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2006-P09853 - addn/remodel/repair
� PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po9853 Crystal Bay, Minnesota 55323 Permit Type: (952) 249-4600 Addition/Remodel/Repair Date Issued: 6/5/2006 SITE ADDRESS: 1350 North Arm Dr Unit# Mound,MN 55364 PI D: 07-117-23-41-0084 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 251.25 Valuation: $ 15,000.00 Plan Review Fee: $ 16331 State Surcharge Fee: $ 7.50 TOTAL FEE: $ 422.06 APPLICANT: Owner/Self OWNER: Kent Stearns M� 1350 North Arm Dr Mound,MN 55364 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE W1TH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING 10DE REQUIREMENTS. � � � �'� ` ���7c�;_ ��� -`, � Arr CANT rERMITEE SIGNATURE ISSUED BY SIGNATU�'FE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 �� 5-3b-0� � � Total Fee: $ �aa� Date Received: ,�/1 D���v Entered By: ;�'L Permit#• (�c�`(��� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print ccll infoYniation) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: ��,�`�U d'�.1� ���v� ��(Z ZIP: 7 3�; Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �NO If yes, a specia!event perrrrit is required with Police Deparlment and City Cozrncil approval 60 days prior to the event. Shzrttle bus service wil!be r•eguired unless applicant clernonstrates sicfficient on-site parhing is avnilable. Non-permittecl events ivill not be allowed NAME OF OWNER: (�C—��-` � 5'i��2c��j PHONE: (home) k-�Z-�{�Z-U Z�Z '�F(work) tnl Z—1c�(—�3 Z-- MAILING ADDRESS: ��U f��k �l���> CITY: ��,1����=��� ZIP: c' 3� CONTRACTOR: ��.1 ���-��� i �c.%�L'L.-(� PHONE: CONTACT PERSON: c MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home RemodeVAlteration (ie: Siding, Windows) � Any earth movement may require MCWD review and permits ! PROPOSED WORK(describe in detcrin:��r�,_,�j ��� ���vG � ST`�S C�c�:' �k(ST<a'G `���� �>C_�C;'(f��. �l�E�,� ; �}� T�2<v2 Ll,���,v���tiGU STORIES: Z SQ.FEET OF EACH FLOOR: 1 Z- � U NO. OF BEDROOMS: ?�_ GARAGE STALLS: ATTACHED Z DETACHED_ ESTIMATED CONSTRUCTION VALUATION(excluding land): � l����� U - �G� 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[ understand this is not a permit and�vork is not to start without a pennit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: C�� DATE: � � b � � 31 Sec.13A4 RIGHTS OF SUBJECTS OF DATA Subd. L Type of data. The rights of individual on whom the data is stored or to be stored shall be as se[forth in this section. SuUd.2. Infonnation required to be given individual. An individual asked to supply priva[e or confidential dataconceming himselfshall be informed of. (a)the purpose and intended use of the requested data within the collecting 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 suppiy private or contidential data;and(d)the identiry of other persons or entities authorized 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 law enforcement officer. The commissioner of revenue mav olace the notice rec�uired under this subdivision in the individual income tax or orooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed���hether he is the subject of stored data on individuals,and whether it is classitied as puUlic,private or contidential. Upon his fuRher request,an individual who is the subject of stored private or public data on individuals shall be shown the data�vithout any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been sho�vn the private data and infonned of its meanin�,the data need not be disclosed to him tor six months thereafter unless a dispute or action pursuant to this section is pendine or additional data on d�e individual has been collected or created. The responsible authority shall provide copies oF[he private or public data upon request by the individual subjec[of the data. The responsible authority may require the requesting person to pay the actual 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 tive days ol the date ofthe request,escluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [fhe cannot comply with the request �vithin[hat time,he shali so inform the individual,and may have an additional five days within which to coinply 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 puUlic or private data concerning himself. To exercise this right,an individual shall notify in�a•riting the responsible authority describing the natiue of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data fow�d to be inaccurate or incomplete and attempt to notity past recipients of inaccurate or incomplete da[a,induding recipients named by the individual;or(b)notiry the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disa�reement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of die 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 pern�it 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 detern�ine 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 sliared 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 yourseif. 6. Your full name is required to process this application or permit. First / �9iddle Last (C�r.v r ,z-��/zr2l 5��k-= S(���f 2�c.)� Address � � �v �,�, �2��� �D�2 . Cih� �1����`��) �� State ���j��Zip Phonc ���—���Z� ( VZC� "7� I understa my rights sta�4ve. � Signaturc J Reset Form �� Ci�CK OFF i.IST FOR ISSUANCE 4F �ERMITS FOR OFFICE USE ONLY ADDRESS 4RLEGAL: /3�o No A/� D�t PID: DESCRIPTION OF WORK: �r�cs ZO�.vI�li 'G REVIE�V BY: � DATEAPPROVED: s'2$�-0�, BUII�DING REVIE`Y BY: DATE APPROVED: S•zr�6. FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes ✓ No PLAN REVIEW � Yes ✓ No SEWER CONN'EC'I'ION STATE SURCHARGE Yes _1L No WATER CONNECTTON INVESTIGATION FEE Yes No _� PARK FEE SAC Yes No � STTEINSPECTION Number of SAC�Units OTHER (specify) ZOYING CH�CK LIST Zoning District: .. Fire Department: Post OfFice: School District: � Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes�_ No Date of Survey: c7- 13-'�� Proposed Setbacks: ' F 2 � Front(Lake): (o�' _�j� ` Right Side: Z L Rear(Street): I 6 2' Ii � Left Side: it/ Adjacent Structures: �}-r�,qc,4-e,�3 Wetland: N 1� Buildin� Height: Def. Hgt. N �_ Peal:Hgt. /�l 1/{� Lot Coverage: O•� Grading: Staff Approval Date: nl I,a By: �— Council Approval Date: �' � Septic: Staff Approval Date: N �,/3- By: Zoning File: !# N° Resolution: # — Resolution Date: Shoreland District: ,�� Avg. Setback: N l �F Bluff Setback: �1 (/.� LotCoverage: 0 �Q Eusting Proposed Hazdcover: 0-75' 75-250' zso-soo� o. k 500-1000' Hardcover Vaziance Required: Yes No .� Date of Council Approval: REviA.RKS (in house): � BUII�DING REVIE`V CHECK LIST �C� � � � CONSTRUCTION TYPE: 'V� Sq Foota;e $ Per Sq Ftg Basement . . x = � lst Floor x � _ 2nd Floor x = Garage x _ x = T4TAL Estimated Coastruction Value: $ !S,o00 °^ Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical Water Connection �Footing � Septic Sewer Connection � ' _�Franaing Fireplace Lawn Irrigation Insulation (Masonry) Other Wall Boazd (Mfg.) Weil(State Permit) _�F�� Grading/Filling Electrical (State Permit) Other REMAR,KS(IN HOUSE): ---------------------- REVIEW BY OTHERS: DATE: . 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I I � I I I I i i , , � I — -�—�—L— — --�—� �-�-- --�-- ---�--L--�------�--�— �— �-- --- �---�-- — � , i ���— � � � � I _ _ - -- - -; i �_ i � I I , I I i ' � ' � --� �- � _.�--�--� -�-' �---- _ ,- _; �--'- ' - -- ' --- -- ' � �-- - _�_-i r -_- I � i i C--f-i-i �- � i � � 1 i i i - i , i i � � � i -i ��_ � l� ° ��Q - � Gct��°�lp ?. COYNE �" �"" *� � f"" RAYMOND A. PRASCH � '� ���� � ���� ��� �'���'�����' 300 "f'!JNSW!CK RV[. S. ��"� cx� :�:� :��* vt �:,� � � � t�� r� 69I7 ID�HO AVE. N. � GOL��:IJ `Jr'�i_!f_Y, "�+INN. x�;�7� ,S"�'���"���'t,�' E3ROOKLYN PARK, MINN. ; . ! �t`�GIS'�'�'��� Ul�D�"� �..f1'4VS 4F STATE OF MINNESOTA �`�91� . INVOICE NO. � ;,�(;�'.!�I��.?� I3Y ��'?�XN�NGF ON' CiTY OF 1V�IINNEAI'OI.Ig i�{,�)_1+� � F. B. 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