HomeMy WebLinkAbout2006-P09517 - addn/remodel/rerpair PERMIT
C�ITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09517
Crystal Bay, Minnesota 55323 Pert7tit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
1/31/2006
SITE ADDRESS: 1367 North Arm Dr Unit#
Mound,MN 55364
P��� 07-117-23-41-0065
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Fireplace Electrical(state)
NOTICES/REMARKS:
Basement remodel
FEE SUMMARY: Pernut Fee: $ 181.25 valuation: $ 10,000.00
Plan Review Fee: $ 117.81
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 304.06
APPLICANT: Owner/Self OWNER: Linda Theisen
MN 1367 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 WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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PLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ .�o . O Date Received: �-� - D(o
Entered By: Permit#: �D 9S/ 7
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please p��int all i�zformation)
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THE APPLICANT IS: (circle o�ze) OWNER� R CONTRACTOR
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JOB SITE ADDRESS: l: , � ��� �{"I�r�'1 D12� ��Z-(,�I`v(.) ZIP: �j��'
Will this be a arade of Homes, Remodelers Showcase Home or other Display Home?
❑ yeS �LvO If yes, a special everzt perrnrt is rec�z�rred tii�ilh Police Departn�ent and Ciry Coarncll approval
60 days prior to tlre event. Shuttle baEs service will be reqirired a�nless applicant de�nonstrntes
szrfficzen!on-site parkiy�g is available. Non�er�nrttecl event,r will not be allowed.
NaME o�ov�vER: Ll N�� �t 1fi��1�E1�,' �xovE: �l�ome� C��>��f 7Z-C�`f� 7U
(work) � -2��-����
MAILING ADDI�ESS: i��(��7 /�`� �z��-��I)IZ��TY: (U i �-� zir: Ss��
CONTRACTOR: �(,'L� PHONE: �
CONTACT PERSON: <��?,t� MOBILE/PAGER: �'�J Z�Z�D��7�->
MAILING ADDRESS: g�?i� CITY: ZIP:
STAT�LICENS�: # EXPIRA'TION DATE:
ARCHI'I'ECT/ENGINEER: PHONE:
MAILiNG ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
T�'PE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows) �
PIZOPOSED WORK(describe in�letain: t�`X�►lr r��t ��, i 1GC��
S'Y'ORgES: � SQ.F'EET OF EACI-�F'LOOR: 1?--C>�� ti�1,41 P� �D(_� 1'JC�`=����'�'-f'�'� �
rro. o� s���oo�s: ,� �a��� s�rA�,�,s: A���cx��� ����c���_
�S'I'I1VIA'�'ED C'ONSB'I�iJC'�'I0�1�A�,iJA'g'ION(exeludiaag land): � ���� ��'�
I hereby apply for a building permit and I acknowledge that the infonnation above is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City and witl� the State BuildinQ
Code;that I undeistand this is not a pennit and work is not to start without a pennit;and that the work will be
in accordance with the approved plan.
����,Ic���r����������: �`l �t-�C-��,� �J-��,�;��,�.� ����: i�l��104�
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. l. Type of data. The rights of individual on whom the data is stored or[o be stored shall be as set forth in this section.
Subd.2. Infoi�nation required to be given individuaL An individual asked to supply private or confidentia]data conceming himself shall be
informed of: (a)die purpose and intended use of the requested data within the collecting state agency,politica]subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested da[a;(c)any hnown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity 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,pt�rsuant[o section 13.32,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice reguired under this subdivision in the individual income tax or propertV tax refund
inshvctions instead of on those forn�s.
Subd.3. Access to data by individual. Upon reques[to a responsible authority,an individual shall be infornied wllether 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 desires,shall be infom�ed 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 ro this section is pending or additional 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 authority
may require the requesting person to pay the ac[ttal costs of making,certifying,and compiling the copies.
The responsible sud�ority shall cotnply inm�ediately,if possible,with any request tnade pursuant to this subdivision,orwithin five days of
the date of Hie reques[,excluding Saturdays,Sundays and lega]holidays,if immediate compliance is not possible. If he cannot comply with[he request
within that time,he shall so inform the individual,and may have an additional five days within which co comply with the request,excluding Sa[urdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accur�cy or completeness of public or private data
concerning himsel£ To exercise this right,an individual shall notity in wiiting the responsible authority describing the nah�re of the disagreement.The
responsible authority shall within 30 days ei[her: (a)con'ect Ihe data found ro 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 individual that he believes the d�ta to be coiTect. Data in
dispute shall be disclosed only if the individual's scatement of disagreement is included with the disclosed data.
The detertnina[ion of the responsible authority 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",tive would like to inforn�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 inforn7ation.
You are notified tl�at:
1. The inforniation you furnish will be used to determine your qualification for the permit or license
requested.
2. You may refuse to supply data,but refiisal may require that the City deny the pernlit or license.
3. The infoinlation may be shared with other local, state or federal agencies to the extent necessary to
process the pennit or license.
4. If your requested pennit or license requires Couucil 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 pernlit.
First hliddle Last
Address
Citv State 7ip Phone
E and�rsGand n�y r'sahts as state� above,
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11 � ��-����.��-� ����z _-_
Signature
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� CH�CK OFF i.iST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I 31�1 /UDR� A21N� �J+e
PID:
DESCRIPTION OF WORK: i3As�vY.��r �=,��sl-4
ZOVPi TG REVLEW BY: DATE APPROVED: �(/�
BUILDING REVIE`Y BY: DATE APPROVED; �. 2�-o ro
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW � Yes � No SEWER CONNECTION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�TING CH�CK LIST Zoning District: N'o c�
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
Rear(Street): Left Sid .
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date: �
Septic: Staff Approval Date: By:
Zoning File: # Resotution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setb ck: L.ot Covenge:
Eusting Proposed
Hardcover: 0-75'
75-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REv1ARKS (in house):
7
BUII..DING REV�W CIiECK LIST
UBC: f�' 3 CONSTRUCTTON TYPE: �l�
Sq Footage $Per Sq Ftg
Basemeat . , x =
lst Floor x =
2nd Floor x _
Gazage x =
x =
TOTAL
Estimated Construction Value: $ 10,OOD �
Inspections Required: Work Requiring Separate Permits:
Site _�Plumbing Fire
Hazdcover Removal d Mechanical Water Connection
F���B Septic Sewer Connection
` _�C Framing _ o�Fireplace Lawn Irrigation
�( Insulation (Masonry) Other
_�Wall Board e� (Mfg.) Well (State Permit)
_�F�� Grading/Filling _�Electrical(State Permit)
Other
REI�ZARKS(IN HOUSE): .
------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
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REVIARKS (TO BE NOTED ON PERMI'I'):
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��O � � D�T TIME �
C1TY OF ORONO c� n��E�iN Z
INSPECTION I SCHEDULED 3� �
PERMIT NO. COMPLETED •
ADDRESS___ I�G�7 /V� �/'N �7 `
OWNER L��/'LC`IA 1 I1 � NTR.
TELEPHONENO. 7 S Z �-T� b7T3
� DESCRIPTION T I'� ���
� 01 FOOTING M 11 MECHANICAL RI� 18 EXCAV/GRADING/FILLING
Q 2 R,4MING {/� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 3 NSULATION Q� 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 4 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED C� PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED r' ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n xt inspection 24 hours in advance. (J52� 249-46��
Owner/Contra ite:
Inspector.
White Copyllnspector's ile Canary CopylSite Notice