HomeMy WebLinkAbout2004-P07409 - addn/remodel/repair � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P07409
Crystal Bay, Minnesota 55323 PeC'CYllt Typ@: Addirion/RemodeURepair
(952) 249-4600 Date Issued: si6�2ooa
SITE ADDRESS: 2640 Kelly Avenue
Excelsior,MN55331
PID: 20-117-23-14-0006
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernrit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required: riumoing iviecnanicai Eiecmcai(siaiej
NOTICES/REMARKS:
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FEE SUMMARY: PermitFee: $ 441.75 Valuation: $ 30,000.00
Plan Review Fee: $ 287.13
� State Surcharge Fee: $ 15.50
TOTAL FEE: $ 744.38
APPLICANT: Danberry Company OWNER: John Vollanar
4410 Shoreline Dr 2640 Kelly Avenue
Spring Park,MN 55384 Excelsior MN 55331
THE UNDERSIGNED HEREBY REQUES'I'S 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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APPLI A T P I I A ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Auulicant, 1-Monthlv Revorts, 1-Assessin�, 1-Finance Page 1
Total Fee: $ � �4 " 3 g Date Received: �-2 I-Oy
Entered By: Permit#: �'D 7�0�/
�l� LrN s S �-I -.Z�1
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 ONTRACTO
JOB SITE �DDRESS: 2� � U �-e ���c /�- ZIP: $�� 9 /
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 Ciry
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: lJ � l l��"'�a v' PHONE: (home)
MAILING ADDRESS: � � �{ c� (�'ork)
`��1���- CITY: �ra�-L-U ZIP: �g
CONTRACTOR: ��t�►, bQ�� C a pHpNE; ��7 j,—v,S 3 -Z
CONTACT PERSON: -�c'��= c� MOBILE/PAGER: 2 S� '7 c�c��
MAILING ADDRESS: _��1�/ S��re (r,,.P �-- CITY: �r l� ZIP: _-�
STATE LICENSE: # �� y
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration�_ Land Alteration
PROPOSED WORK(describe in detai�: �� `��-� �2��.�
STORIES: / SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �f�, oav
� �
I hereby apply for a building permit and I aclrnowledge 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 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 plan.
APPLICANT'S SIGNATURE: � DATE: � Z�
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights ot individusl on w6om t6e data is stored or w be stored shall be u set forth ln this section.
Subd.2. Information requlred to be given individual. An individual asked to mpply private or conSdential data concerning h(msdf s6a11 be
informed of: (a)the purpose and intended use of the requested data withln the collecting state agency,politiesl subdlvision,or statewide system;(b)
whet6er he may refuse or is legally requtred to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or rnnfidential data;and(d)the identity of other persons or entities authorized by siate or federal law W receive the data. This requirement shall
not spply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law eniorcement ofticer.
The rnmmissioner of revenue mav olace the notice reauired under this subdirision in the individnal income tax or orooertv tu refund
instructions mstead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible suthorin•,aa Individual shall be informed whether he is the sabject of
stored data on iodividuals,and whether it is classitled as publtc,private or conRdential. t'poo hfs furt6er reqnest,an individusl who is the sabject of
stored private or public data on indlviduals shall be shown the data without any c6arge to him and,if he desim,shall be Informed of t6e content and
meaning of that data. After an individual has beea shown t6e private data and informed of its meaning,the data need not be disclosed to 6im for six
months thereafter unless s dispute or action pursuant to this section is pending or additional data oo the indi�idaai has been collected or creatsd. The
responsible authority shall provide rnpies of the private or public data upon request by t6e Individual subject of tLe data.The responsible authority may
requlre the requesting person to pay the actual rnsts of maldng,certifying,and rnmpiling the rnpies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the
date of the request,excluding Saturdays,Sundays and legal holidays,it immediste compliance ls not possible.If he cannot comply with the request within
that time,6e shall so inform the individual,and may 6ave an additional five days within w�hich to comply with the request,excluding Saturdays,Sundays
and legal holldays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himself. To exercise this right,an individual s6a11 notity io writing the respoau'bie suthority describing the nature of the dlsagreement The
responsible authority shall withln 30 days either: (a)correct the data found to be lnaccarate or inrnmplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the indlvidual;or(b)notif�•the individual that 6e believes the data to be correct Data in
dtspute shall be disclosed only if the individual's statement of disagreement is included Rith the disclosed data.
The determination of the responsible suthority may be appealed pursuant to the provisions of t6e sdministrative procedure act rdating 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�ou 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 den�the permit or license.
3. The information may be shared with other local,state or federal agencies to the eztent necessary to process
the permit or license.
4. If your requested permit or license requires Council acdon 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.
���� �B'� !z J d tti'��/`�'�/
First Middle Last
`�SY� �.,. ... ��
Address
'I,Ja.�� ��... S���i /� `{7/d5` 3 z
City State Zip Phone 1
I understand my rights as stated above. .
Signature
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 26 yp /�o((y �...t
PID: '
DESCRIPTIONOFWORK: K��-c,l..a.� (Z,,c�-w,,,oe�c.. � �
ZONING REVIEW BY: �tJ!A DATE A.PPROVED:
BUILDING REVIEWBY: _ DATE APPROVED: y• t c -br
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLANREVIEW Yes ✓ No SEWER CONNECTION
STATE SURCHARGE Yes -�' No WATER CONNECT70N
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECT70N
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: N� G tf�lrur'•,�
v
Fire Depanment: Post O,f,j�ce: School District:
LotArea: Sq.ft. Acres �dth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wet .
Building Height: Def. Hgt. P ak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution:# Resoludon Date:
Shoreland District:
Avg.Setback: Bluff Setback Lot Coverage:
Existing Proposed
Hardcover: 0�75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes N Date of Council Approval: �
REMARKS(in house):
� 32
. .
BUILDING REVIEW CHECK LIST ` ` '
UBC.• �'3 CONSTRUCTION TYPE: � �1
Sq Footage $Per Sq FIg .
Basement x _
1 st F[oor• x _
2nd F[oor x _
Garage x =
x =
TOTAL
Estimated Conshuction Value: $ �p_pvo 0 0
Inspeceions Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal �Mechanical Water Connection
Footing Septic Sewer Connection
�_Framing Fireplace Lawn Irrigution
�( Irrsu[ation (Masonry) Other
_� Wall Board (Mfg.) Well (State Permit)
... Final Grading/Filling _�Electrical (State Permit)
Other
REMARKS(INHOUSE):
-----------------------------------------------
-----------------------------
REVIEW BY OTHERS: DATE:
Access: Existing N�y
Access Approval: Date g�,:
REMARKS (TO BE NOTED ON PERMIT): ~ �Y � M �"""" -r
33
DATE TIME
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CITY OF ORONO CALLED IN s-//'�D�
INSPECTION NOTICE SCHEDULED S_/9_Q�l a: d P�/I
PERMIT NO. 7�I O� COMPLETED
ADDRESS .2 e •
OWNER CONTR. � �2�'
TELEPHONE N0. `'l S2 `�� I O S��Z.
� DESCRIPTION ��� O� ,
� O7 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRA 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y NSULA ON 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WAI.L BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL �� 36 FOUNDATIOWREMOVAL
� OWN NTRACTO TO MEET YOU:J_/ YES_NO
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W� WORKSATISFACTORY:PROCEED ❑PROJECTCOMPIEfE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN F{OURS. p pH0T0 TAKEN
INSPECTOR WILL AETURN ❑CITATION ISSUED
O STOP ORDEfl POSTED.CALL INSPECTOR
❑IIJSPECTION REQUIRED.CALI ARRANGE ACCESS.
Call forthe ex in pection 24 hours in advance. (g52) 249-46�0
Owner/Contra o n sit :
Inspector. '�
White CopyllnspectoPs File Canary Copy/Site Notice
[� DATE TIME /
CITY OF ORONO CALLED IN �`s'�L
INSPECTION NOTICE SCHEDULED "� :3O
PERMIT NO. /�D7�6�' COMPLETED
ADDRESS a��� /��� �
OWNER CONTR.
TELEPHONE NO.�.SZ�7/ O�S.3�.
� DESCRIPTION �dN�+'`� - ���'0�
� 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 OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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
c�., COMMENTS:
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��RKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W O CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALI INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 forthe ne t inspection 24 hours in advance. (952� 249-46�0
OwnerlCon it :
Inspector. �
White Copyllnspector's File Canary CopylSite Notice