The URL can be used to link to this page

Home My WebLink About2006-P10576 - addn/remodel/repair . � PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P1o576 Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair (952) 249-4600 Date Issued: 12/1/2006 SITE ADDRESS: 2765 Kelley Pkwy [Tnit# Long Lake,MN 55356 P�� 33-118-23-12-0002 DESCRIPTION: • Construction Type VN Proposed Use: Commercial-Business � ' �i� Census Code 32� .� Permit Class: Building Permit Type: Addirion/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: Scparatc permits required: Plumbing Mechanical Electrical(state) NOTICES/REMARKS: Interior Build Out for MN Maxillofacial&Oral Drs. FEE SUMMARY: Permit Fee: $ 1,273.75 Valuation: $ 150,000.00 Plan Review Fee: $ 827.94 State Surcharge Fee: $ 75.00 TOTAL FEE: $ 2,176.69 APPLICANT: Scott Builders,Inc. OWNER: Skin Care Doctars 12 E.Division St 2765 Kelley Pkwy Buffalo,MN 55313 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. // r� - �. ' \ ' ;/ -, � __ - l:- � ,' .,�. ,/�'j , _ �, < � _) AP ICANT P�R ITEE SIGNAI'URE •SSUED[3Y S[GNATURE C�� Copies: I-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, I-Assessing,(If Septic, I-Septic) Page l h i./�� U�"� ��l�` ��.. � �� ^{ DateReceived: ��-1�'��i� Total Fee: $ ��, � r!k, • i, r Entered By: ;'�, '��. Permit#: f� /��'6 CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ----------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER O CONTRAC OT R� ` � JOB SITE ADDRESS: 2�65 Kelley Pkwy, Orono, MN ZIp. 55356 (Orono Professional Center) Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes ❑X NO If yes, a special enent permit is r�equired with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus sernice N�ill be required unless applicant demonstrates sufficient on-site parking is anailable. Non-permitted events will not be allowed. NAME OF OWNER: � �illofacial and Oral PHONE: (home) Dr. Abdollah Rahimi (work) MAILING ADDRESS: CITY: ZIP: CONTRACTOR: Scott Builders, Inc. PHONE: 763-684-0000 CONTACT PERSON: Dave Larson MOBILE/PAGER: 612-804-1041 MAILING ADDRESS: 12 E_ Di vi�i on St_ CITY: Ruffalo ZIl': 55313 STATE LICENSE: # N�p EXPIRATION DATE: N�p, ARCHITECT/ENGINEER: Paul Meyer Architects pHONE: 763-557-9081 MAILING ADDRESS: 15650 36th Ave. N #170 CITY: plvmouth ZIP: 55446 NAME: pa>>� MPTeT- REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home emo Alteration (ie: Siding, Windows) PROPOSED WO�tK(describe in detai�: �� Y� `� �� •�cJ7� p� �e�Sc �� c r STORIES: SQ.FEET OF EACH FLOOR: �! 1 Z S 59'L�P �� NO. OF BEDROOMS: N A GARAGE STALLS: ATTACHED DETACHED_ ESTIMATED CONSTRUCTION VALUATION(excluding land):- f-S'd� �b 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 1 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 pla ,l � APPLICANT'S SIGNATURE: � - - —DATE: �� /� b 31 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 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 wnfidential data;and(d)the identity 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 investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the notice required under this subdivision in the individual income ta�c orpropertv tax refund instructions instead of on those forms. Subd.3.Access to data by individual. Upon request to a responsible suthority,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 dats on individuals shall be shown the data without any chazge 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 authoriry shall provide copies of the private or public 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 additional 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 individual may contest the accuracy or completeness ofpublic or private data conceming himsel£To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature ofthe 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 inc�uded with the disclosed data. The 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 public. 5. You have certain rights under M.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. First Middle Last Address Cit� State Zip Phone I nders and my r' s as te above. � �� " Signat re c ��',' y 'ma s ��a�9�t �d� � �� 32 ,�.. , I ' • • . �I3EC� OFF i�IST FOR ISSU.ANCE DiF' i'ER►.1�ITS FOR OFFICE USE ONL�'� � ' . A,DDRESSORLEGAL: 2��5 1<e11,e 1�w PID: DES CRSPTIO�T OF'vV'OR.F�: ��N� . - ______.._---- ------ -------�_--__----------------- ZOY .S�i IG RE'V'IE�V BY: N AA.TE APPl30VED: . � . . DA.TE APFROVED; i r • 2� o'c� gtTII.,DING RE�LE�V l3Y__ __--_ ---�-----------------------=------------------------------ k'EES TO BE CHA.RGEA: Misc. Fezs Calculated By: - �E�T Yes �/ No PLAN REVIEtiV ' � Yes � No SE��IER CO�INECTION STATE SURCHARGE Yes �/ No WATERCONNECTTOi�T„ _ INVESTIGATION FEE Yes No � P�K FEE SAC Yes No � SITEINSPECTION Number of SAC�Units OTHER (specify) �ONit�TG CTI�CK LIST zaning Discrict: _N�� G__�'�C�Q . U ' Post OfFice: School District: • ' Fire Degartment: � Lot Area: Sq.ft. Acres ' Width Depch Survey Submitted:� Yes No Date oE Survey: Proposed Setbacks: • : Froac(Lake): Ri�t Side: , Rear(Strezt): Loft Side: Adjacent Structures: etLand: Suil�lin�Hei�p.t: Def. Hgt, Peal:Hgt. Lot Coveraae: Grading: StaEf Approval Date: gy�; Cauncil App:cval Date: _ ' � Sep�ic: Staff Appro'/al Date: �Y� Zoaing File. � Resolutioe: � Resolution Date: Shorelznd Discrict: _ I.,ot Covera;e: Av�. Setback: Bluff Secback: E�.istina Proposed Hz�dcover: 0-75' _ - 75-25Q' 2�0-500' 500-1 G'C�' Zar�COt�: �;'c:i2IlC� G�.^�L:ti��: ;25 ,r`� D3:_ n�C'OlL7CL APFrOVZ: RE�L�g�;S (inhouse): • • . , $UILI�ING REVIEti� CT�ECK LIST �C� � � CONSTRUC'TION'TYPE: �� {3 . Sq Footage $Per Sq Ftg ' Basement • . . ,. x _ . . lst Fioor � x • . . . � ' 2nd floor x _ • �� , Garaoe x — . z = TOTAL Fstimated Construction VaIue: $_ � SO�pOO Insgections Requirec�: Work Requiring Separate Permits: Site _�Plumbing Fire � Hardcover Removal �_Mechanical Water Coaaectio❑ Footing ' Septic Sewer Cannection �• � Fr�a • Fireplace Lawn Irrigation �' Insulatioa (Masoary) Other Wall Boazd —�- . (�'jf8•) Wetl (State Perm.it) —�F�� Grading/Filling _�Electrical (State Permit) Other REMARKS (IN HOUSE): . -. - .� - ------------------------------------------------------------------------------------ REVIE'4V BY OTHERS: DAT'E: Access: Ezistiag New . Access Approval: Date gy; ' ------------------------------------------------------------------------------------------ REI�TARh'S (TQ SE NQ'I'ED Qv PERi1�Il'i'): 8 tJ � � DA E TIME ✓ CITY OF ORONO CALLED IN �'i � q •C�G INSPECTION, OTICE / SCHEDULED � � .'3�� PERMIT NO. ��7 b COMPLETED ADDRESS � � � K� �I-� a�r�(/U� OWNER CONTR.-�� TELEPHONE NO. �(a — �� "�� " �'��'''��l � DESCRIPTION � �� 01 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 � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z 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 J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � o • �v,�,,.(3,[T b L"e�S T� �n'9f"� � �b:lPf ° AK1 i-.-�,s �. �A� ��.�., 13 r�,� �� W Q —� �k1��' �'c�� -�1vv�S � � �C o -�-� �v� �� TO � �S�.� � Re�s �dn�' i3, ( � +y r -,,�.,'� � . j d W ❑WORKSATISFACTORY:PROCEED C� PROJECTCOMPLETE � CORRECT WORK 8 PROCEED �SSUE CERTIFICATE OF OCCUPANCY W � ❑ ORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING �_pERMANENT �—I�-LS 7 ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ OwnerlContractor on site: Inspector. W n S White Copyllnspector's File Canary CopylSite Notice � '^��`^i �� A E TI M E ✓ CITY OF ORONO p/o 576 CALLED IN � INSPECTION N SCHEDULED �y��7 � PERMIT NO. COMPLETED ADDRESS F� OWNER a�b� CONTR. L TELEPHONE N0. l 3� � �'" � DESCRIPTION ��m/✓Ir l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAM�NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � O 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 = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: - oc � ., � L1/1 c . W1 �� l ( ✓1 � � 0 � � 0 � W a Q � Z w � W � � d W ❑/W''ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � �CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTIOfV REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� Z49-4600 OwnerlContractor site: Inspector. White Copyllnspector's File Canary CopylSite Notice