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Home My WebLink About2004-P07554 - windows - -, PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P07554 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 6�li2oo4 SITE ADDRESS: 1090 Loma Linda Ave Mound,MN 55364 PID: 08-117-23-23-0010 DESCRIPTION: Proposed Use: Residential Pern-ut Class: Building Census Code O/S-Building Permit Type: Minor Alterations Petmit Sub-type(s): Windows DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 181.25 Valuation: $ 10,000.00 State Surcharge Fee: $ 5.50 TOTAL FEE: $ 186.75 APPLICANT: Owner/Self OWNER: Richard&Kim Klocek MN 1090 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. 9 ' '�'� '�r�"�� C��=� APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1 r � - Total Fee: $ ! ��- � DateReceived: ' EnteredBy: `�'"�=- Permit#: � r �_, CITY OF ORONO - BL'ILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please pri�at all infornzation) -------------------------------------------------------------��-=+�;--------------------------------------------------- THE APPLICANT IS: (circle one) �WNEI�,OR CONTRACTOR JOB SITE ADDRESS: �� C-G/�7�1 �/�l CICt ��E� ZIP: _,��' �.�'-� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �i No If yes, a special everit permit is required with Poli.ce Departnze�zt and City Coacnci.l approval 60 days prior to the event. No�z-penni.tted eveizts will izot be allowed. NAME OF OWNER: ��l L�"_ ��/m {��DC�� PHONE: (home) �`�sx � �`:��/11�� (work)�5,� �_ . G�f��/`�X �3 MAILING ADDRESS: �GxfG�Lf1�?.�_ 11h�� lo� CITY: (��D�Z r�' ZIP: ��"� CONTRACTOR: ��j�f�L�fs(Jf'J��'�� PHONE: CONTACT PERSON: �i�!� MOBILE/PAGER: MAILING ADDRESS: �5��,-� �2S c�,f�if U� CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: /�" � f�--<�� '� �� ` � . r /� ARCHITECT/ENGINEER: a ,✓1 ��r7�r'1 �ji1�� - PHONE: �% ' ��'.%�.7 f MAILING ADDR.ESS: �� l�° �i a {`'�i.r �'h/f..• CITY: '�G�r,r,�,�,'w,�„1 ZIP: ��c NAME: �Oi� %��-+'...- �; � r� r REGISTRATION# %�3��(�� -� TYPE OF WORK: New Addition Accessor Structure Move Home Remodel/Alteration � PROPOSED WORK(describe irz detail): /�'' ,'" '"�T ��v1�,1�r,� � ��i`� '�s' ��x�' „ < 2 . /� � a �/' `; r, i '`J/� f 1� '� - 1 '-E'- � ��? , ��y��- STORIES: � SQ.FEET OF EACH FLOOR: ��(� NO. OF BEDROOMS: _� GARAGE STALLS: ATTACHED DETACHED� 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: , �U.%� �� .l ;J DATE: � � � � `�✓v! � 9 ��/�� , / r � Sec.13.04 RIGATS OF SUBJECTS OF DATA " Subd.1. Type of data. The rights of individual oa whom the data is stored or to be stored shal!be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himseif shall be informed of: (a)the purpose and incended use of the requested data within the collectiog 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 nfusing to supply private or confidential data;and(d)the identity of other persons or entities authoriud by state or federal 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 taw enforcement officer. Ths commissioner of revenue mav nlace the notice required under this subdivision in the individual income tax or vrooertv tax refund instructions instead of on those fortns. 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 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 desiru,shall be informed 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 addidonal 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 authoriry may require[he requesdng person to pay che actuat costs of making,certifying,and compiling the copies. The responsible authority shatl 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 lega]holidays,if immediate compliance is not possible. If he cannot comply with the request within that ame,he shall so inform the individual,and may have an additional five 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 individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall natify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)conect the data Found to be inaccurate or incomplete and attempt to notify past recipiencs of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be cortect 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 authoriry 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. �%�hur� L�� 'j�� First Middle Last ��1?M u1 �I/l c:�r:c. �liC� • naa«ss �r�n,o �n� �.�'!�� 1 a��'�' City State Zip � Phone I understand ri ts as stated above. ��`�l Signature 1� � HARDCOVER CALCULATIO ORKSHEET ' 3�TBACK ZONE: (CIRCLE ONE) 0-75' 75- 250-500' S00-I000' EXISTING HARDCOVER IN ZONE �l � A. House �L�.� x �`�"3 = S.F. Length Width z = S.F. x = S.F. x = S.F. B. Garage �• jJ a- �� _ � S.F. C. Drivewcty ' � x = �� S.F. L = S.F. /� �j 1 D. Sidewnik �� x �J`�J` = S.F. x = S.F. E. Pati.o/Deck a .�� _ ��_S.F. -r = S.F. F. Landscape z = S.F. Urcderlain x = S.F. By Plastic x = S.F. Or FaGric • G. Otfier x = ��.�S.F. �fQ� TOTALHARDCOVERINZONE - --��S.F. A TOTAL PROPERTYAREA IN ZONE S.F. B A �A'/.�� a x�oo = � S. % PROPOSED HARDCOVER IN ZONE A. House x = S.F. Leitb rh Widrh ,r = S.F. X = S.F. x = S.F. � B. Garnge a S.F. G Driveway z = S.F. x = S.F. D. Sidewalk x = S.F, x = S.F. E. Patio/Deck x = S.F. x = S.F. F. Lanclscnpe x = S.F. Underlain x = S.F. By Plastic x = S.F. Or Fabric G. 01her x = S.F. TOTAL HARDCOVER INZONE - S.F. A TOTAL PROPERTY AREA IN ZONE - S.F. B A = B x 100 = % 23 DATE TIME " CITY OF ORONO CALLED IN - L-O INSPECTION NOTICE SCHEDULED �� QTPJ7 PERMIT NO. �D �7SS� COMPLETED ADDRESS—I� �d �� l�,.� �e� OWNER K�� -e� CONTR. ' TELEPHONE NO.___ 9�A� '" � l�.S/0:55� � DESCRIPTION %r� J ' ��'G`� � 01� 11 MECHANICAL RI 18 EXCAV/GRADING/ ILLING Q 2 F MIN 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 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO ��., COMMENTS: � W a � � O �. � O � W � Q � Z W � W � � d W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next in pection 24 hours in advance. (J52� 249-46�� OwnerlContra r it inspector. White Copyllnspector's File Canary CopylSite Notice ✓ Df,T�, TIME CITY OF ORONO ALLED IN �-' INSPECTION N TICE SCHEDULED 7- --� : d PERMIT NO. COMPLETED ADDRESS l�g� �--��Q ��Q OWNER /��f K��C�`L— CONTR. TELEPHONE NO. �SZ �9S l T�O� , r' _ � -- �� ¢ C� � DESCRIPTION _ ��C -9� � lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS ti O 03 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 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTIC FINAL � 35 HARD COVER REMOVAL J 10 PLUMBING FINAL ,�j 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � J O � � O � W � Q � Z W � W � � d W WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 �CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WFLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUtRED.CALL TO ARRANGE ACCESS. Call for the ne inspection 24 hours in advance. (952) 249-460� OwnerlContrac�o�� s e: Inspector. � White Copyllnspector's Fil Canary CopylSite Notice