HomeMy WebLinkAbout2003-P06874 - tenant finishes � PERMIT
CIT�' OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P06874
Crystal Bay, Minnesota 55323 P@fI711t Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: iii2v2oo3
SITE ADDRESS: 2765 Kelley Pkwy
I.ong Lake,MN 55356
P I D: 3 3-118-23-12-0002
DESCRIPTION: UBC Occupancy B
Construction Type VN
Proposed Use: Commercial-Business
Permit Class: Building Census Code 437
Pernut Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/Remodel/Repair
T�/1Qi�[� �'//I/S�'
DETAILS:
Approved per resolution#:
Separate permits required: riumoing iviecnanicai Eiecmcai(siaie�
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 2,152.95 Valuation: $ 307,000.00
Plan Review Fee: $ 1,410.43
State Surcharge Fee: $ 155.50
TOTAL FEE: $ 3,718.88
APPLICANT: McCarthy Construction(see notes) OWNER: City of Orono(Vacant Land)
11100 Bren Road West, Suite 200 P.O.Box 66
Minnetonka,MN 55343 Crystal Bay, MN 55323
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APP� ANT PERMITE�S`IGNATURE ISSUED BY S[GNATURE
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Copies: 1-File(Si2nitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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�Total Fee: $ ,37�8 . 8 S � ,�, 1 r�' Date Received: ��(� l..p����
Entered By: �j� r'�;�''� Permit#: �o �
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CITY OF ORONO - BUILDING PERNIIT APPLICATIOIeT
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR /����'��
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JOB SITE ADDRESS: .J 1 �' � l� � ��`� 0'�C G�ZIP: � l�/Y ��f�
NAME OF OWNER: �d � �� �` r PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �����' � �'�'� C�S � PHONE: �s Z ���l �� �
CONTACT PERSON: ,:j�r�.,i� MOBILE/PAGER (�f�. 3 � �f CO Ce O
MAILING ADDRESS: /(( o u 8��� /Z��{ �-t-��'f CITY: /� � �-� ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: �I„ ec� ��� C1 '� lS PHONE: (� �Z. �.��/ 2 Z- � 7
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New X Addition Accessory Structure
Move Remodel/Alteration Land Alteration
� / /
PROPOSED WORK(describe in detai�: ���-�� 1 n^ P►���`� 1�-�°� � 5 � °- � °l t-cs 1'S
c��c« w� l� �� �e,�.� bt� �� —
STORIES: ( SQ.FEET OF EACH FLOOR: S �-� �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �D 7,� �-' v
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conform ce with the ordinances and codes of the City and with
the State Building Code; that I understa this is not pe it d work is not to start wittrout a
permit; and that the work will be in c e ' ap ved plan.
� / � /
APPLICANT'S SIGNATURE: DATE: l � ` � ��
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SIJBdECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the daCa is stored or to be stored shall be as set forrh in this secdon.
Subd.2. Information req�rired to be given individual. An individuai asked to supply private or confidendal dara concerning himself shall
be informed of: (a)the purpose and intended use of the requesud data within the collecting 3rate agency,poliacal subdivision,or statewide sysum;
(b)w6ether he may refuse oY is legally required to supply the requested data;(c)any imown consequeace azising from his supplying or refusing to supply
private or confidendai data;and(d)the identiry of other persons or endties authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve data,punuant to secdon 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of tevenue mav piace the notice recluired under this subdivision in the individual income tax or nropem taz refund
instcuctions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of swred data on individuals,and whether it is class�ed as public,private or confidendal. Upon his further request,an individual who is the subject
of stored private or public data on individuals shall be shown the data wichout any charge w him and;if he desires, shall be informed of the content
and meaniag of d►at data. After an individual has been shown che privace dara and informed of its meaning,the data need not be disclosed to him for
six months thereafur unless a dispute o�acrion pursuant to [his secdon is pending or additionat 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 respansible authority
may require the requesting person m pay the acmal cosu of making,certifying,and compiling the copies.
The responsible au[horiry shall compiy immediately, if possible,with any request made pursuant to this subdivision,or within five days of
the dau of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with die request
within that time,he shall so inform the individual,and may have an addiaonal 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. M individua!may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing�he nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt W nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the dara w be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The decerminadon of the responsible authority may be appealed pursuant to the provisions of the administraave procedure act reladng 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 fumish 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 Ciry deny the permit or license.
3. The information may be shazed 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.
Fi�� Middle Last
Address •
Ciry State Zip Phone
I understand my rights as stated above.
Signamre
' BUII,DING REVIEW CHECB LIST
�C' j CONSTRUCTION TYpE: 1l� V N
_ Sq Footage $Per Sq Ftg
� Basement . x _
lst Floor x _
2nd floor x _
Garage x _
z _
70TAL
Estimated Construction Va1ue: $ '�p`��(�c9 c�°`'
Inspections Required: Work Requiring Separate Permits:
Site _,�Plumbing Fire
Hudcover Removal Mechanical
Footing ' --� Water Connection
. Septic Sewer Connection
— °�Fram�ng Fireplace Lawn Irri ation
Insulation g
�Wall Board ��0�'� Other
�F� � � �MfS•) Well(State Permit) .
Grading/Filiing _�Electrical(State Permit)
Other
REMARKS(IN HOUSE�:
REV�W BY OTHERS• --"�'"�-' -------�-___�w�__
DATE:
Access: Ezisting New .
Access Approval: Date
By:
REbZA,RI�S (TO BE NOTED ON PERivII'1�: __�-_�-------------- ----- -
8
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2-1�s k�1�.� nA�2kw,A�•� .
PID•
DFSCRIPTION OF WORK: -��vArv� r�N�s i�
ZO�T�1G REVIEW BY: DATE APPROVED: io �2�-v 3
BIJII�DLIIG REVIEW BY: DATE APPROVED: i b _2� -a�
FEES TO BE CHARGED: Misc. Fees Calculated By:
pERMI'f Yes .� No
PLAN REVIEW Yes � No SEVVER CONNECITON
STATE SURCHARGE Yes r/ No WATIItCONNECTTON
�GATION FEE - Yes No PARK FEE
SAC Yes No � SIT'EINSPECITON
Number of SAC�Units ,a, �„f �,-,., o��,,.,� OTHER (specify)
ZONI1'G CHE.CK LIST Zoning District: o c� � -.
Fire Department: Post Off . School District: �
Lot Area: Sq.R. Acres � Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side: �
Rear(Street): Left Side:
Adjacent Structures: W tland:
Buildiag Height: Def. Hgt. Peal. gt.
Lot Corera;e:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By
Zoning File: # Resolution: # Resolution Date:
Shorelaad District:
Avg. Setback: Bluff Setback: Lot Coverage:
E���g Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
(Se��) �/
DATE TIME
CITY OF ORONO CALLED IN �` 7
INSPECTION N TICE SCHEDULED " ��� " /D.' .�
PERMIT NO. COMPLETED
ADDRESS a 7�S 1 �
OWNER CONTR. '
�
TELEPHONE NO. ��Z 3�'9 �D�' / i
,
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� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI � 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAI 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 OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 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:
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� �ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WlLL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContrac��n�s�¢e:
Inspector � � U
White Copy/lnspector's F le Canary CopylSite Notfce
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N TIC SCHEDULED .3-I2� /�
PERMIT NO. D��� COMPLETED
ADDRESS oZ 7�os GLc-��c>�M
OWNER ONTR. �G GG�L�
TELEPHONE N0. �.�Z �P I� I
� DESCRIPTION
� �— i�1��2�rti� ��-e �� r
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER7FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 OEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAI 15 SEPTIC INSTALL 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑PROJECTCOMPLETE
W �CORRECT WORK 8 PROCEED ❑ISSUE ERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR RE�NSPECTION �TEM PORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe nex inspection 24 hours in advance. (g52) 249-4600
OwnerlCon�on i e:
Inspector. �
White Copyllnspector's File Canary Copy/Site Notice