HomeMy WebLinkAbout2005-P08767 - addn/remodel/repair � PERMIT
CITY OF ORONO
1750 Kelley Parkway- PO Box 66 Permit Number: p08767
Crystal Bay, Minnesota 55323 Permit Type:
Addirion/RemodeURepair
(952) 249-4600 Date Issued: 6/15/2005
SITE ADDRESS: 565 Leaf Street Unit#
Long Lake,MN 55356
P��� OS-117-23-41-0028
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit Type: Addirion/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 1,273.75 Valuation: $ 150,000.00
Plan Review Fee: $ 827.94
State Surcharge Fee: $ 75.00
TOTAL FEE: $ 2,176.69
APPLICANT: Herman Renovarion OWNER: Kosierazki&Fox
5645 Eureka Rd. 565 Leaf Street
Excelsior,MN 55331 Long Lake MN 55356
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.
1 � �
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APPLICANT PE E GNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
� � � �,- . �- <�,
Total Fee: $ Date Received: h',��-0�
Entered By: ��,� (=f� �'}�T � /�.���,�' Permit#: � 4�-7�p7
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pf�i�it all infornzation)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��5 �-��d/ cS�. ZIP: ��rJ �jC�
VVill this be a Parade of Homes, Remodelers Showcase Hoine or other Display Home?
❑ Yes �0 If yes, a special event pe��mit is required with Police Departmerat and City Council apprrovol
� 6 0 days prior to t he even t. S lzzr t t le bz�s service wi l l be reqarire d z�n less app lican t den�orTstrates
st�cient on-site parking is available. Non per�nitted events will not be allowed. �
NAME OF OWNER: 1�x�i""-���'�����/ PHOi�tE: (honle)
MAIT�,ING ADDRESS: ��DUr C-E�� S✓ • CITY: �J��--Q (work)
ZIg': ��v
CONTRACTOR l�i��7'� t PHOlVE: 1�2 �`�7�`�7�
CONTACT PERSON: �6C� MOBILE/PAGER: ��!�. 2-�Z �US�7
MAILING ADDRESS:c`�(v�u ��� /°�,� CITY: ����.�/CI� ZL�P:�33 l
STATE LICENSE: # ''7l(3� EXPIRATION DATE:
ARCHITECT/ENGINEER: S1� PHONE: cl S 2- ' .3� ^ ��l �
MAILING ADDRESS: ' ` CITY: F��=�e�IP: _�� j
NAME: �J�(� G�(,/L�r�'7/U'�' REGISTRATIOI�T: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration �
PROPOSED WORK(describe in detai�: 1.�� G�u'� �'f�-S �f� �/'U�
/.-�(/l lllL� 5��� ��J� ,�ZU� � �� v?1Nf� ���:��5� / �'�i�i f,
STORIES: � � SQ.FEET OF EACH FLOOR: `` ` D' ` `( �i� 2
N• •F SE)R��MS. GARAGE STALLS: ATTACHE) )ETACHED
ESTIMATED CONSTRLTCTION VALUATION(excluding land): $ ���; L�
—�
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 not to start without a permit;and that the work will be
in accordance with the approved plan. r
/��'� �
APPLICANT'SSIGNATURE: OVC �� � DATE: �'�� �S�
31
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 shall be as set forth in this section.
Subd.2. Information required to be given individual.An individual asked to supply private or confidential data conceming 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 confidential daca;and(d)the identity of other persons or entities authoriud by state or federa(law to receive the data.This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of rovenue mav place the notice required under this subdivision in the individual income tax or gronertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual.Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of
stored data on individuals,and whethcr it is classified 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 infonned of the content and
meaning of that data. 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 collected 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 requiro the requesting person co pay the aceval costs of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comp(y with che request
within that time,he shall so inform the individual,and may have an additiona!five days within which to comply with the request,excluding Saturdays,
1 Sundays and legal holidays.
Subd.4.Procedure when data is not accurate or complete.An individual may contest the acctuacy or completeness of public or private data
conceming himself.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible suthoriry shall within 30 days either: (a)coaect the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplote data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct.Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the adminishaNve procedure act relating[o
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 fumish certain private or
confidential information.
You are notified that:
1. The information you fiunish 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
Address
C�ty State Zip Phone
I understand my rights at ve.
� /�
���-(/
Signature
32 -
• CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: S 6 5 [�c:.�F s�•
PID:
DESCRIPTION OF WORK: �1�ww�_ ���c�Q S�_�,�..� [_�.��wc, s�A c�
ZO.�i TG REVIE`V BY: � DATE APPROVED: S- Z� -��
BUII�DING REVIE`V B : DATE APPROVED: �- z� -�s
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes _l� No
PLAN REVIEW � Yes � No SEWF�t CONNECTION
STATE SURCHARGE Yes �/ No WATERCONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No v STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONI�iG CH�CK LIST Zoning District: c� C
Fire Department: Post O�ce: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear (Sueet): Left Side:
Adjacent Structures: W land:
Buildin� Height: Def. Hgt. P al:Hgt.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: B :
Zoning File: # Resolution: !# Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Covera�e:
Eusting Proposed
Hardcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Vaziance Required: Yes No Date of Council Approval:
REVIA.RKS (in house):
�
BUII�DING REV�W CHECK LIST
UBC: (?• 3 CONSTRUCTION TYPE: 1,Cr�1
Sq Footage $Per Sq Ftg
Basement x _ .
1st Floor x _
2nd Floor x =
Garage x _
x =
TOTAL
Estimated Construction Value: $ /S 0,ti oc� `�
Inspections Required: `Vork Requiring Separate Permits:
Site �_Plumbing Fire
Hazdcover Removal ,� 114echanical Water Connection
Fa��g � Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
�Insulation (Masonry) Other
_�Wall Board (Mfg.) Well (State Permit)
—�.F�� Grading/Filling _�Electrical (State Permit)
Other
REMARKS(IN IiOUSE): �-
------- ---- -------------------------------------
REVIE�V BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy; �
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REI�IARKS (TO BE NOTED ON PER1VIi�:
8
� �U"'t _ �
�pA�E TIME
4 CITY OF ORONO CALLED IN � �.
INSPECTION NO�I��7�� SCHEDULED � !� %00
PERMIT NO. �� COMPLETED
ADDRESS 'S�5 L.e�.7��"7�' ,
OWNER CONTR. A��i!'�'r�c ����kz��v�
TELEPHONE NO. �O�Z Z�Z D 57�
� DESCRIPTION � G►'��
lV FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
AMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
O INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 CqMPLAINT
� 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
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CQRRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CA lT0 ARRANGE ACCESS.
Call for the n xt nspection 24 hours in advance. (952� 24J-46��
OwnerlC a on it :
Inspector. �-
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