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Home My WebLink About2004-P07728 - addn/remodel/repair " � - PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 Po��2a Crystal Bay, Minnesota 55323 P@PlTllt Typ@: Addirion/RemodeURepair (952) 249-4600 Date Issued: �i2oi2ooa SITE ADDRESS: 2515 Kelly Ave Excelsiar,MN55331 P I D: 20-117-23-12-003 8 DESCRIPTION: Proposed Use: Residential Pernut Class: Building Census Code 214 Permit Sub-type(s): Addn/RemodeURepair Permit Type: Addirion/RemodeURepair DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 97.25 Valuation• $ 4,000.00 State Surcharge Fee: $ 2.50 TOTAL FEE: $ 99.75 APPLICANT: David Heinsch OWNER: David Hardten 5780 North Arm Dr. 2515 Kelly Ave Mound,MN 55364 Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �j D /// —�{/,�Y%v " APPLICANT PERMITEE SIGNATURE ISSUED BY S GNATURE Cot�ies: 1-File(SiQnitures Required), 1-Avnlicant 1-Monthlv Reuorts, 1-Assessine, 1-Finance Page 1 w Total Fee: $ � 7� Date Received: �'7-ZU-�`� Entered By: Permit#: "772�P' 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 OR CONTRACTOR JOB SITE ADDRESS: o�s � S ,- "`��I �� ZIP: Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: ��A-t� t`�fl�CX 1� C/�Q�S�� PHONE• (home) � (work) MAILING ADDRESS:��S ��j�� t/� CITY: �2P�dlD ZIP: CONTRACTOR: � /�� PHONE: CP�2- �F�a 7�/C� CONTACT PERSON: MOBILE/PAGER: Co('z-�(�c��?�d MAILING ADDRESS: ,57d�(� �lcd.�7'1�''A�.rn/1. �.CITY: ��1,`,9 ZIP: �;s� STATE LICENSE: # ARCHITECT/ENGINEER: - PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure � Addition Move RemodeUAlteration Land Alteration PROPOSED WORK(describe in detai�: �if/r'�c�� t�i� ��"" �"'� �r�.q-��c3s� STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION(ezcluding land): $ ��Oo�o O I hereby apply for a building perxnit and I acknowledge that the information above is complete and accurate;that the work will be in conforniance with the ordinances and codes of the City and with the State Building Code; that I understand this is not a pernut and work is not to start without a pernut;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: � DATE: � ��QJ � � 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 shali be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or cont7dential data concerntng himself shall be inCormed 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 confidential data;and(d)the identity of other persons or entities suthorized by state or federal law to receive the data. This requirement shatl not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivisibn 5,to a law eniorcement officer. The commissioner of revenue mav olace the notice reauired under this subdivision in the individual inrnme tax or pronertv 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 ciassiFed 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 dats. 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 rnllected or created. The responsible authority 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 oi making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,w7th any request made pursuant to this subdivision,or within five days of the date otthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot compty with the requestwithin that time,Ae shali so inform the individual,and may have an additional five days within which to comply with the request,ezctuding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is rtot accurate or complete. An individual may contest the accuracy or compieteness of public or private data concerning himself. To exerctse this right,an individual shall notify in writing the responsible suthority 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 paat recipients of inaccurate or Inrnmplete data,inciud(ng rec(pients named by the lndlvidual;or(b)noHfy the indivldual that he beUeves the data to be rnrrect. Data in dispute shall be disciosed only if the Indlvldual's statement of disagrecment is included with the disclosed data. The determination of the responstble suthority may be appealed pursuant to the provisions of the adm(nistrstive procedure sM 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 furaish 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(available upon request)to review private data on yourself. 6. Your full name is required to process this apptication or permit. First Middle Last Address City State Zip Phone I unders n my rights as stated above. Sig BUILDING REVIEW CHECK LIST �C� �' � � CONSTRUCTION TYPE: �'^� _ Sq Footage $Per Sq Fta Basement . . . x _ lst F1oor x � _ 2nd floor x _ Garage x _ . x = TOTAL Estimated Construction Value: $ �/ Uo0 �'— Inspections Required: `Vork Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Nlechanical Water Connection Footing ` Septic Sewer Connection • ' Framing Fireplace Lawn Irriga[ion Insulation (Masonry) Other Wall Boazd � (Mfg.) Well(State Permit) �F�� Grading/Filling Electrical (State Permit) Other REMARKS(IN HOUSE): , ------------------------------------------------------------------------- REV�W BY OTIiERS: DATE: Access: Ezisting New . Access Approval: Date gy; -------- �:------------------------------------------------------------- REIVZ4RKS (TO BE NOTED ON PERivII 8 . . � CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY A.DDRESS OR LEGAL: Z S'i S /<e I � � PID: DESCRIPTION OF WORK: �.,�,�0,4�,,.•i ��+-�� ZO,VI�Ii G REV�W BY: DATE APPROVED: � -z� - �y BjJII.,DI�TG REVIE'4V B : DATE APPROVED; -� .2v-o�j FEES TO BE CHARGED: Misc. Fees Calculated By: PERII�IIT Yes _� No PLAl�I REVIEW Yes -�! No ✓ SEWER CO�]NECI'ION STATE SURCHARGE Yes � No WATERCONNECI'ION INVESTIGATION FEE � Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC-Units OTHER (specify) ZONING CH�CK LIST Zoaine District: aV� G'�f�'�,Q . Fire Department: Post OfFice: School District: � Lot Area: Sq.ft. Acres � Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front(Lake): Right Side: Reaz(Street): Left Side: Adjacent Structures: Wet d: Building Hei;ht: Def. Hgt. P •Hgt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution # Resolutioa Date: � Shoreland District: Avg. Setback: luff Setback: I.oc Covecage: xisting Proposed Hazdcover: 0-75' 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes No Da[e of Council Approval: REl�'LARI�S (in house): 7 DATE TIME ✓ CITY OF ORONO CALLED IN �^Z d"� INSPECTION NO E SCHEDULED —2-��C�I �30 PERMIT NO. �d�I Z g COMPIETED ADDRESS ��S ��_�fIY/� OWNER CONTR. �(/f G� �-GP i%�SC� TELEPHONE NO. �� U 2-� O � DESCRIPTION "� �� v`�-- � 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 Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 5 F 14 SEWER HOOK-UP 06 PROGRESS � 0 �DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARO COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: � W a � � O � � O � W � Q � 2 w � W � � O W� ORKSATISFACTORY:PROCEED PROJECTCOMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the ext inspection 24 hours in advance. (g52) 249-46�� Owner/Co o site: Inspector. � White Copyllnspector's File Canary CopylSite Notice