HomeMy WebLinkAbout2006-P10255 - addn/remodel/repair M PERMIT
CITY OF ORONO Permit ►vumber:
Z750 Kelley Parkway- PO Box 66 P10255
Crystal Bay, Minnesota 55323 Perr7lit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 9/20/2006
SITE ADDRESS: 2765 Kelley Pkwy Unit#
Long Lake,MN 55356
PID: 33-118-23-12-0002
DESCRIPTION: UBC Occupancy B
Proposed Use: Commercial-Business Census Code 437
Permit Class: Building
Permit T e: Addirion/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
YP
DETAILS:
Approved perresolution#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 923J5 Valuation: $ 90,000.00
Plan Review Fee: $ 600.44
State Surcharge Fee: $ 45.00
TOTAL FEE: $ 1,569.19
APPLICANT: David Wayne Const. Inc. OWNER: Skin Care Doctors
7363 Washington Ave. S 2765 Kelley Pkwy
Edina,MN 55439 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.
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APPLICANT PERMITEE SI NATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
• � �
Total Fee: $ �.`���/, / �� Date Received: `;,2 (1 �%�
Entered By: PermiY#: /) � �
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CITY OF ORONO - BUILDING PERMIT APPLICATION
��� All information must be submitted in full before plan review will be started.
�`t�,
(please print all inforination)
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THE APPLICANT IS: (circle one) OWNER ORct�ulvTRACTO
JOB SITE ADDRESS: �271v7 � P(�'I[_i,�,►c.�.i� ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ 1'es � NO Ifyes, a special event permit is reguired with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonst�-ates
sufficient on-site parking is available. Non-pernaitted events will not be allowed
NAME OF OWNER:�Ki►7 C�� �.�.t��.(,�,5� PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: '�t� W . � �� (,t�'L±�� �C...- PHONE: �SZ ��'y`��Z-�� y
CONTACTPERSON: �1:' tM�� MOBILE/PAGER: 95Z� LfZ- C�7� (
MAILING ADDRESS: �73k�� Ufc:� ncr-���-; :�... S CITY: �-�i����. ZIP: ��f3`j
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: ��tc>�,�i'V►6�+'s E_ /�',�C>c� PHONE: `1�;Z���`f� '��`fOl
MAILINGADDRESS: �,3�,'��ll <<(y� Qri �'Z CITY: 1'h����1��-tti��k.� ZIP: ��3c_s
NAME: ���,�y�� (�,,�.�,�rrrc�� REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Reinodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits !
PROTPOSED WORIK(describe in detain: � �v� � C F �5� irY1F�/iC�' �(-�'�.�. .
1�7t�. c� Cati� 7- :2'� a� �J'�<<�i � ._ rc �� �'� at� vt� � �i'Ie�TWOc�cl��
STORIES: � SQ.FEET OF EACH FLOOR: `7LC=� f
NO. OF BEDROOMS: �— GARAGE STALLS: ATTACHED -- DETACHED ----.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �C; C�;(; , G(1
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 tlus 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 SIGNATU DATE: �'� �fv
31 �
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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 supply private or confidential data concerning himselfshall 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 ro 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 shal I
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 ma�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 of the 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 authority shal)provide copies of the private or publ ic data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority 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 additionai 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. An individua(may contest the accuracy or wmpleteness of public or private data
conceming himself. To exercise this right,an individual shall notify in writing the responsibie authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)coaect the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate 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.
T'he 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
publia
5. You have certain rights under M.S. 13.04(availabie upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Sigoature
: , ,� �s, 32
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.
C'�IECK OFF i,IST FOR ISSUANCE O�' PERi.'VIITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 2-1(.� ICe` PA �cw A
PID:
DESCRIPTION OF WORK: i�NN�-� Frn�«�.► ,�A�o�n c,.� o�- c.rx is 1�rr s�Rc�
ZO�TG REVIE`V BY: ---N 1 r DAT'E APPROVED:
BUILDING RE'VIEtiV BY: D A T E APPROVED: �-3�-o �
F`EES TO BE CHARGED: Misc. Fees Caiculated By:
p�g�T Yes ✓� No
PLAN REVIEtiV � Yes ,/ No SEtiVER CO�INECTION
STATE SURCHARGE Yes _/ No tiVATERCONNECTION
INVESTIGATION FEE Yes No PE1RK FEE
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (sgecify)
ZONI�tG CH�CK LIST Zoning Discricc: /�ro G�-�/'r� �.
Fire Deparcment: Post Office• School District: �
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes o Date of Survey:
Proposed Setbacks:
Froat (Lake): Ri�t Si :
Rear (Street): Left Side:
Adjaceot Structures: W tland:
Buildin� Height: Def. Hgt. P �Hg�•
Lot Covera?e:
Gradino: Staff Approval Date: By: Council Approval Da[e: '
Sep�ic: Staff Approval Date: �Y�
Zoaing File: (# Resolutioa: n Resolution Date:
Shoreland District:
Avj. Setback: Bluff Setba : L.o[Coverage:
E�isting Proposed
Hardcover: 0-75'
75-25Q'
2�0-500'
f 5Qa-1000'
� )
�� � �
Hardco��er Va.riance Required: Yes No Da�e oE Council ApProvz!:
RE! L4R'S (in house): P£.��T s 2 O � = "� C�'''��
It,s T' � �u � � � � p I o i o z 'r'
� � .-� .O .
r
BLT�DING REVIEtiV CI�iECK LIST
�C� � � CONSTRUCTTON TYPE: �((3
Sq Footage $ Per Sq Ftg
Basement X _
lst Floor x _ �
2nd F7oor x _ �
Garage z �
z =
TOTAL
9�0 00�
Estunated Co�struction'�aIue: $_
Inspections Required: `Vork Requiring Separate Permits:
Site _�Plumbing Fire
Hardcover Removal ,�' Mechanzcal Water Coaaectioa
Footing ` Septic Sewer Connectio❑ �
� � Framing Fireplace Lawn Irrigation
_�Insuiation (Masonry) Other
Wall Boazd
�/ . (Mfg.) Well (State Permit)
_�F�� Grading/Fillin� 9C Electrical (State Permit)
O ther
REMARKS (IN�IOUSE): " -- --
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REVIE'4V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date �y:
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REMARKS (T�SE NOTED ON PERll�fI1�:
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CITY OF ORONO �/�j��qCALLED IN �
INSPECTION NOTICE �SCHEDULED — �� '�
PERMIT NO. ����S.S_ COMPLETED �
ADDRESS �.� l�c,�-
OWNER CONTR. -�
TELEPHONE NO. 9 0 -7 0
� DESCRIPTION � �-�--�CJ,� G�Q V��j
� 01 FOOTING 11 MECHANICALRI 18 EXCAV/GRADING/FILLINGIP��,�
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
05 FI AL 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED �ROJECT COMPLETE
W ❑CORRECT WORK 8�PROCEED r SUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETt}RN
❑STOP ORDER POSTED.CALL INSPECTOR '�CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �952� 249-46QQ
Owner/Contractor�n sitQ:
Inspector. �J 1_)
White Copyllnspector's File Canary CopylSite Notice
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►/" p` I ���� /O DAT� v� TIME
T CITY OF ORONO CALLED IN a�
INSPECTION N /�CE SCHEDULED �� �
PERMIT NO. / � S COMPLETED ��— / '�� '� �
ADDRESS �s � !�/
OWNER CONTR. �a�,
TELEPHONE N0. %�o� a 9� ��9-�
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q �RAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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 FOILOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 WARO COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
c�., COMMENTS:
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WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑ ORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call tor the next inspection 2a hours in advance. (g52) 249-4600
Owner/Contractor on site:
Inspector. C�o j
White Copy/lnspector's File Canary CopylSite Notice