HomeMy WebLinkAbout2004-P07795 - plumbing CiTY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: Po��9s
Crystal Bay,'Minnesota 55323 PefCTllt Type: Addition/RemodeURepair
(952) �49-4600 Date Issued: s�6i2ooa
SITE ADDRESS: 525 McCulley Rd
Maple Plain,MN 55359
P I D: 31-118-23-24-0012
DESCRIPTION:
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate pernuts required: riumoing iviecnanicai rirepiac;e i�iner-�i nis is wny seperaie permii requiredj
NOTICES/REMARKS:
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.... .... ._ ... ... . ....... ...... .... . ' ' '
FEE SUMMARY: PernutFee: $ 321.25 Valuation: $ 20,000.00
State Surcharge Fee: $ 10.50
TOTAL FEE: $ 331.75
APPLICANT: Stephan Homes(see notes) OWNER: Chris Steffon
3775 Co. Rd. 92 525 McCulley Rd
Maple Plain,MN 55359 Maple Plain,MN 55359
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 ISSUED BY SIGNATURE
Copies: 1-File(Si,enitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
���
Total Fee: $ �'�� � Date Received: 8- `�-O �
Entereu�By: J�� 1� Permit#: AD7795
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�at all i�iforn:atio�i)
-------------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��� �'7� �ci�(E�I �0�4� ZIP: 5�3�I
Will this be a Parade of Homes, Remodelers Sliowcase Home or other Display Home?
❑ Yes � No If yes, a special event perinit is reqi�ired with Police DepaJ•tna.ent af�.d City
Couyicil appiroval 60 days pYior to the event. Non perrnittecl evefats will not
be allowed.
NAME OF OWNER: ��-�phan �2� Covlst. PHONE: (home) �a �,?-�
n (wo k)
MAILING ADDRESS: �775 �'o. �d• �o� CITY: , jF �a;� ZIP: 5535J�
CONTRACTOR: �j-(�-�pl�r� ��5 PHONE: �� - 3�a -�/�'9
CONTACT PERSON: CI-�,r;s MOBILE/PAGER:
MAILING ADDRESS: Sa,,�Q �S ,4F��,=_ CITY: ZIP:
STATE LICENSE: # aG0�3ii�.
ARCHITECT/ENGINEER: �t= P �(�n�,; S�e�;qn PHONE: 7(3- 7�0 -$00�
MAILING ADDRESS: ��-��ITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeUAlteration Land Alteration
PROPOSED WORK(describe ilz detai�: t-;n;5h �e,�-��t�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ a0 /-�
I hereby apply for a building permit and I aclmowledge that the infortnation 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 pernut 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: � G
Sec.13.04 RIGHTS OF SU$J�CTS 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 concerning h[mself shall be
informed of: (a)the purpose and intended use of the requested data within the collectfng 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 data;and(d)the identity of other persons or entlties authorized by state or federal Iaw 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 revenue mav olace the notice reauired under this subdivision in the individual income tax or orooertv tax refund
instructions instead of on thase forms.
Subd.3. Access to data by individusl. Upon request to a responsible authorlty,an indiv[dual shall be informed whether he is the subJect of
stored data on indlviduals,and whether it is classitied 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 intormed of the content and
meaning of that data. Atter an individual has been shown the private data and informed of its meaning,the data need not be disciosed to him for siz
months thereafter unless a d[spute or action pursuaat to this section is pending or additional data on the individual has been collected or created. The
responstble authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible suthority may
requfre the requesting person to pay the actuai costs 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 requcst,excluding Saturdays,Suadays and legal holidays,if immediate compliance is not possible.If he cannot comply with the requestwithin
that time,he shall so inform the individuai,and may have an additional tive days within which to comply with the request,excluding Saturdays,Sundsys
and legal holldays.
Subd.4. Procedure when data is not accurate or complete. An individual may rnntest the accuracy or completeness of public or private data
concerning himself. To exercise this rtght,an indtvidual shall notify in writing the responsible suthor(ty describing the nature otthe 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)notify the indivfdual that he belleves the data to be correct. Data in
dispute shall be disclosed only If the inJividual's statement of disagreement is included with the disclosed data.
The determinatlon of the responsible authority may be appealed pursuant to the provisions ot 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. T6e 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
City Stste Zfp Phone
I under y ' t tated ov
Signature
CIiECK OFF LIST FOR ISSUANCE OF PERMITS
, FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �Z S �'V�c C�I�e•� (Z.o.ai/� '
PID:
DESCRIPTION OF WORK: (�ow�:2 Cx—v�L F�N�s M
ZO�IG REY�ti� BY: (� DATE APPROVED:
BLRLDI�IG REVIE`V BY: DAT'E APPROVED; a -S •��
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERIVIIT Yes ✓ No
PLA1�T REVIEW Yes _�;�i No f SEWER CONNECTION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC-Units OTHER (specify)
Z01TING CHE.CK LIST Zoning Districc: nr c� c(-� O .
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Street): Left Side:
Adjacent Structures: Netland:
Building Hei;ht: Def. Hgt. Peal:Hgt.
Lot Coveraoe:
Gradine: Staff Approval Date: By: Council Approval Date:
Septic: Scaff Approval Date: By:
Zoning File: # Resolution: # Resolutioa Date: •
Shoreland District: �
Avg. Setback: Bluff Setback: LotCoverage:
Existine Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMA.RKS (in house): P�2 0 2�c��r�s d-`. I-4-n�sR p c�
7
. %
Bi,T�,DING REV�W CHECK LIST
UBC: R ' 3 � CONSTRUCTION TYPE: V IJ
_ Sq Footage $Per Sq Ftg
Basement . x _
lst floor x _ .
2nd Floor x _ .
Garage x = �
x =
TOTAL
Fstimated Construction Value: $ Zp,o�d "'�
Inspections Required: `Vork Requiring Separate Permits:
Site �Plumbi.ng Fire
Hardcover Removal _�Mechanical Water Connection
, �����g � Septic Sewer Connection �
X Franung __�Fireplace Lawn Irrigadon
oC Insulation (Masonry) Other
_�Wall Boazd __�(Mgg,) Well (State Pecmit)
�' F�� Grading/Filling oc Electrical (State Permit)
Other .
REMAIEZKS(Pi T HOUSE): .
-----_--------------------------------------------------
REVIEW BY OTHERS: DAT'E:
Access: Existing New .
Access Approval: Date gy; �
��_��----------------------------------------------------
RENIARKS (TO BE NOTED ON PERl�IIT�: S,�• N o�5 oN o�-��„�„�
v s�e w�-rJ
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��� DATE TIME
CITY OF ORONO CALLED IN S G'>
INSPECTION NO ICE ,�. SCHEDULED � � �
PERMIT NO. � � COMPLETED
ADDRESS ��-� � ��C" '-C._�.�C-E-��
OWNER CONTR. �`-���/�L�f-//�'!S
TELEPHONE NO.��c� .I�S � ( � .��Z `-yj�l
7
� DESCRIPTION ���-�-t��--
� 01 FOOTING 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
Z04 WAIL 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
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL ^ 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YO YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
�CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (952) 249-46��
OwnerlContra o ite:
Inspector.
White Copylinspector's ile Canary Copy/Site Notice