HomeMy WebLinkAbout2002-P05584 - addn/remodel/repair - � PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Posssa
Crystal Bay, Minnesota 55323 Per'mit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 9�9i2oo2
SITE ADDRESS: 1001 Loma Linda Ave
Mound,MN 55364
PID: 07-117-23-14-0008
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: PernutFee: $ 125.25 Valuation: $ 6,000.00
State Surcharge Fee: $ 3.50
TOTAL FEE: $ 128.75
APPLICANT: Quality Basement Waterproofing OWNER: Gilman Sorenson
280 Orono Orchard Rd. 1001 Loma Linda Ave
Wayzata,MN 55391 Mound MN 55364
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 ISSliED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Aoplicant, 1-Monthlv Reoorts, 1-AssessinQ, 1-Finance Page 1
, �
Total Fee: $ �-�� d �Ss Date Received: �-j- �-j =-�
Entered By: � Pernut#: �� ,�S�'��
CITY OF ORONO - BUILDING PERNIIT APPLICATIOleT
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
�. __—_,..,. -
JOB SITE ADDRESS: ��O l ,�oma L,., �� ZIP• SJ 3( �
NAME OF OWNER: L�Uc�►�� S� �� v� PHONE: (home) lo/2-SZ/-/rP Z�
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: Qu z l, ���, ��s e,-n Q-�f GtJa-��r pr,g�i �S'1- �7 6-/(�O �
CONTACT PERSON: `�; c�'c (2 z� �(-�� MOBILE/PA Elf. !�/2-7 S�'7--�f�!'�d
MAILING ADDRESS: 7�'p �.-Or�,,•;o �rc�.?���Y: Gt��-,-�-o-� ZIP: $�3 r'/
STATE LICENSE: # �tJ�q-
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK(describe in detai�: �r�����:� L<.��-�r ���_��'
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 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: I `1'/� Z
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF S[TBJECTS 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 reqiric�ed to be given individual. An individual asked to supply private or confidenaal data concerning himself shall
be informed of: (a)the purpose and inunded use of the requesred dara within the coUecting State agency,potitical subdivision,or sratewide system;
(b)whether he may refuse oY is legally required co supply Fhe requested data;(c)any lmown consequence arising from his supplying or mfusing to supply
private or confidenaal data;and(d)the idendty of o[her persoas or enddes auchorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve data,punuant to secdon 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income tax or prooem taz refund
instmcuons ins[ead 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 swred data on individuals,and whe[her it is class�ed as public,private or co�denaal. Upon 6is further request,an individual who is the subject
of stored private or public data on individuats shall be shown the data without any charge to him and;if he desires,shall be informed of the content
and meaning of[hat data. After an individual has been shown the privau dara and informed of iu meaning,the dara need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuanc co this secdon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shaU provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesdng person to pay the acaal cos[s 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 days of
the date of the request,excluding Saturdays,$undays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
within that time,he stiall so info�in rhe individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays. .
Subd.4. Procedure whea data u 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 shall notify in writing the responsible authuriry describing[he nature of the disagreement�
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompiete and aaempt to nodfy past recipienu of
inaccurate or incomplete data,including recipients named by che individual;or(b)notify the individual that he believes the dara to be correct. Data
in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provuions of the adminisuadve 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 aze notified that:
1. The informatiom you furnish will be used to detemune 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 shazed with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit of 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 •
City State Zip Phone
I understand my �ights as stated above.
>Q�p�/�`?�
,�- -�
s�gnan,re
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /op � Go,r.�,4.e..�rue,�
PID:
DESCRIPTION OF WORK: =� �. � �,.+Q
ZO�.vNi G REVIEW BY: DATE APPROVED:
BITILDING REVIEW BY: DATE APPROVED: q � � o �
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW � Yes No �/ SEWER CONNECTION
STATE SURCHARGE Yes �.,� No WATER CONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning Districr. �� Ffs9i✓l.� /�
��rr
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres idth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Sueet): Left Side:
Adjacent Structures: Wetland
Building Height: Def. Hgt. Peal:Hg
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Dace: By:
Zoning File: # Resolution: # Re lution Date:
Shoreland Districr.
Avg. Setback: Bluff Setback: Lot Coverage:
Eusting Proposed
Hardcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Vaziance Required: Yes No ' Date of Council Approval:
REMARKS(in h0use):
7
. '
BUILDING REVIEW CHECK LIST `
�C� /G� '� CONSTRUCTION�'YPE: �N
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x _
2nd Floor x =
Garage x =
a =
TOTAL
Estimated Construction Value: $ (p,0 0 0 ��-
Inspections Required: Work Requiriag Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insuladon (Masunry) Other
Wall Boazd (Mfg.) Well(State Permit)
�F�� Grading/Fllling Electrical (State Permit)
Other
�� REMAR��.S(IN HOUSE): .
------- ------------------------------__---_------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By;
---------------------------------------------------- -
REI�IARKS (TO BE NOTED ON PERNII�:
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