HomeMy WebLinkAbout2005-P07440 - attacjed decl � �!
PERMIT
CITY OF ORONO Permit ►vumber:
2750 Kelley Parkway- PO Box 66 P07440
Crystal Bay, Minnesota 55323 Pel'mlt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 5/12/2005
SITE ADDRESS: 605 Park Lane
Long Lake,MN 55356
P I D: 06-117-23-41-0049
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Sub-type(s): Deck-Attached
Permit Type: Addirion/RemodeURepair
DETAILS:
Approved per resolution#: 5139
Separate permits required:
NOTICES/REMARKS:
�._� [�a_"_'T__.1_ •h___Tl"_T"i
•.a����v��✓vvi� a a��va aaav a wv�
FEE SUMMARY: PermitFee: $ 83.25 valuation: $ 2,190.00
Plan Review Fee: $ 54.08
State Surcharge Fee: $ 1.60
TOTAL FEE: $ 138.93
APPLICANT: Owner/Self OWNER: Sean&Leah Daly
MN 605 Park Lane
Long Lake,MN 55356
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.
�
APP E T SIGNA ISSUED BY SIGNATURE
Copies: 1-File(SinnituresRequired), 1-Avplicant, 1-MonthlvReports, 1-AssessinQ, 1-Finance Page 1
� �� �
Total Fee: $ ���� �j� Date Received: `=�� L`l"��'�
Entered By: �L��� Permit #: �� ��y�{�
�;,,ry-�� �/1 �
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print alI informafion) �
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: j��U�����i l/�} ZIP: � � __>
,
i
NAME OF OWNER: ` V� PHONE: (home)�j - �1 � ��(_;
�-� � �` � ��'� L
MAILING ADDRESS: �/t� CITY: �Ci��' '1,v ZIP:
, s _
�`'vti� �,bZ -Y7�-b3�
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CONTRACTOR: I PHONE:
CONTaCT PERSON—� �10BILE/PAGER:
MAILI�G ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: I � � �� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
P OP SED WORK (describ in detai�: �r �1 (�,����� � GC�-!l��'�(, -�C�-C.-�'�
Z,"�- ��
STORIES: SQ. FEET OF EACH �I.00R:
N0. OF BEDROOMS: GARAGE STALLS: ATT. DET. � C
, �-�I � ���
-� ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �
I hereby apply for a building permit and I ackno���led�e that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciri- and with the
State Building Code; that I understand this 's not a permit and work is not to start without a permit;
and that the work will be in accordance w' h the ap o��ed plan.
/� �'
APPLICANT'S SIGNATURE: ��� ' ( � � � �� DATE: ����� �
NOTE.� Parade of Homes e ve require separate pe�mit approval by Po/ice Department and City
Council 60 days prior to the ent. Non permitted events wi//not be a//owed.
f • �
Sec.l 3.04 RlGtii'S OF SUBJECTS OF DATA
Subd. I. Type of data The rigfits of ind'mdual 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 w�►en an individual is asked to supply investigative data,pursuant to sedion 13.82,subdivision 5,to a law enforcement officer. '
The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or oropertv 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 prnate or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be iniormed 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 thereaker unless a dspute or action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall prrnide copies of the private or public data upon request by the individual subject of the data. The responsible authority may
require the requesting persoo to pay the actual costs of making,certitying,and compiling the copies.
The responsible anthority 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 comptete. 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 iound 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 onh rf the individual's statement of disagreement is included with the disclosed data.
The determinatioo 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 ma}•refuse to suppty 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.
- � � ��
First Middle �t
�����,(< <a
Address
- C��►n,� �1V� �3�0
City State Zip Phone
I understand my rights as tated a ove.
' �
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
A.DDRESS ORLEGAL: lo oS PA21� Lvw� �
PID:
DESCRIPTION OF WORK: p�=���
ZO�TG REVIEW BY: DATE APPROVED: Z-Z� �o�'
BUII.,DING REV�W BY: DATE APPROVED; Z.�d -cr�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAl�T REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE � Yes No ✓ PARK FEE
SAC Yes No� STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: .
Fire Department: Post Office: School District: •
Lot Area: Sq.ft. 8<<8S( Acres , Z � Width Depth
Survey Submitted: Yes K No Date of Survey: i -1 Z-��1
Proposed Setbacks: �
Freat{Lake): �i32� Right Side: S•3
Rear (Street): �y.S Left Side: 3Y'
Adjacent Structures: q-rr�c.��� Wetland: iv/�a /
�_
Building Height: Def. Hgt. f� I✓i Peal�Hgt. --
Lot Coverage: ?.o•s
Grading: Staff Approval Date: N�� By: Council Approval Date:
Septic: Staff Approval Date: N 1✓3 gy;
Zoning File: !� oy-Z�cB�b Resolution: # Resolution Date: �-Z2-oH
Shoreland District: y,PS
Avg. Setback: o.l� Bluff Setback: �J //� Lot Coverage: ?�o.�
Eustin; Proposed
Hazdcover: 0-75' 43�t
75-250' s�.e
250-500'
500-1000'
Hardcover Variance Required: Yes�_ No Date of Council Approval:
REMARKS (in house)•
7
BUII,DING REV�W CAECK LIST
�C� - �2' CONSTRUCTION TYPE: \//`)
_ Sq Footage $Per Sq Ftg
Basement x _
lst Floor x _
2nd Floor x _
Garage x _ �
�Pf�_ Z��, x Io_�o = 2� iSo, o0
TOTAL
Estunated Construction Value: $__ Z�g b,oa
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Dc Footing " Septic Sewer Connection �
_,�Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well (State Permit)
°� F�� Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): � ,
---- --------------------------------------------------------__
REVIEW BY OTHERS: DAT'E:
Access: Ezisting New .
Access Approval: Date By;
---- -----------------------------------------------------------
1tEMARI�S (TO BE NOTED ON PERMI�:
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO ,ItC SCHEDULED '7q� /
PERMIT NO. �/ COMPLETED
ADDRESS �i�D S ��/ �
OWNER �C.�C_ IJL�� CONTR.
TELEPHONE NO. �4�Z 7�� 7 73�j
� DESCRIPTION �� "' �e�
� 01 FOOTING 11 MECHANICAL 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 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 OS FINAL 14 SEWER HOOK-UP O6 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
� 02 �o � a.�.e ��
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0
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W
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
�CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Ca11 for the next in ction 24 hours in advance. (g52) 249-4600
Owner/Contra it
Inspector. C�. �
White Copyllnspector's File Canary CopylSlte Notice
��-f, 1��( - /
� I �C � -=�� D E • TIME V
CITY OF ORONO J � ���ALLEO IN �� �
INSPECTION NOTIC � _�� SCHEDULED �•' � �
PERMIT NO. COMPLETED
ADDRESS �t�lJ � /�'�-�' •'�/� l�-i•-�"'.��
OWNER��I�f' /.�.if��%'/ CONTR.
TELEPHONE NO. �� �-� ��/ �- �� �-� �
� �r.� �.E:.:��1/
� DESCRIPTION �-1 i�Cti/ - `"��C�'k � �/c'J� �.�.
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHOREJWETLANDS
�
O 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
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUM8ING FINAL t 36 FOUNDATION/REMOVAL
Z OWNERICONTRACTOH TO MEET YOU�r YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED PROJECTCOMPLETE
� , ❑CORRECT WORK&PROCEED • r' ISSUE CERTIFICATE OF OCCUPANCY
p ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN
INSPECTOR W4LL RETIJRN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspe tion 24 hours in advance. (J52� 249-4600
OwnerlContractor o si .
Inspector.
White Copyllnspector's File , Canary CopylSite Notice
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