HomeMy WebLinkAbout2003-P06416 - addn/remodel/repair T �
CITY F R PERMIT
� � �N� permit Number:
2750 Kelley Parkway- PO Box 66 P06416
Crystal Bay, Minnesota 55323 P@I'1111t Typ@: Addirion/RemodeURepair
(952) 249-4600 Date Issued: 9ilsi2oo3
SITE ADDRESS: 1045 Loma Linda Ave
Mound,MN 55364
PID: 08-117-23-23-0022
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addirion/RemodeURepair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#: 5030
Separate pemuts required: EiecBicai�siaie�
NOTICES/REMARKS:
T="_/___T__7_ O_/"�__=__
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FEE SUMMARY: Pernut Fee: $ 411.45 Valuation• $ 27,000.00
Plan Review Fee: $ 267.42
State Surcharge Fee: $ 14.00
TOTAL FEE: $ 692.87
APPLICANT: Owner/Self OWNER: Timothy&Kristi Osterberg
MN 1045 Loma Linda Ave
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 SIG RE ISSUED B GNATURE
Conies: 1-File(SiQnitures Required), 1-Atyplicant, 1-Monthlv Revorts, 1-Assessing, 1-Finance Page 1
e �
Total Fee: $ ��"���'�. �� Date Received: ( n - I I - O�
,,,
Entered By: ,,�Q�,�� Pernut#: n ,- , �_i/(�
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CITY OF ORONO - BUII.,DING 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 CONTRACTOR
JOB SIT'E ADDRESS: ���� l��y�,��. ���` ZIP: �j��j(�;�
NAl�� OF OWNER: �.Y�;�i 1 � �i vV� �/�V���'►'�� PHONE: (home) �{-],? -1 C57,�
. , (work) �(:-���- �1�j�-(��.f1
MAII.ING ADDRESS: I D y�� 1 c�r�..l--�'�G�� ��'� CITY: (X�� ZIP:��,'-��I-
CO\�'I'RACTOR: "xw'k �.U�'c��i� PHONE:_ '-}�.� - JI�7�3�
COr�'ACT PERSON: r��ti�, MOBILE/PAGER: �7��(
M.AILING ADDRESS: CITY: ZIP:
ST�iT'E LICENSE: # �-�j�7
ARCHITECT/ENGINEER: ?4�-� PHONE:
MAII,I�i 1G ADDRESS: CITY: ZIP:
NA._1IE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detain: Y�E �IC�f'L� �:-i� r'��l,�.�cu:� ���-�C ��c �
r�-r�� (,t.IfZt.C_.�"C1��C'�L\`� `�
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOviS: � � GARAGE STALLS: ATT. DET.
EST�IATED 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: C-., ►1 -G�j
1
NOTE! Parade of Homes events require separate permi approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
�• .
Sec.13.04 RIGHTS OF SLJBJECTS 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 this section.
Subd.2. Information reqirired to be given individual, pn i�rv�dual asked to supply private or confidendal data concerning himselg
shall be informed of: (a)the purpose and intended use of the requesud data within the collecang state agency,poliacal subdivision,or statewide
system;(b)whether he may refuse or is legally required to suppty the requested data;(c)any Irnown consequence arising from his supplying or
refiuing to supply privare or coafidential data;and(d)the identiry of other persons or entiaes authorized by srate or federal law to receive the data.
T6is requirement shall not apply when an individual is asked to supply invesdgadve data, pursuant to secdon 13.82, subdivision 5, to a law
enforcement o�cer.
The commissioner of revenue mav olace the norice rewired under thi subdivision in the individual income c r r .*..M ��
instrucdons mstead of on those forrtL.
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 whether it is class�ed as public,private or co�dendal. Upon his further request,an individual who
is the subject of stored private or public data on individuals shalt be shown the dara without any charge to him and,if he desires,shall be informed
of the content and meanin�of that data. Aher an individual has been shown the private data and informed of its meaning,the data need nat be
disclosed to him for six months theceafter unless a dispute or acaon pursuant to this secaon is pe�ing or additional data on the individual has been
collected or created. The responsible authoriry shail provide copies of the private or public data upon request by the individual subject of the data.
The responsibte authority may require the requesang person w pay the actual cosu of making,certifying,and compiling the copies.
Tha responsible authoriry shatl comply unmediately,if possible,with any request made pursuant to this subdivision,or within five days
of the dau of the rcquest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request wi[hin that time,he shall so inform the individual,and may have an additional five days within which to comply wi�the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeaess of public or
private data conceming himself. To ezercise this right,an ic�ividual shall noafy in writing the responsible authoriry descdbing the nature of the
disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipientc of inaccurate or i�omplere data,inc(uding recipienu named by the individual;or(b)noafy the individual that he believes the data
to be coaect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authority may be appealed pursuant co the provisions of the adminis�ative procedure act relating
m contested cases.
DATA P iVACY 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 pemut or license from the �iry 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 pemut.
o �(X,✓LL�
First Middle
Last
Addrcss
C�ry State Zip Phone
I understand my rights as stated above.
. ��
Signamre
6
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS ORLEGAL: i O`-�S (�oww �,�,�.r p�
PID:
DESCRIPTION OF WORK: /�rcvac�t � (�,atR•4 e�
ZO�TING REVIEW BY: DATEAPPROVED: �'-/S�o3
BUILDING REVIEW BY: DATE APPROVED: 9-i s-03
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
pLA��t REVIEW Yes v No SEWER CONNECTION
STATE SURCHARGE Yes r� No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------------------------------------------------------------------------------
ZOti�ING CHECK LIST Zoning District: (J2-I(3
Fire Department: Post Office: School District:
Lot Area: Sq.ft. �y�(� Acres �9,yZq Wid[h Depth
Survey Submitted: Yes X No Date of Survey: 6•2.b-D3
Proposed Setbacks:
Front (Lake): Z9� Right Side: 5�`
Rear (Street): `�0' Left Side: �o�
Adjacent Structures: i4-r-►-Au� Wetland: N��A
Buildin� Hei;ht: Def. Hgt. o•k Peal:Hgt.
Lot Covera�e: �T•�1
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # 0 3 •Zg 3� Resolution: # `��c ;ii Resolution Date: h ;'> -�'� .
Shoreland District: ��-�s
Av�. Setback: iv i✓a- Bluff Setback: Ny} L.ot Coverage: q•S
Existin� Proposed
a
Hardcover: 0-75'
7�-250'
250-500' i S•� �r•�
500-1000'
Hardcover Variance Required: Yes No a Date of Council Approval:
RE�L4RKS (in house):
7
. � . ..
BUILDING REVIEW CHECK LIST �
� �C� �'� CONSTRUCTION TYPE: �/I`�
Sq Footage $Per Sq Ftg
Basement x _
lst Floor x. _
2nd Floor x _
Gazage x _
a =
TOTAL
Fstimated Construction Value: $ 2�,000 '�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
—�F���o' Septic Sewer Connection
_�Frami.ng Fireplace Lawn Irrigation
°�'{"`� (Masonry) Other
-�°�� . (T'if8•) Well(State Permit)
—�F� Grading/Filling _�c Electrical(State Permit)
Other
RENIARKS(IN HOUSE):
---------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gY;
___�___���__��__��----------------------------
REMARKS (TO BE NOTED ON PERMIZ�:
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. CERTIFICATE OF SURYEY
FOR: KRISTI OSTERBE ��4�� �
RG ���
LEGAL DESCRIPTION: Lots 28, 27 & 2B LOMA LINDA, Hennepin County, MinnesoEa.
LOMA LINDA A VE. - o
ed e o/ Ditumirtoua rood O �
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- - _ - 130.0 Plat 131.08 Meas. g���.
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140.0 Pla t 139.95 M as.
, �����, CITY QF ORQ��
��, � SITE C�LANI aRA���v� ���
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• Denotes found monument i:i�� _ � '
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I hereby certify that this survey, p!on or reper wos File No.
DEMARS—GABRIEL my direct supervisian ond thot I cm a duly Reyistera f�a�ddsb�,yor �nderd the 121 69
LAND SURVEYORS, I�C� Laws af tne sto�e of M�nnesota.
3030 Horbor Lane No. � ''�� Book-Page
Plymouth, MN 55447 David E. Crook . 416/27
Phone:(763) 559-0908 j ���� I�� Sca�e
Dote: __��`_t�'yLl-�--_ M1nn. Reg. \o. 22d14 1"=30�
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DATE TIME
CITY OF ORONO CALLED IN �
INSPECTION N SCHEDULED a' �
PERMIT NO. COMPLETED �f "'
ADDRESS
OWNER CONTR.
TELEPHONE�'���- .!��3 .
� DESCRIPTION �e�^ �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILUNG
Q 02 FRAMING 13 MECHANICAI FINAL 19 LAKESHORE/WEfLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALLBD. 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
i09 PLUMBING RI 23 SEPTICFINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOH TO MEET YOU:_YES_NO
y COMMENTS:
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� �'�NORKSATISFACTORY PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFOREC�/ERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP OROER POSTED.CALL INSPECTOR
❑INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-4600
OwnerlContracto on '
Inspector
White Copylinspectors File Canary CopylSite NoNce
V
CITY OF ORONO CALLED IN �D DyjE,,,_� 7 TIME
G/ >
INSPECTION N TICE SCHEDULED /d-28'� ��. o
PERMIT N0. I CO COMPLETED
ADDRESS � �Q�J� l-O/YI Gt L i,�/�.4
OWNER ��.U I P/,%�,—CONTR. �P�� ���✓�-e r
TELEPHONE N0. �L I oZ Q'j D L-�T�
� DESCRIPTION � (`�(.r�%vS�-�L.�
01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� � F 13 MECHANICAI FINAL 19 LAKESHORE/WETLANDS
Q
Q03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC AAAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J MBING FINAL 36 FOUNDATIOWREMOVAL
2 OWNE NTRACTOR TO MEET YOU:_YESr NO
ti COMMENTS:
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W� ORKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFOREC�IERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. O PHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next i pection 24 hours in advance. (g52) 249-4600
OwnedCon r si :
Inspector. �
White Copyllnspector's File Canary CopylSHe Notice
✓
��� � TIME
CITY OF ORONO CALLED IN
INSPECTION NOTI � y��,, SCHEDULED �"_� 3��
PERMIT N0. �' COMPLETED
ADDRESS I��� �-U(71C�. �—` +1 c� C�� =f
OWNER �' iti�� �S} �.r I� 4r�� CONTR. c%f�V��
TELEPHONE NO. ������� ' �� � �� � J >I
� DESCRIPTION � �' ���'�-`��-�-- �`'-`��
� 01 FOOTING r � 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
05 FIN-_A� 14 SEWER HOOK-UP O6 PROGRESS
� 0� 6EM0-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10.?LUM8ING FINAL � /` 36 FOUNDATION/REMOVAL
��WNERICONTRACTO�MEET YOU:✓YES_NO
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W� WORKSATISFACTORY:PROCEED ROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call forthe next i spection 24 hours in advance. (J52� 24J-46��
OwnerlContract si
Inspector.
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