HomeMy WebLinkAbout2004-P07693 - entrance monuments CITY OF OR N PERMIT
27�0 K�IIe Parkwa -OPO BOox 66 Permit Number: Po�693
Y Y
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249-4600 Date Issued: ��2i�2ooa
SITE ADDRESS: 38o Leaf Street
L.ong Lake,MN 55356
PID: 04-117-23-23-0027
DESCRI PTION:
Proposed Use: Residential
Permit Class: Building Census Code 649
Permit Type: Accessory Structures Perxnit Sub-type(s): Entrance Monuments
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 83•25 Valuation: $ 2,500.00
Plan Review Fee: $ 54.08
State Surcharge Fee: $ 1.75
TOTAL FEE: $ 139.08
APPLICANT: ��ony Thomas Homes OWNER: �'T'��ny Thomas Homes
4100 Berkshire Lane 4100 Berkshire Lane
Plymouth,MN 55446 Plymouth,MN 55446
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.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Requiredl. 1-Avnlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
� Tota3 Fee: $ ,�j7 � �0 Date Received: �7-t���
Entered By: 1��-- Permit#: ��� 7�D �
CITY OF ORONO - BUILDING PERMIT APPLICATION
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���'\ All information must be submitted in full before plan review will be started.
(please pri�it all i�ifori�zation)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: � ��� C�� � S7�` ZIP:
Will this be a Parade of IIomes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a special event permit is required with Police Depc�rtment afid City
Council approval 60 days pf�ior to the event. Non permitted events will not
be allowed.
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NAME OF OWNER:�l�l �`1d�� �/ ��c�i�?�': �s�7�S PHONE: (home) 5'S � 4'2 y/
work) �%/Z �_�y�i'� '��`"/�
MAILING ADDRESS: �CGO ,���jkS`;'��l�� � CITY:/�1y�y��-�j, ZIP: S`�'�'Y�
CONTRACTOR: ��l ���'� 1c�• o.'.,'r- PHONE:
CONTACT PERSON: L r�o ,� .<� �?� �;' 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
RemodeUAlteration Land Alteration
PROPOSED WORK(describe in detai�: i"N ry�pa ii�r i�'ID��e�i1� r�f��5'
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 2'�0�"`" P�. t�,�,,�J°a
I hereby apply for a building pernut 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 permit and work is t to start without a permit; and that the work will be in accordance with
the approved plan.
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APPLICANT'S SIGNATURE• �� DATE:� � �` �
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights ot individual on whom the data is stored or to be stored shall be as set torth in this section.
Subd.2. informatton requtred to be given indivldual. An individual asked to supply private or confldential data concerntng himself shall be
informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivlsion,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising trom his supplying or refusing to supply
private or contidential data;and(d)the identity of other persons or entitfes suthorized by state or federal law to receive the data. This requirement shall
not apply when an individual fs asked to supply investfgative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The rnmmissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or orooertv tax refund
instructions(nstead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether tt is classified ss public,private or contldential. Upon his further request,an indiv[dusl who is the subject of
stored private or publlc 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 data. After an individual has been shown the privste data and informed of tts meaning,the data need not be disclosed to him for six
months thereafter unless a dfspute or actton pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or pub8c data upon request by the indlvidual subject of the data.The responstbte authortty may
require the requesting person to pay the actuat costs ot making,certitytng,and compiling the copies.
The responsible suthority shall rnmply immediately,if possible,with any request made pursuant to this subdivision,or within flve days ofthe
date otthe request,excluding Ssturdays,Sundays and legal holldays,if immediate compliance is not possible.If he csnnot comply with the requestwithin
that time,he shall so inform the individual,and may have an additional tive 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 individusl may contest the accuracy or completeness of public or private data
concerning 61mse1L To exerclse this right,an individuai 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 past recipients ot
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the indlvidual that he believes the dats to be correct. Data in
dispute ahall be disclosed only if the Indlvldual's statement of disagrecment is included with the disclosed data.
The determination of the responsible suthority 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(available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
�a � �
Address
City State Zip Phone
I understa y rights as stated above.
n
Sign ture
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CHECK OFF LIST FOR ISSUANCE OF PERIYIITS
FOR OFFICE USE ONL Y
ADDRESS OR LEGAL: ��3 O C.�.�4�= sr
PID:
DESC.RXPTIONOF yvORK: L=N7it�C.c: �'►�^'^"' -s
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ZONING REVIE tV B Y: DATE APPROVED: �7- � • �Y
B UILDING.REVIEW B Y: DATE APPRO C�ED: � - � -�y
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FEES TO BE CHARGED: Nlisc. Fees Calctclated By:
PERMIT Yes ✓ No
PLAN.REVIEGV Yes �/ �Vo SEWER GONNECTIDN
STATE SURCI�ARGE Yes � tVo tiVATER CD�WECTION
INVESTIGATION FEE Yes No ✓ PARK FEE
SAC Yes No �/ SITENSPECTION
Nccmber of SAC Units OTHER (specify)
ZONIlYG CHEC.F�'LIST Zorting Dlsh•ict.•
Fire Departrnent: Post Off ce: Sclzool District.� _..
Lot Area: Sq.ft. Acres GYidth Dept{i
c�-��f, o
S�crvey Subr::itted: Yes oG No Date af Scavey: oiv �'�r�
Proposed Setbncks: �
Frorst(Lake): � ' Rig/it Side: 5
Rear•(Street): G•!� Left Side: �•�e
Adjcrcent Structcu•es: �-<< Wetlancf.•
Buildilig Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approvccl Date: By: Cotcncil Approval Date:
Septic: Staff�lpproval Dc�te: By�
Zonirig File: # Resolution: # Resol�ction Date:
�•�L n• Shoreland Dish•ict:
(�' Avg. Setbnck: Bluff Setback: Lot Coverage:
p p' Etisting Proposed
Hc�rdcover: 0-7.i'
75-250'
250-500'
500-1000'
Kardcover Vnriance Reqaiired: Yes No Date of Couisci!�ipprovc�l.•
REt1IARKS(in l:ouse):
31
ti
B UILDING RE VIE t�CHECK LIST
UBC: N�A CONSTRUCTIO!V TYPE:
Sq Foatage .�Per Sq FtJ
Basente�ct x =
1 st Floor x =
2nd Floor s =
Gctrctge r =
.r =
TOTAL
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Estimated Constructia: Value: �S Z, S vv
Inspections Required: Work Requiriitg Separate Permits:
Site Pl�arnbing Fire
Harcicover Rernovc�l Mechanical YYater Gonnection
Footing Septic Setiver Connectiaz
F�•aming Fi�•eplace Lawn Irrigcttion
lnsedation (titasonry) Otlier-
GYal1 Boc�rd (Ntfg.) Well(Stnte Permit)
Final Gr�ccdir:g/Fillin� Electr•ical(State Perfrtit)
Other
RENIARh'S(IN HO USE):
REVIEW BY OTHERS: DATE:
�Iccess: E,risting Netiv
,�ccess�(ppi•ova1: Date By:
IZE�'I�ARKS(TO BE NOTED O[V PERNIIT):
32
�.qATE TIME ✓
CITY OF ORONO ALLED IN /�Z-'�G`�
INSPECTION NOTIC SCHEDULED 7__ z zJ l��',�U
PERMIT NO. �C� ���� COMPLETED
` ��-�S S-� �
ADDRESS ��(�' �
OWNER CONTR. � - `��`YU--" j
TELEPHONE NO. �(�.� S�� - C �/
� �CRIPTION ���� �G`�'t'�✓YV�.�r S
11�/(01��'FfdOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q�Z 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
� 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:
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W WORKSATISFACTORY:PROCEED f� PROJECT COMPLETE
� ❑CORRECT WORK 8�PROCEED r, ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. �952� 249-Q6QQ
OwnerlContrac
Inspector.
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