HomeMy WebLinkAbout2004-P08142 - addn/remodel/repair CITY-OF ORONO PERMIT
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Permit Number:275(; Kelley Parkway- PO Box 66 PermP08142
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 11/30/2004
SITE ADDRESS: 4535 North Shore Dr
Mound,MN 55364
PID: 07-117-23-31-0007
DESCRIPTION: UBC occupancy R3
Proposed Use: Residential Construction Type VN
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeVRepair
DETAILS:
Approved per resolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 54.00 Valuation: $ 1,500.00
Plan Review Fee: $ 35.08
State Surcharge Fee: $ 1.25
TOTAL FEE: $ 9033
APPLICANT: Owner/Self OWNER: Roger&Elaine Haydock
MN 4535 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.
APPLICANT PEIWITEE SIGNATURE ISSftD BY SIGNATURE
Conies: 1-File(Sienitures Rewired).1-Annlicant,1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
Total Fee: $ Date Received: o-a -d
Entered By: Permit#: 2
CITY OF ORONO Ae6LDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
------------------------------------------------------- ----- -------------------------------------------------------------
THE APPLICANT IS: (circle one) OnWNE OR CONTRACTOR
JOB SITE ADDRESS: z 43,r /Jy 2-� S H 0 tc-E 8r--- ZIP: S-f 3 G Y
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes 0 No If yes, a special event permit is required with Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: 6LA U,--- PHONE: (home)�SL Y 7-4- YS-?,s'
(work) '? `/,P`/ d Y S S
MAILING ADDRESS: YS3 S AJa,4-11-f CITY: ZIP: Sri 6 Y
CONTRACTOR: 5 e cf PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure x
Addition Move
Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail): &06"3 6 ASA 'hC61<-J S T-A)"
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ( SZ)Z)
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 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: G%� � �J ° DATE: /Q/27AY
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.
Subd.1. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall 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 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,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax 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 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 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 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 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 accuracy or completeness of public or private data
concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the 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 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 data.
The determination 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",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. 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 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.
6Your full name is required to process this application or permit.
✓
C jL,p, 11.1 CG /`A A(Ll L% �(i/>1 ` ,0"C—
First
LFirst Middle Last
a S 3 S o o a-(H s-"wt.
Address
j o Inn►,, sT 3 G k/
City State Zip Phone
I understand my rights as stated above.
9�!: 4n c4r(�
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMUS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: YS36- A/OR771 Tn� D0?-
PID:
DESCRIPTION OF WORK: Sey- sr.n r� t/1,Z-.r K
ZOIVIIVGREVIEtVBX: _ _ -_-__-__F--DATEAPPROVED: // 2,3-ay
BUILDINGREVIEWBY: DATEAPPROVED: i z3- Y
-------------------------------------IX------------------------------------_----_.----- ------ ------- ---
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes ✓ No SEWER CONIVECTION
STATE SURCHARGE Yes ✓ No WATER COMVECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District: _..
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes_ 74-t No Date of Survey: -ict-d2-
Proposed Setbacks:
Ftmwt(Lake): 1r,3 �= Right Side: -11
Rear(Street): 1111 t Left Side: 13'
Adjacent Structures: O Wetland: NIA
Building Height: Def. Hgt. O,k Peak Hgt.
Lot Coverage: NO G(MAI&e-
Grading: Staff Approval Date: —` By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: SPS
Avg.Setback: O-k Bluff Setback: N/A Lot Coverage: N-C.
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000' �o C}lpnrc�I
Hardcover Variance Required: Yes No K_ Date of Council Approval:
REMARKS(int house):
31
B UILD.�IVG RE VIEW CHECK LIST
UBC: �i U - l CONSTR UCTION TYPE: . N/V
Sq Footage S Pei-Sq Ftg
Basenuen't r =
-I st Flood• x =
2nd Floor x =
Garage,' x =
x
TOTAL
Esdinated Construction Value: S 1.!;:00
Inspecrions Required: Work Requiring Separate Per•rnits:
;Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_,K f Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (AIfg.) Well(State Permit)
D� Final Grading/Filling K Electrical(State Permit)
Other
REXARKS(INHOUSE):
- -------------------------------------------------------___---__ -_---_____---- ____----_---
RIMEW BY OTHERS: DATE:
Access: Existing rVew
Access Approval: Date By:
—--------—-----------------—_----_----------------------------_. — ------------------___. _ —_—
REIIIARKS (TO BE NOTED ONPE&WIT):
32
V
CZATM TIME
CITY OF ORONO 7Z CALLED IN O
INSPECTION N IC SCHEDULED
PERMIT NO /. '/D . 19'-- COMPLETED
ADDRESS /VV_Y -A 06 4
OWNER '✓ CONTR.
TELEPHONE N . Z &ap.S 6_ T N
DESCRIPTION
4 01 FOOTING 11 MECHANIC 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL INAL 19 LAKESHORE/WETLANDS
h 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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 FINAL 35 HARD COVER REMOVAL
10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:
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Uj1<WORK SATISFACTORY:PROCEED ElPROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site*
Inspector. —1 —
White CopyMspectoes File Canary Copy/Site Notice
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E&EPARATJON
WANK WALE,BD.TO ROOF CITY OF ORONO
SH'E,AnUNG. IF CEILING IS USED FOP, BUILW,,JG Qf_p;. T PLAN RIEVIEW
FIREWALL THEN SUPPORTING INSPECTOR_ moi'
WALLS MUST ALSO BE PROTECTED DAT 1-Z .o _,a t;r.s►T tv0.
❑ - ) �•
-GARAGE FIREDOM
JOINTS TAPED .t: ' :ONS
A'NOTED
SOUD CORE El
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In` 1,,; rrid zo;dr;, code
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