HomeMy WebLinkAbout2005-P09277 - re-roof - PERMIT
CITY OF ORONO
�'S��e��ey Parkway- PO Box 66 Permit Number: P09277
Crysta Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(95Z) 249-4600 Date Issued:
10/13/2005
SITE ADdRESS: 4210 North Shore Dr Unit#
Mound,MN 55364
P��� 07-117-23-43-0015
DESCRIPTION:
Proposed Use: Residential Census Code O/S-Building
Permit Class: Building
Permit T e: Addition/Remodel/Repair Permit Sub-type(s): Building-Re-Roof
YP
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Replace Garage Roof w/New Roof-2'Pitch Replacing Flat Roof
FEE SUMMARY: Permit Fee: $ 23.50 valuation: $ 500.00
Plan Review Fee: $ 15.28
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 39.28
APPLICANT: Owner/Self OWNER: Sara Broeker
MN 4210 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.
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APPLICANT PERM[TEE SIGNATUR� ISSUED BY S[GNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ � !� ,� „ � ��� Date Received: l U-/U-Q�
Entered By: ,E'jyL'(� ��� � Permit#: J'�C.'`�:�-7?
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it a1!infoimation)
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THE APPLICANT IS: (cif�cle one) OWNER CONTRACTOR
JOBSITEADDRESS: �2-10 1.���"� S�O� � FZ Zip: s53�p�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS �NO If yes, n specinl event per���zt rs reguired with Police Depar�tment ar�d City Counci!approva!
60 days pr ior to the evend. Shzrttle bars service tivill be r•eguired iu�less applicant demorzstr�ates
sarfficient on-site parking is available. Non-per•mitted events tivill not be allorved.
NAME OF OWNER: y�'� �'���' PHONE: (home) �2���3��
MAILING ADDRESS: �2-1`� �d� 5�� C12TY: ��� ���Z P�SS3� �
CONTRACTOR: �� ���'� PHONE:�S 29 3 S 38�
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDl�ES5�l42(Y�A*/V l 0.v 1� __CITY: �M,T�KA ZIP: 553��j
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration k
v��-c� �5�. �oa�' �
PROPOSED WORK(describe ir�,de�i�: � 1�..� �c
�.00-F - 2` � � � -r
S'I'ORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTAC�HEi) DE'TACHED
E�TII�AT�i3 CONS'�RUCTION VALUATIOIW(excluding land): $ 56C�
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�vith the State Bui lding
Code;that I understand this is not a permit and w •� to start without a permit;and that the work will be
in accordance with the approved plan.
APPLICANT'S SIGNATU . ATE: �`�Z�O�
31
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Sec.13.04 RIGHTS OF SUBJECTS 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.
_._.__.._..._._. c„f,�l 7 tAfotm . . . nindixidual.Anindividual.askedtnsuppLy�rixate.or.confidentiaLdataconceming.himselfchalltia
infarmed 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 supply
private or wnfidential 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,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mayplace the notice required under this subdivision in the individual income bx or property 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 informed whether 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 informed 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 to this section is pending or additional data on the individua(has been collected or created. Tlie
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 actual costs of making,certifying,and compiling the copies.
The responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,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 five days within wliich 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
� conceming himself.To exercise this right,an individual shall notify in writing the responsible authority describing the natvre ofthe disagceement.The
responsible authority shall within 30 days either. (a)coaect the data Eourtd to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or i�complete data,including recipients named by the iridividual;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 inclucJ�with the disclosed data.
The detetmination of the responsible authority may be appealed pursuant to the provisions of the adminisuative procedure act relating to
contested cases. ,
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DATA PRIVACY ADVISOR'i�`
. In accordance with M.S: 13.04,Subd:2,"Rights of subjects of data",i,Ti�vould 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. 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 reyuested 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 y�'t1r'self.
6. Your full name is required to process this application or permit.
`JJ��4l'` � �-�C�� D���C.�
First Middle Last
42�0 ►►�c�'�- s� t�� gsz
Address
,�w�.� �,� �53C�4 ��Z�'�
Cit,y State Zip Phone
1 understand my ri as stated ove.
Signature
32
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
� ADDRES�OR LEGAL: Y2�c� ivo 2i7t s I�e.� 0 2
PID:
DESCRIPTIO�T OF WORK: (_u�a►,�c,p /Lov r- P�rcr!-� sa�3o�e C�A-rl,�C�e
ZO�i�TG RE'VIEW BY: DATE APPROVED: `�.D c��,►�
BUII..DING REVIEW BY: DAT'E APPROVED: �o--/Z-�S
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW � Yes � No SEWER CONNECTTON
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTTON
Number of SAC�Units OTHER (specify)
ZONII�TG CH�CK LIST Zoning District: N'c� Glf���Q .
Fire Department: Post Office: School District: •
Lot Area: Sc.ft. Acres � Width Depth
Survey Submitted: Yes o Date of Survey:
Proposed Setbacks:
Front(L,ake): Ri Side:
Rear(Street): Lef Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Covera;e•
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: BI ff Setback: L.ot Coverage:
E sting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REIi�IA�tKS (in house):
.,
.
BUYLDING REVIEW CHECB LIST
�C� ,`"3 � CONSTRUCTION TYPE: \/�
Sq Footage $Per Sq Ftg
Basement.- . . x _ .
1st Floor x _
2nd Floor x _ �
Gazage R =
R -
TOTAL
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Estimated Construction Value: $ SO c�
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Fr�g Fireplace Lawn Irrigation
Insuladon (Nlasonry) Other
Wall Boazd (Mfg.) Well(State Permit)
�F�� Grading/Filling Electrical(State Permit)
Other
REMARKS(lN HOUSE): .
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RE'VIEtiV BY OTHERS: DATE:
Access: Existing New �
Access Approval: Date gy;
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RENIARKS (TO BE NOTED ON PERi1�II�:
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(� �I DATE I�/O�ME
�5-CITY OF ORONO ca��Eo ir���1���a
INSPECTION NOTI E �/ SCHEDULED -1�CL����
PERMIT NO. � ( � COMPLETED � ��-vc�r�L1
ADDRESS `7`�/I� /�/ ' S�D/"C ,,��_
OWNER C �'CONTR.
TELEPHONE NO. �� � 7� �� �G�
� DESCRIPTION � ���-� '
� 01 FOOTING 11 MECHANICAL RI 18 E /GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINA 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES NO
� COMMENTS:
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W� ❑WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED !� ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-46��
OwnerlContractor on site:
Inspector. � �� ri�
White Copyllnspector's File Canary Copy/Site Notice