HomeMy WebLinkAbout2004-P08221 - entry roof I
PERMIT �
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Poa22i
Crystal Bay, Minnesota 55323 P@CCTIIt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: i2�29�2004
SITE ADDRESS: 2765 Ke1lyAve
Excelsior,MN 55331
PID: 21-117-23-23-0001
DESCRIPTION: UBC Occupancy R3
Conshuction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Pernut Type: Addition/Remodel/Repair permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
_T__C
+����� ��vva
FEE SUMMARY: Pernut Fee: $ 35.70 Valuation: $ 900.00
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 36.70
APPLICANT: Owner/Self OWNER: Amir Einafshar
MN 2765 Kelly Ave
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.
�---_ _ -- � �'.
. _
� _��. - C �`��'1 (��,� ���
- CANTPER1GiI'TC N URE ISSUEDBYSIGNATURE
Copies: 1-File(Si�nitures Required). 1-Anplicant 1-Monthlv Revorts, 1-AssessinQ, 1-Finance Page 1
. c-� �2/Z/6 y
.- ���
Total Fee: $ �p•?� Date Received: r'�"�'��
Entered By: Permit#: �O$22 �
CITY OF ORONO - BUILDING PERMIT APPLICATION
- All information must be submittgd in full before plan review will be started.
(please pri�zt all i�zfor»zation)
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THE APPLICANT IS: (circle one) O`JVNER OR CONTRACTOR
JOB SITE ADDRESS: 2�G��G�/��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 czpproval 60 days prior to the event. Non per�nitted events will not
be allowed.
NAME OF OWNER: ��/��y� �/IGY1� PHONE: (home) � �I�
(work) �
MAILING ADDRESS:���� ��/ ✓�i CITY: �f��� ZIP: �
,
CONTRACTOR: '� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
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�: �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $_�
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 this is not a pernut and work is not to start without a pernvt; and that the work will be in accordance with
the approved plan.
__--------._._.
APPLICANT'S SIGNATURE: DATE: I� i���
> �,
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.i. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in thls section.
Subd.2. Intormation required to be given individual. An i�dividual asked to supply private or contidential data concerning 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 con�dential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement sfiall
not apply when an indivfduai is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a Iaw enforcement offcer.
The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income ts►x or orooertv 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 conf7dential. Upon his further request,an individual who is the subject of
stored private or public data on Indivlduals shall be shown the data without any charge to him and,if he desires,shall be intormed of the content and
meaning of that data. After an individual has been shown the private data and informed of its meaning,the datu need not be disclosed to him for six
months thereafter uniess a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shAll provide coples of the private or pubiic 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 duys of the
_ _ . _. __
dute of the requesf,excluding Saturdays,Sundpys 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,exciuding Suturdays,Sundays
and legal holidays. �
Subd.4. Procedare when data is not accurate or complete. An individusl may contest the accuracy or completeness of pubiic or private data
concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the dlsagreement.The
responsible authority shall wtthin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,inciuding recipients named by the individual;or(b)notify the individual thst he believes the data to be correct. Data in
dispute shall be disclosed oniy if the individual's statement of disagreement is iacluded with the disclosed data.
The determination of the responsible authority may be appealed pursuunt to the provisioos 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
con�dential 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 application or permit.
• First Middie Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature
� •
� CHECK OFF LIST FOR ISSUANCE OF PERlI%fITS
FOR OFFICE USE ONLY
ADDRESSORLEGAL: z7�5 Kel�ti r4ve
PID:
DESCRIPTION OF yf�ORK: cN r�i o�
------------------------------------- ----- ------------------------------------------------------------------ -
ZO�VINGREVIEyvBY: DATEAPPROVED: �z-�-oY
B UILDItVG.REV.TEW B : �- DATEAPPRO vED: � z-�- oY
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FEES TO BE CHARGED: Nlisc. Fees Ccciczclated By:
PERctitIT Yes � No
PLAN R.�VIE LV � � �vo ✓ SE LVER GONivECTION
STATE SURCHARGE Yes � tVo tiVATER CO! tWECTIOIV
INVESTIGATIQ�V FEE Yes tVo P�RK FEE
SAC Yes No SI1'E INSPECTIOIV
Nccmber of SAC U�iits OTHER (specify)
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ZO[YIIYG CHECh'LIST Zor�ing District:
Fire Depai•hnent: Post Off ce: Scliool Disn•ict: _„
Lot.�lrea: Sqft. Acres �Yidtl� Depth
Siu-vey Subniitted: Yes�C_. No Date of Stuveti�: (��`�L- 0l
Proposed Setbacl.s: �q,/Z
Frortt(btt�e): �Oa�� R�r�&t�fe: ZO' '+
�(Sir�i): S`f� "r Left Side: 8Z� �
Adjacent Structures: i4r�r-�cHEO WetlRncf: N l✓�-
Builcling Height.• Def. Hgt. ��, Peak Kgt. �
Lot Coverage: � �J[.
Gr•ading.• Staff Approvci!Date: — Bv: Cocvicil rlpprovc�l Dc�te:
Septic: StccffAppr•ovn!Dnte: — BY�
Zo�iing File: # — Resoli�tiai: # Resoltitioai Date:
Slioreland Dish•ict:
Avg.Setbnck: �ivifi_ Bla�ffSetbc�ck: N�� LatCover•age: d•1�
Etiisting Praposed
Hc�rdcove�•: 0-7.i'
75-250' 0•�
250-500'
500-1000'
Harcicover Variance Reqccirecf: Yes No_� Date of Council Approval:
REd�lARKS(ire house):
31
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B UILDING RE VIEYY CHECK LIST
UBC: �Z•� CONSTRUCTIOcYTYPE: �[IJ
Sq Footnge S Per�Sg Fr.g
Bc�sente�tt t =
1 sr Floor x =
?nd Floor � _
Gc�r•cge � _
� _
TOT�{L
0
Estilriated Caistriictiol: Value: � `�pp 9�
Inspectior:s Required: tYork Reqc�iriitg Separate Per�r�its:
Sile Plu�nbrrig Fire
Hardcover•R�rnovnl A�feclianical G(�ater•Cai�tection
Footing Septic Sewer Connection
Framir�g Fireplace Lctwn. lrrigation
lnsulation (r�lasonn�) Odter
GY'al!Board (Ntfg.) GYell(State Per•+nit)
oC Finc�l Gradi,tg/Filli,t,; Efecn•ical(St�te Permit)
Oth er
IZEttitARliS(INHOUSE):
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RE T�IE yV B Y OTHERS: � • DATE:
Access: E,cistin,; Nerv
Access�{pprov�l: Date By:
--------------------------------------------------------------------------__.----------------------------------------
REt'�I�Rh'S (TO BE NOTED ONPEI�titIT):
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