HomeMy WebLinkAbout2004-P07273 - addn/remodel/repair � `' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�z�3
Crystal Bay, Minnesota 55323 P@Cllllt Typ@: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 3i4i2oo4
SITE ADDRESS: isao Long Lake B��a
Long Lake,MN 55356
PID: 26-118-23-33-0031
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: �.iec;�ricai(sia�ej
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 9725
Valuation: $ 3,200.00
State Surcharge Fee: $ 2.10
TOTAL FEE: $ 99.35
APPLICANT: MattKeller OWNER: �O� �I��ol+� ���-c�-
508 lst. St.E 1580 Long Lake Blvd ���-"��'
Waconia,MN 55387 Long Lake MN 55356
THE UNDERSIGNID HIItEBY REQUESI'S PIIZMISSION TO MAKE THE REAI.IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTAB DINGCODEREQiJIREMENTS.
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APPLICANT PEKMITEE SIGNATURE lISSUED BY SIGNATURE
Copies: 1-File(Sieriin�res Required). 1-Applicant. 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
w.
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Total Fee: $ �1 C i � Date Received: 3 �� -G
Entered By: i2_U Permit#: � � 7 2
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforn:ation)
THE APPLICANT IS: (circle one) OWNE OR CONTRACTOR
JOB SITE ADDRESS: � � �� (�vy�� �-17�� ��1�� ZIP: �� �s�
Will this be a Parad� of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ��No If yes, a special event permit is required with Police Department and City
Council approva160 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: � ��C�LI� f��10►n�-�uhsan pHONE: (home) g' y��` �`�y
(work)
MAILINGADDRESS: ���G C-p�'1�j �f� �����CITY: �V�C>�?L ZIP• �S3s-r�
CONTRACTOR: /' '�f r 1LC'���'�— PHONE: � l �'• ��� • ��I 9
CONTACT PERSON: ��� �/t�i2 MOBILE/PAGER: S��-�
MAILING ADDRESS: � l S S� ��s CITY: l.�/��c'n,%� ZIP: S��3�
STATE LICENSE:�- �C - � �3 ' N 5"
ARCHITECT/ENGINEER: S � � � �,lt'u�p�l�-z... PHONE: L/�� � Z �� � � L/�// �
MAILING ADDRESS: �,'C �' i S� S � � CITY• �✓�����` ZIP: 5 5��•. ?
NAME: �71��7 N� �.(�;�('� REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration � Land Alteration
PROPOSED WORK(describe in detain: _�l�'��e- �t'� �,,�z�� S{��'�%'���- ��-, (�''.-��i �-�--
<_ W��� .��?011e- C�t' c�(cQ �Lv4e-}' �
STORIES: �' SQ. FEET OF EACH FLOOR: S��
NO. OF BEDROOMS: �.� GARAGE STALLS: ATT. t% DET. NJ
��c� .
ESTII�IATED CONSTRUCTION VALUATION (excluding land): $ ��,�(,} �
I hereby apply for a building pernut and I aclrnowled e that the information above is complete and accurate;that the
work will be in conformance with the ordinan a d codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to ta without a pernut;and that the work will be in accordance with
the approved plan.
�� �
APPLICANT'S SIGNATURE: ' DATE: 3 1 �)
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights oC individual on whom the data is stured or to be stored shail be as set forth in this section.
Subd.2. Information required to be given individual. An individual asl-ed to supply pri�•ate or con£dential data rnncerning himself shall be
informed of: (a)the purpose and intended use of the requested data within the collectia,g state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)an��l-nowa consequence arising from his suppl�iog or re(using to supply
private or confidential data;and(d)the identity otother persons or entities authoraed b}-state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to semon 1��2,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav nlace the notice reaaired under this sub�isision in the individual income tat or orooertv ta�c refund
instructions mstead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible aothoritc,an individual shall be informed N hether he is the subject of
stored data on individuals,and whether it is classified as public,prn ate or confdential. L-pon his further request,an indicidual who is the subject of
stored private or public data an individuals shall be shown the data withaut an}-charge�o him and,if he desires,shail be inCormed o(the content and
meaning oC that data. Atter an individual has been shown the pri�ate data and informed of its meaning,the data need not be disclosed to him for sIx
months therea[ter unless a dispute or action pursuant to this section is pending or additional data on the Individual has been coilected or created. The
responsible authority shall provide copies o[the private or pub(ic data upon request by the individual subject of the data.T6e responsible authority may
require the requesting person to pay the actual costs of mal:ing,cerq[ying,and compilin�tbe copies.
The responsible authority shall comply immediately,i[possibie,with an�-requtst made pursuant to this subdivision,or within five days of the
date of the request,excluding Saturdnys,Sundays and legal holida�s if immediate mmplixnce is not possible.If he cannot comply with the request within
that time,he shall so intorm the individual,and may have an additiooal five days h ichin w hich 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
concerning himselC. To ezercise this right,an individual shall notif�in writing the respoav'ble authority 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 of
inaccurate or incomplete data,including recipients named by the individual;or(b)notif�-the individual that he believes the data to be correcL Data in
dispute shall be disclosed only if the individual's statement of disaereement is(nduded�.ith the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administratice procedure act relating to
contested cases.
DATA PRIVACY AD�ZSORY
In accordance�vith M.S.13.04,Subd.2,"Rights oisubjects of data",we would like to inform}-ou that your request
for a permit or license from the City of Orono or an}�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 eatent necessary to process
the permit or license.
4. If your requested permit or license requires Council acuon to approve, some information may become
public.
5. You have certain rights under M.S. 13.0-3(available upon request)to review private data on yourself.
6. Your full name is required to process this app(ication or permit.
�
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First Middle Last
Address
C�ty State Zip Phone
I understa as tated above. .
�,�,,_..._
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Signa[ure
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �S�O (�o.�k� (�/�k.� r3c..v✓.�
PID:
DESCRIPT'ION OF WORK: �A sT�2 f3�.-d fb�on�. f?.c,=r,t,o�o��
ZO.�i G REVIEW BY: / DATE APPROVED:
BUII.,DING REV�W BY: DATE A.PPROVED; 3-2-�y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,/' No
PLAN REVIEW Yes No � SEWER CONNECTTON
STATE SURCHARGE Yes ✓" No WATE�tCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SIT'EINSPECfION
Number of SAC-Units OTHER (specify)
ZONING CI�CK LIST Zoning Districr. N c> G
Fire Department: Post OfFice: School District: �
Lot t�rea: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: Wet d:
Building Height: Def. Hgt. Pe • Hgt.
Lot Coverage:
Grading: Staff Approval Date: By. Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: � Resolution: !/ Resolution Date;
Shoreland District:
Avg. Setback: Bluff Setb k: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: �Ces N Date of Council Approval:
REMARKS (in house):
7
BUILDING REVIEW CHECK LIST
�C� _ R '3 CONSTRUCTTON TYPE: �(N
_ Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor z _
Gazage x =
x =
TOTAL
Estimated Construction Value: $ 3 Zpv �
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing � Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
_o,�Wall Board (Mfg.) Well (State Permit)
—.1�.F�� Grading/Filling _�Elecuical (State Permit)
Other
REMARK.S(IN HOUSE): .
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REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
------------------------------------------------------
REI�ZARI�S (TO BE NOTED ON PERivIIT�:
8
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D TE TIME
CITY OF ORONO CALLED IN 3 r� �
INSPECTION NO CE SCHEDULED �
PERMIT N0. 7a�•3 COMPLETED
ADDRESS l sg0 C a�-,c� �� ,�l1/� /
OWNER CONTR. �Q� �1��
TELEPHON E NO..�3a5+��l -
� DESCRIPTION ���n�"�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING�� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y �IBbb1�N 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z �6aAl�i[" 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPUUNT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
2 OWNERICONTRACTOR TO MEET YO YES_NO
y COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPOFiARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION REQUIRED.C LTO ARRANGE ACCESS.
Ca11 forthe ex inspection 24 hours in advance. (952) 249-4600
OwnedC o s e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
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