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Home My WebLink About2000-P03376 - addn/remodel/repair PERMIT CITY;OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Po33�6 Crystal Bay, Minnesota 55323 P21'�711t Typ@: Addition/Remodel/Repair (612) 249-4600 Date Issued: �2i22i2o��-1 SITE ADDRESS: 2497 Kelly A�e EXCELSIOR,MN 55331 PID: 20->»-23-i2-oosl DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Census Code 434 Permit Class: Building Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution #: Separate permits required: riumoing Giecnicai �siaiej NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 209.25 Valuation: � 12,000.00 State Surcharge Fee: $ 6.00 TOTAL FEE: $ 215.25 APPLICANT: BENCHMARK CONTRACTING OWNER: A H EVANS& D EVANS 2331 DRIFTWOOD Ln 2497 KELLY AVE MOLJND, MN 55364 EXCELSIOR MN 55331 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. �� / . �� ,�I .�.+�,.,_ /�'7�_ L ANT PE 1 EE SIGNATURE SSUED BY SIGNATi.JRE ��- Copies: City,Applicant, Assessor, Finance Page 1 'I`otal Fee: $ -�/� `� 5 Date Received: /�- � � �C(` � Entered By: Permit#: f, ; -; -� �� !��/ici/c�� —�-�%j'� �l�' ��<-�•i�r/� CITY OF ORONO - BUILDING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) -------------------------------------------------------------------------------------------- _ THE A.PPLICANT IS: (circle one) OWNER OR CONTRACTOR ) �_.,^_..._ ___,� JOB SIT'E ADDRESS: �`��" �'�� -- i.�� . ZIP: SS�7 � C NAl�iE OF OWNER: �if�,G�i�� L��2=� PHONE: (home) ��-�7///70 . (work) MAILING ADDRESS: ;�� % � ,�`� CITY• %.�� ; ZIP' ;.» 3 ��` , CO\�'RACTOIL � 71 E, �,r �ct „rE� PHONE:. ��- �S-�y`,`' COr�TACT PERSON: �--°%�- � �� NIO� E/PAGER: � ;- -C� � M.4II..I�i 1G ADDRESS: � . �; / t7;:��'��:c�cac� ,�N CITY: J71z�,�vi� ZIP: �5� .,�� ST�TE LICENSE: # a v/ ��y� ARCHITECT/ENGINEER: �/i-F PHONE: NI_A.II,ING ADDRESS: CITY: Z�: �T e�1IE: REGISTRATION# TYPE OF WORK: New Addition Accessory Stntcture Move Remodel/Alteration� Land Alteration PROPOSED WORK(describe in detain: �f�y�-�o ��' o%/ ��,i� �� .lt ShL�� F�:/ " GL'17r � t- ��v - - - � !�E' STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTLIIATED CONSTRUCTION VALUATION (escluding land): $ /�� C%�%�= _ I hereby apply for a buildinJ 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 Buildin� Code; that I understand this is not a permit and work is not to start without a permit; and that the work wi1T be in accordance with the approved plan. A DATE: l�- � �C% APPLICANT'S SIGNATURE: �:�;��-,' � NOTE! Parade of Homes events require s parate'permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. 5 Sec.13.04 RIGHTS OF SIJBdECTS OF DATA r � 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 secdon. Subd.2. Information reqirired to be given individual. An individuai asked ro supply private or confidenaal data conceming,himself shall be informed of: (a)the purpose and in[ended use of the requested data wichin the collecdng state agency,polidca!subdivision,or statewide rystem;(b)whether he may refuse or is legally required ro suppty the requested data;(c)any lrnown consequeace arising from his supplying or refusing m supply privam or confidential dara;and(d)the idenriry of other persons or enades authorized by sare or federal law to receive die data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. 'Rie commissioner of revenue mav olace the notice reauired under this�ibdivision in the individual income raz or nroeertv tax refund instrucrions instead of on those forms. Subd.3. Access to data by individual. Upon request W a responsibie auchority,an individual shall be informed whether he is die svbject of stored data on individuals,and whether it is classified as public,private or co�dendal. Upon his further reques�an individual who is the subject of stored private or public data on individuals shall be shown the dara without any charge to him and,if he desires,shall be informed of the content and meaning of that data. Aher an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafcer unless a dispure or acaon pursuant to this secaon is pending or addirionat data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or pub(ic dara upon request by the individual subject of the data. The responsible auchority may require the requesring person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediacely,if possible,with any request made pursuant to this subdivision,or within five days of the dace of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy with the request within that ume,he shall so inform the individual,and may have an addidonal 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 compieteness of public or priva�e data conceming himself. To exeroise this right,an ic�ividual shaii notify in writing the responsible authoriry describing the nawre of the disagreemenG The responsible authoriry shall within 30 days either: (a)correct the daa found to be��a�M��te or incomplete and attempt to nodfy past recipients of inaccura[e or incomplete data,inctuding recipientc nacned by the individual;or(b)noafy the individual that he believes the daa to be correct. Data in dispute shall be disclosed only if the individual's sratement of disagreement is included with the disciosed dara. The deternunaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act reladng m 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 �ity 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 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(available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. �� '��- IQoc.� �o�'►n 5�.�- First Middle Last � � �% f/b i�r LcJ O GY'�/ �-.� Address �Io�� vh n� ss-�6 y ��.-��s— C��Y Srate Zip Phone I understand my rights ate above. � � Sig mre 6 � � � CHECK OFF LIST FOR ISSUANCE OF PERMITS - FOR OFFICE USE ONLY ADDRESS OR LEGAL: 2�f c1 r1 K C l,L.� /q'v�' PID: DESCRIPTION OF WORK: t4T-{ ��- ZO�TING REVIEW BY: �P � -- DATE APPROVED: � Z- r 4 -u a BUII�DING REVIEW BY: DATE APPROVED: � z{� -o� FEES TO BE CHARGED: Misc. Fees Calculated By: pERMIT Yes ✓ No pLAN REV�W Yes No ✓ SEWER CONNECTION STATE SURCHARGE Yes _� No WATERCONNECTION INVESTIGATION FEE Yes No ,� PARK FEE SAC Yes No v STTEINSPECTION Number of SAC Units OTHER (specify) ��________________ __---- -------------____ --- --------------- ZOti7�'G CHECK LIST Zoning Districc: �(/'o C K�1/� � Fire Department: Post Office: School Disuict: Lot Area: Sq.ft. Acres Widch Depth Survey Submitted: Yes No , Date of Survey: Proposed Setbacks: Front(Lake): Right Side: � Rear (Street): Left Side: Adjacent Structures: We d: Building Hei�ht: Def. Hgt. Pe Hgt. Lot Covera�e: Grading: Staff Approval Date: B Council Approval Date: Septic: Staff Approval Date: BY Zoning File: # Resolution: # Resolution Date: . . Shoreland District: Avg. Setback: Bluff Setback: Lot Coverage: Existing Proposed Hazdcover: 0-75' 75-250' ��; 250-500' . �, 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: RENIARKS (in house): 7 . � . BUILDING REVIEW CHECK LIST � � �C� IZ � 3 CONSTRUCTION TYPE: \(IV Sq Footage $Per Sq Ftg Basement x = lst F1oor x — 2nd Floor x = Garage x = R - TOTAL Fstimated Construction Value: $_ 1 Z, , O oo'� Inspections Required: Work Requiring Separate Permits: Site o�Plumbing Fire Hardcover Removal Mechanical Water Connection F��g Septic Sewer Connection _�C Framing Fireplace Lawn Irrigation Insulation (Masonry) Other +' �C Wall Boazd (Mfg.) Well(State Perm.it) �F� Grading/Filling oL Electrical(State Permit) Other REi�1ARKS(IN HOUSE): . -------------------__ ____ ________________--------------------------------------------------------- REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date By; REi1�IARKS (TO BE NOTED ON PERMI�: ---�-N-~----w-~- 8