HomeMy WebLinkAbout2003-P06346 - addn/remodel/repair CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: P06346
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 6/3/2003
SITE ADDRESS: 1120 North Shore Dr W
Mound,MN 55364
PID: 07-117-23-23-0005
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/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: riumbing iviechanicai Eiecmcai(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 741.75
Valuation: $ 63,500.00
Plan Review Fee: $ 482.23
State Surcharge Fee: $ 32.25
TOTAL FEE: $ 1,256.23
APPLICANT: Remodeling Concepts LLC OWNER: Jay A Lezer
6830 Washington Avenue S 1120 North Shore Dr. W.
Eden Prairie,MN 55344 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.
G -
APPLICANT PERMITEE SIGNATURE j ISSUED BY SIGNATURE
Conies: 1-File(Sienitures Required), 1-ADolicant, 1-Monthly Reports, 1-Assessine, 1-Finance Page 1
Total Fee: $ /a25e , -?3 Date Received: � C
Entered By: i? ,S Permit #:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ZIP: S53�
NAME OF OWNER:-� -�J L -Q_ PHONE: (home)
(work)
MAILING ADDRESS: CITY: pQo,._,o ZIP: s53cc�
CONTRACTOR: L Lc- PHONE: �1 S Z-5�►� -(og�c�
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: (oB3o-wwtujr u,j-aj A�tz- S CITY: Sbzp� t Pnn,R,L: ZIP: m,J
STATE LICENSE: # Z0m crj Wcj
ARCHITECT/ENGINEER:_ PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition X Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail):
1n1 �c`�nooZ ��S-r,r�c..(„4czgc.� �, �,g,r►r�.,�
STORIES: 1 SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: - GARAGE STALLS: ATT. �(_ DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ Co�k�cp°6
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 ith the approved plan.
APPLICANT'S SIGNATURE: cy�- DATE: --:9E17 S -ZZ-o3
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
Sec.13.04 RIGHTS OFSUBJECTS OFDATA
Subdivision]. 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.2. 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,ifpossible,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 ofpublic or private
data concerning himself. To exercise this right, an individual shall notes 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 notes
past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notes 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 maybe appealed pursuant to the provisions of the administrative procedure act relating
to contested cases.
DATA PRIVACYADVISORY
In accordance with M.S.13.04,Subd.2,'Rights ofsubjects ofdata"we would like to inform you thatyour requestfor apermit 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(see following page)to review private data on yourself.
6. Your full name is required to process this application or permit.
PLEASE PRINT
First / Middle Last
'V
Address
City State zip Phone
I unde stand is as stat d above.
Signature
10
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 1120 rU o2ll-M s t+94,4E %O 2 W
PID:
DESCRIPTION OF WORK: A o 0 1 T a nl 2t_
ZONING REVIEW BY: Ple DATE APPROVED: 6--3-Q3
BUILDING REVIEW BY: DATE APPROVED: 4, 3 - %J!5
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓' No
PLAN REVIEW Yes _� No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION.
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 be No Date of Survey: 11-
Proposed Setbacks:
Front(Lake): 14 7' Right Side: 2-0.2
Rear(Street): 290 Left Side: ZS
Adjacent Structures: W/A Wetland: N/A
Building Height: Def. Hgt. m.,k= Peak Hgt.
Lot Coverage: Al lii
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: X o
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
BUILDING REVIEW CHECK LIST
UBC: 12- 3 CONSTRUCTION TYPE: Yn1
Sq Footage $Per Sq Ftg
Basement x =
1st Floor x. _
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $_( 3 S'a.
Inspections Required: Work Requiring Separate Permits:
Site _/ Plumbing Fire
Hardcover Removal PcL Mechanical Water Connection
Footing Septic Sewer Connection
oc Framing Fireplace Lawn Irrigation
K Insulation (Masonry) Other
of Wall Board (Mfg.) Well State Permit
_ Final Grading/Filling -Electrical(State Permit)
Other
REMARKS ON HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERM):
8
DATE TIME
V
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. 1 COMPLETED
ADDRESS
OWNER C0NTR. - O O/xq
TELEPHONE N0.
=FOOTING
ON—
I(
N � ��• `
11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 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
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES/NO
COMMENTS:
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LUQ WORK SATISFACTORY:PROCEED ❑ PROJECT 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. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
[ISTOP 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/Contractoi
s_te:
Inspector.
White Copy/Inspector's Fie Canary Copy/Site Notice
ATE TIME
CITY OF ORONO CALLED IN 7-14-6-3
INSPECTION NO `/ SCHEDULED -7 2,H Jcy0 Nl
PERMIT NO. COMPLETED
ADDRESS =2 All2w rf- ,6c. k)
OWNER CONTR. C�nrncc
TELEPHONE NO. qS!Q ?YJ /1?C
DESCRIPTION
01 FOO 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
2 FRAM 13 MECHANICAL FINAL 19 LAKESHOREAVETLANDS
y 03"A�SULATION 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
Q 07 DEMO-FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
ti
COMMENTS:
&&k "yj 7&tjL I A -f LL�
0
W
oz
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W
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4j ❑WORK SAT FACTORY:PROCEED ❑PR ECT COMPLETE
W ORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
C1 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 n xt inspection 24 hours In advance. (952) 249-4600
Owner/Contra site:
Inspector.
White CopyMspector's le Canary Copy/Site Notice
V
DATE TIME
CITY OF ORONO CALLED IN 7--f®-O�
INSPECTION NOTICE SCHEDULED -31
PERMIT N0. COMPLETED Pc vt
ADDRESS
OWNER CONTR.
TELEPHONE NO.
6/2— (o P 1596
DESCRIPTION
LLI 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
tk
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y INSULATIO 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
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
OWNERICONTRACTOR TO MEET YOU:—YES—NO
y COMMENTS:
44
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ORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE
W ❑ RRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next Inspection 24 hours in advance. (952) 249-4600
Owner/Contra
Inspecto
White CopyMspector's File Canary Copy/Site Notice
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