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Home My WebLink About2007-P11419 - addn/remodel/repair PERMIT CITY� OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p11419 Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair (952) 249-4600 Date Issued: 9/21/2007 SITE ADDRESS: 4140 North Shore Dr Un�t# Mound,MN 55364 P�� 07-117-23-44-0052 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: Plumbing Mechanical Electrical(state) NOTICES/REMARKS: Remodel kitchen&Laundry FEE SUMMARY: Permit Fee: $ 321.25 valuation: $ 20,000.00 Plan Review Fee: $ 208.81 State Surcharge Fee: $ 10.00 TOTAL FEE: $ 540.06 APPLICANT: Owner/Self OWNER: Ted&Carrie Woychick MN 4140 North Shore 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. � � �� PLICANT ITEE,,$i.�sN - - --- C— �1,� SUED BY SIGNATURE _� ___.. Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 , y (��C7 ��,p� Total Fee: $ J'��d.f�,( Date Received• 9-��'D 7 Entered By: Permit#: �L CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all informatioh) THE APPLICANT IS: (circle e) �OWNER R CONTRACTOR JOB SITE ADDRESS:�/ � /[�r��la,-� ��, z�: 5S 3� � Will this be a P ade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes No Ifyes, a special event permtt is reguired wdth Police Departrrrent and City Council approval 60 days prior to the event. Shuttle bus service will be reguired unless applicant demorrstrates suffacient on-site parking is available. Non permitted events will not be allowed i NAME OF OWNER�� `�'� � HONE: (home) � 7 �� MAILING ADDRESS: /l��7 � . CITY: y �wor�� CONTRACTOR: � PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CTTy; �p; NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure �, Move Home RemodeUAlteration (ie: Siding, Windows) Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detai�: � � �� - i� ' r STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(ezcluding land): $� � I hereby apply for a building permit and I acknowledge 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 Sta.te 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: DATE; Q� 31 e . Sec.13.04 RIGHTS OF SUBJECI'S OF DATA $ubd.1. Type of data. 'The right�of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Infoimation required to be given individual.An individual asked to supply private or confidential data conceming himself shal I be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivisioq or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities suthorized by state or fede�al law to receive the data.This requirement shal l 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 may place the notice rec�uired under this subdivision in the individual income tax or pronerty tax refund instructions instead of on those forms. Subd.3.Access to data by individual. Upon request to a responsible authority,an individual shall be infartned whether he is the subject of stored data on individuals,and whether it is classified es 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,shal l be informed of the content and meaning of that data. After an individual has been shown the private dam and informed of its m�ning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe da�. The responsible authority may require the requesting peison 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 five days of the date ofthe request,excluding Sadudays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional Sve 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 acc�aacy or completene�ofpublic or private data conceming himself.To exercise this right,an individual shall notify in writing the respons�ble authority descn'bing the nature of the disagreement The responsible authority shall within 30 days either. (a)coaect the data found to be inaccurnte 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 data to be correct Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed daYa. The determination of the responsible authority may be appealed pursuant to the provisions of the adminiskative 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 fumish 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 C6uncil action to approve,some information may become public. 5. You have certain rights under M.S. 13.04(a'vailable upon request)to review private data on yourself. 6. Yout full nazne is required to process this application or permit. �y -�- �� First�E� i d� Las ��'�" —`� L Q � Address 1�i��/� ,�'�it/ �� gSa y�� a,.s�6 C�b' State Zip Phone I unders nd my rights as s ed above. Signa ��t��at� �T � ,� 32 _ � � "� . . �CHEC3E�C�FF i,IST FOR ISSUANCE ��'�ERMITS S OR LEu�AL: �OR OFFICE U5�v� Sfne�r(' ' �r ' p,IDIRES �' PID: �DESCRI�'T�O�i OF WORK: c�c=z _------ - ZOY.I�G REVIEtiV BY: N I J� DATE APPFOYED: . DATE.�:P'PROVED; �- �� e� �ULLDING REVIE�V BY: ��CQ.�.�------- • . " k'EES T4 BE CHARGEU: � Misc. Fees Calculated By: P��T �es � No PLAN REVIEtiV '� Yes _� No SE��TER CO�TNECTIOI�1' STATE SURCHAR.GE Yes �� No �'ATERCONNECTION INVESTIGATION FEE Yes No —� PARK FEE SAC Yes No � STI'EIl�TSPECZTOld' . Number of SAC•Units OTHER (specify) . 2pi�TG �HE.CK LIST Zoaing Districr.~ t/r/� GK�-/U( � � . Fire Deparcment: Post OfFice: School District: • � Lot Area: Sq.ft. Acces ' Width Depth Survey Submitted:� Yes No Date of 5urvey: _ Proposed Setbacks: � • : Front(Lake): Ri�lxt Side: , Rear(Street): Left Side: Adjacent Scructures: �Vetland: auildin�Hei�t: DeE. Hgt. Peak Hgt. Lot Covera�e: Gradind: Scaff App:oval Date: _ By: Council Approval Date: ' Septic: StafE Approva!Date: � �Y� �V J1. Zoaln�File: ��_ Resotutioa: n Resolution Date: Shoreland Distric�: Avg. Se[back: E!uff 5et5ack: L.otCove2je: E�sting Propased H��dcaver: G-7�' 75-250' Z�Q-S�.�J' �CO-1CC�J' ,- :y . _.�,;_,. Na�CC.O`:2C C2 R?yL!Ce�: `:2� ,�4 iJi:.:.. V'. �.v��: i-�vr —. ti�Z 1?� F.EZLaRhS (.Lnh��e): a , . SUILDING REVLE�Y CHECK L�ST . UBC� � '3 ' CONSTRUCTION TYPE: V� Sq Faotaae $Pec Sq Ftg ' Basemeat • . . ,. X = • . 2st Floor � x • _ • • • � � � ' 2nd Floor x = ' ' � • Garage x — • z — TOTAL FsEimated Construction Yalue: $ Z0,d�°� Inspectioas Requirecl: �Yo�k Requiring Separate Petmits: 5 ite _�Plumbing Fire • Hazdcover Removal _�Mechaaical Water Coaaection Footing ' Septic 5ewer Connection �• �_Fr��o � Firepiace Lawn Irrigation /,/ TDsuiatioa (Ma�onry) t?cher y� �Yall Boazd (Mfg,) Well(State Permit) _�F�� Grading/Fillin0 C Eleccrical (Scate Permic) Other REh�ARKS(1N HOUSE): . . . ' .. - -------------------- REVIE'4V SX OTHERS: �A�: Access: Ezisting New • Access Approval: Date gy: � REI�IARKS (TO EE NOTED ��I PER�1�1�; � � �� o— ` D TE TIME � CITY OF ORONO CALLED IN �-� INSPECTION TI SCHEDULED �. %� PERMIT NO. � COMPLETED ADDRESS_-__ T'��D /VQ7"�1 �� OWNER � �.� �ONTR. TELEPHONE NO. � z —"T7 Z �'�Z-9� � DESCRIPTION �h S C,c-Q � UY� � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORFJWETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE Q ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE IPISPECTION Q O FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � a � � � C " SS 0 � 0 � W � Q � 2 W � W � � O � � RKSATISFACTORY PRQCEED ❑ PROJECTCOMPLEfE W CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMAPIENT ❑CORRECTUNSAFECONDlTIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR �INSPECTtONREQUIRED.CALLTOARRANGEACCESS. Catl forthe next ins ion 24 hours in advance. (g52) 249-4600 Owner/CoMractar e: ' s inspector. White CopyMspectw's Flle Canary CopylSRe Notice