individuals shall be show� the data without any charge to him and, if he desires, shall be in(ormed of the content and
meaning of that data. After an indi�idual has txen shou� 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 authority shall provide copies of the private or public data upon request by the indnidual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of mal;ing,certifying,and compiling the copies.
The responsible authority shall comph� immediately, if possible, with any request made pursuant to this subdivision, or within five days of the
date of the request, excluding Saturdays, Sunda�s and leDal holidays, if immediate compliance �s not possible. If he cannot comply with the request within
that time, he shall so in(orm the individual, and may ha��e an additional fi�e 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 ma}- contest the accuracy or completeness of public or private
data concerning himself. To exercise this right, an ind"nidual shall notih• in writing the respon��ble 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 recipients of
inaccurate or incomplete data, including recipients named b�� the indi�•idual; or (b) notify the indnidual 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 discla�d data.
The determination o( the responsible authorin� may be appealed pursuant to the pro�isions of the administrative procedure act relating to
contested cases.
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", �re �vould like to inform you that your request
for a permit or license from the Cit}• of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
l. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to suppl}�data, but refusal may require that the Ciri•deny the permit or license.
3. The information may be shared �;ith other local, state or federal agencies to the extent necessary to process
the permit or license.
4. [f your requested permit or license requires Council action to approve, some information may become public.
5. You have certain rights under n1.S. 13.04 (a��ailable upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
�rv t l�' •�•n �-�K—t=CrZ c=---i �>Sc:,
First 1 h dle Last
�til�1.� 1�—i���n 1 ���-r 3� '�1 r����.�.
Address
1�I,J:J��v..v 1�`\ � �. ���� ��y� L"_�� � 1 '- IZL.�� (��
City State Zip Phone
[ understand my rights as stated above.
__'��_ � `�---�
Signature --
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRES� OR LECiAL: s s = w A�o
PID:
DESCRI ION OF WORK: � C2e,o� Z�,�n,�.A�c:Z
------------+----------------------------------------------------------------------------------- --------
ZONING REVIEW BY: I i9 DATE APPROVED: .
BUILDING REVIEW BY: �— DATE APPROVED: 2-� -�y
------------+---------------------- --------------------------------------------------------- ------
FEES TO'BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REWIEW Yes r/� No SEWER CONNECTION
STATE Si�RCHARCTE Yes � No WATER CONNECTION
INVESTIC�ATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
------------»------------------------------------------------------------------------------------ -----
ZONING GHECK LIST Zoning District: ivc� Ch�s4-rvqQ
a- i
Fire Department: Post Office: School District:
Lot Area: 5q.ft. Acres Width Dept
Survey Subm�tted: Yes No Date of Survey:
Proposed Setbacks: I
Fro�t(Lake): Right Side: �
Rea�(Street): Left Side:
Adj�cent Structures: Wetland:
Building Height: Def. Hgt. Peak H .
Lot Coverags:
Grading: St�ff Approval Date: y: Council Approval Da e:
Septic: Staff Iqpproval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg;Setback: Blu Setback: L o t C o c e r a g e :
Existing Proposed
Har�lcover: 0-75'
�'i 75-250'
' 250-500'
500-1000'
Har cover Variance Required: Yes No Date of Council Approval:
REMARK� (in house):
BUILDING REVIEW CHECK LIST
UBC: f2- 3 CONSTRUCTION TYPE: �(N
Sq Footage $Per Sq Ftg ,
Basement x =
1 st Floor x =
2nd Floor x —
Garage x =
x =
TOTAL
Estimated Construction Value: $ 3S o 00 �`—'
�
Inspections Required: Work Requiring Separate Permits
Site �_Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Se��er Connection
�_Framing Fireplace Lawn Irrigation
�Insulation (Viasonry) Other
Wall Board (Mfg.) Well (State Permit)
_,�Final Grading/Fillina Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
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tL FOOTING �/ 11 MECHANICAL RI 18 EXCAV GRADING/FILLINCa
� ING�t� 13 MECHANICAL FINAL 19 LAKES ORE/WETLANDS
I ULATION � 24/25 WOOD BURNER/FIREPLACE 34 TREE R MOVAL
Z WALL BD. 12 WATER HOOK-UP 17 SITE IN PECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGR SS
� 07 DEMO-SITE 27 SEPTIC MAINL 21 COMP INT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLO -UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD C VER REMOVAL
� 10 PLUMBING FINAL 36 FOUND TIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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