HomeMy WebLinkAbout2004-P07627 - bathroom to 2nd story loft CITY OF ORONO PERMIT
Permit Number:
2750 Kelley Parkway - PO Box 66 P07627
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 7/12/2004
SITE ADDRESS: 4119 Oak Street
Long Lake,MN 55356
PID: 06-117-23-41-0110
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:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 643.75 Valuation: $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.50
TOTAL FEE: $ 1,087.78
APPLICANT: Lake Country Builders OWNER: Micheal&Paula Huddy
Peter W. Jacobson 4119 Oak Street
339 Second Street Long Lake,MN 55356
Excelsior,MN 55331
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.
APPLICPERM1,rgg'�Ir,NATURE ISSUED BY SIGNATURE r�
Conies: 1-File(Sienitures Required), 1-ADplicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
Total Fee: $ 108 -7, 79 _ Date Received:
Entered By: Permit#: p�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER CONTRACTOR
JOB SITE ADDRESS: 0 a�� e,c ZIP: '3- S-3 5-
Will this be a Par de of Homes, Remodelers Showcase Home or other Display Home?
F-1Yes
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: P1 AC P d f6,,le, -40 W 4,, PHONE: (home) R 5-Z L(71(- 7/2
(work)
MAILING ADDRESS: Sck✓>lQ- CITY: ZIP:
CONTRACTOR: Z uvt i PHONE: S ' y �76(-
CONTACT PERSON: Sc<rah ,l(,'a m56 rl MOBILE/PAGER: (a1� . Sr6o 66y�
MAILING ADDRESS: ,2'4 S ee`f CITY: 45-c< fo✓ ZIP: X533/
STATE LICENSE: # C'-
ARCHITECT/ENGINEER: I' 1 kf AAa> AC'6- i Y? PHONE: c(7t(-
MAILING ADDRESS: 4 CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition _ Move
Remodel/Alteration _ Land Alteration
PROPOSED WO (describ in detail): S�7/I(/
� • G� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: ? GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ S� (� d 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 with
the approved plan.
APPLICANT'S SIGNATURE: ATE: L
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.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 entitles 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 glace the notice required under this subdivision in the Individual income tax or oroaerty 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.
6. Your full name is required to process this application or permit.
SMr411r �-
First m/� Middle
Address
City State Zip Phone
I understand y rights as stated above.
Q'G
nature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: L 11 i (pi4 tc
PID:
DESCRIPTION OF WORK:
ZONING REVIEW BY: �MN DATE APPROVED:~6 -36
BUILDING REVIEW BY: DATE APPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,/ No
PLAN REVIEW Yesf No SEWER.CONNECTION
STATE SURCHARGE Yes �/No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
ZONING CHECK LIST Zoning District: /v v Gh
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 Side:
Adjacent Structures: ` tland:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution:# Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No 40r--JA,,.
Date of CouncilApproval:
REMARKS(in house): * ,—� ,.� , — rr-
7
BUILDING REVIEW CHECK LIST
UBC: 2 _ CONSTRUCTION TYPE: y ti
Sq Footage $Per Sq Ftg
Basement x =
1st Floor x _
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ S�,000
Inspections Required: Work Requiring Separate Permits:
Site ge Plumbing Fire
Hardcover Removal Mechanical Water Connection
M Septic Sewer Connection
_o Framing Fireplace Lawn Irrigation
_ c Insulation (Masonry) Other
__�( Wall Board (Mfg.) Well(State Permit)
o` Final Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DAA; � -
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PEItM11):�-
8
14 DATE TIME
CITY OF ORONO CALLED IN '"� .
INSPECTION NOTICE SCHEDULED
PERMIT NO. a 7L^P2_ 7 COMPLETED
ADDRESS
t.
OWNER G� CONTR. C�>~.�-�/3/�
TELEPHONE NO. l �7y 172-tl 4L
DESCRIPTION
W 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
Q 02 FRAMING13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 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
07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBIN 36 FOUNDATION/REMOVAL
Z RICONTRACTOR T MEET YOU: YES NO
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WWORK SATISFACTORY:PROCEED 11 PROJECT COMPLETE
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❑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
❑CITATION ISSUED
1-1STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance. (952) 249-4600
Owner/Contractor it
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
DA E TIME v
CITY OF ORONO PD 76,,7 7 CALLED IN 51'
INSPECTION N TICE SCHEDULED
PERMIT NO. COMPLETED
ADDRESS :
OWNER CONTRR../ �f////f CSD 1016rS
TELEPHONE NO. �� -73(p �3-J o
DESCRIPTION
W 01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADING/FILLING
W 02 FRAMI 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h
O INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 0 D. 12 WATER HOOK-UP 17 SITE INSPECTION
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
LUT 09 PLUMBING RI 23 SE7YES
35 HARD COVER REMOVAL
v 10 PLUMBIN F.1NAL 36 FOUNDATION/REMOVAL
'
Z OWNE CONTRACTORO MEET YOU: NO
to COMMENTS:
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ZCORRECT
ISFACTORY:PROCEED ❑ PROJECT COMPLETE
WORK&PROCEED n
ISSUE CERTIFICATE OF OCCUPANCY
Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
Ci BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
11STOP ORDER POSTED.CALL INSPECTOR 11 CITATION ISSUED
❑ INSPECTION REQUIRED.CA TO ARRANGE ACCESS.
Call for the n x ' spection 24 hours in advance. (952) 249-4600
Owner/Contr r ns
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice