HomeMy WebLinkAbout2003-P07107 - addn/remodel/repair - kitchen remod T F R N PERMIT
�'I `SY � � O O Permit Number:
2750 Kelley Parkway - PO Box 66 Po�io�
Crystal Bay, Minnesota 55323 Permit Type: additior�emodevxepair
(952) 249-4600 Date Issued: t2n��2oo3
SITE ADDRESS: 865 Partenwood Rd
Long Lake,MN 55356
PID: OS-117-23-43-0002
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential Construction Type VN
Buildin Census Code 434
Permit Class: g
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
(��-R-� �-e--n�o-�
FEE SUMMARY: Pernut Fee: $ 451.85 Valuation: $ 31,000.00
State Surcharge Fee: $ 16.00
TOTAL FEE: $ 467.85
APPLICANT: Plekkenpol Builders OWNER: R Greene&J Piccard
401 E 78th St 865 Partenwood Rd
Bloomington,MN 55420 Long Lake MN 55356
THE LJNDERSIGNED 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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APPLIC T RM EE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Repuired), 1-Applicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
�'otal Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BLZLDING 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 OR CONTRACTOR
� � ] ^,1 ^, ` ��1 c}'
JOB SITE ADDRESS: �4^� �,;������ �=������� ��CI�° ��,IC� l�"��� ZIP: 5 > 3 � �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a special event permit is required with Police Department and City
Coacncil approl•a160 days prior to the event. Non permitted events will not
be allowed.
f-��,,��f G�e-e r� �
NAME OF OWNER: �Un� i �Lo, ��� PHONE: (home)`1.5�� -�I7�-���5
.., � (work)Li� `''J --57� 1
MAILING ADDRESS: �ia S i'����n,�r����� ���;i CITY: L,���, y��, ZIP: .S`s �
CONTRACTOR: �IF �I�P��,�u � ��I;1 , �L�r t S PHONE: i S� ��6 �'�a�
CONTACT PERSON: ,�u ,.,� ;�, (��Q g � NIOBILE/�2: �/;�- � �. - 3�S
MAILING ADDRESS: j �
�f b � F_ • �7�t ��- CITY: � ��,-Y, ,n��� �,�ZIP: ����� . c7
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition �iove
RemodeUAlteration� Land Alteration
PROPOSED WORK describe i�: detai �/ '� �
( �� /[e�';o�' � � �,� '(' � r� �,r?u ��e �% ��;�1 �-
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�e a� CI- Z61 S fc� I I ��J P i,a� I 5?!� /►'1
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: �TT. DET.
�?
ESTIMATED CONSTRUCTION VALU�TION (excluding land): $ � � d d v
I hereby apply for a building pernut and I ackno«�ledge 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 pernut and work is not to start without a permit; and that the work will be in accordance with
the approved plan. j
, �
APPLICANT'S SIGNATURE: - � DATE: �� �� "��
��' r
Seo13.04 RIGHTS OF SUBJECTS OF DATA ,
Subd.1. Type of data The rights of indivldusl on w6om t6e data is stored or to be stored shall be as set forth in this sectlon.
Subd.2. Intormation required to be given individual. An ind(vidual asked to supply prtvate or confidential data concerning 6imself shall be
informed of: (a)the purpose and intended use of the requested data withio t6e collecting state sgency,political subdivision,or statewide system;(b)
whet6er 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 rnntideotial data;and(d)t6e Identity oi other persons or entities sut6orized by state or federal law to receive the dats. This requlrement shall
not apply when an individual is asked to supply investigative data,pursuant to sectioo 13.82,subdIvision 5,to a law enforcement o[ticer.
The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or orouertv taa refund
instruMions instead of on those forms. -
Subd.3. Access to data by individusl. Upon request to a respoosible authority,an indlvidual shall be informed whether he Is t6e subject of
stored data on iodividuals,aod whether it is classifled as public,prlvate or rnnlideotial. Upon his further request,an Indivldual w6o ts t6e subject of
stored private or public data on Individuals s6all be shown the data without any charge to him and,if he desires,shall be Intormed of t6e rnnteot and
meaning ot that data. Atter an individual has been s6own the private data and lnformed of Its meaning,the data need not be disclosed to hlm for sla
months thereafter unless s dispute or action pursuant to this section is pending or addittonal data on the individual has been collected or created. The
responsible authority shall provide rnpies of t6e prlvate or public data upon request by the individual subject o[t6e data. The responsible authority may
require the requesting person to pay the sctual costs of making,certifying,and compiling the copies.
The responslble suthority shall comply lmmediately,i[possible,with any request made pursuant to thls subdivision,or within five days otthe
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compllance is not possible.If he cannot comply wit6 the request within
that time,6e shall so Inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays
and legal holldays.
Subd.4. Procedure when data is not accurate or rnmplete. An lndividual may contest t6e accuracy or completeness of pubilc or private data
concerning hlmself. To exercise thls right,an individual shall notify in writing the responslble authority describing the nature of t6e disagreemenG T6e
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or Incomplete and attempt to nottfy past recipients o[
lnaccunte or incomplete data,including reclpients named by the individual;or(b)notify the individual that he belteves the data to be correct. Data in
dlspute shall be dlsclosed only if the indlvidual's sWtement ot disagreement is iocluded with the disclosed data.
The determinatton of t6e responsible authority may be appealed pursuant to the provislons 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 eztent 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.
Flrst Middle Last
Address
C�n' State Zip Phone
I understand my rights as stated above. .
Signature
• CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY
ADDRESS OR LEGAL: L�(o5 P�42 i�rv w o o� ��✓-�
PID:
DFSCRIPTION OF WORK: I�. T c.i.-Q.,.� (?,�.��.�o(�.Q�
ZO.vI�Ti G REVIEW BY: (/a DATE APPROVED:
BUII.DI�i TG REVIEW BY: DATE APPROVID; �Z- �� - v,3
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes _� No t/ SEWER CONNEC"ITON
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: N o C�h4,�•�c,P ..
cJ
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: Ned d:
Building Height: Def. Hgt. Pe�Hgt.
Lot Coverage:
Grading: Staff Approval Date: B� Council Approval Date:
Septic: Staff Approval Date: By
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Covecage:
Existino Proposed
Hazdcover: 0-75'
75-250'
250-500' �
500-1000'
Hardcover Variance Required: Yes ho Date of Council Approval: '
REMARI�,S(in house):
7
BUII,DING REVIE`y CHECg LIST
�C: 1��3 CONSTRUCTION TYPE: '�IJ
_ Sq Footage $Per Sq Ftg
Basement x _
lst Floor x _
2nd F1oor x _
Gazage x _
x =
TOTAL
F,stimated Construction Value: $_3�,O a U°"
Inspections Required: `Vork Requiring Separate Permits:
Site _�pl�b�g Fire
Hazdcover Removal Mechanical Water Connecdon
Footing ` Se tic
5!Frazning p Sewer Connection �
Fireplace Lawn Irrigation
�Insulation (Masonry) Other
_,�Wall Boazd • (Mfg,) Well (State Permit)
—�F� Grading/Filling _p�Electrical(State Permit)
Other
REMA,RKS(IN HOUSE):
REVIEW BY OTHERS• DATE: ��_�� --- - __
Access: Ezisting New .
Access Approval: Date
By:
---------------------_----------
RE11�IA.RBS (TO BE NOTED ON PERiv1IT�;
8
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'�p`� I `�q �P'�� �_T��� .
CITY OF ORONO ALLED IN 6 �.,.�
INSPECTIO CHEDULED
PERMIT N0. ' ' �� COMPLETED
ADDRESS ��DS � �^ l�d �
OWNER CONTR. ��Q ��I<2��I.2 �1,
TELEPHONENO. ��2 - 3'Z8' - 13�05
� DESCRIPTION ��-�'`` C�"I�.s-�� ��
t� 01 FOOTING 11 MECHA�JICAL RI 18 CAV/GRADING/FILLING
� FRAMI 13 MECHANICAL fINAL 19 LAKESHORE/WETLANDS
y
Q LATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS F�NAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
`'� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= PLUM 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 0 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
y COMMENT :
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W� WORKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WFLL AETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next nspection 24 hours in advance. (g52) 249-4C00
OwnedConUa
Inspector.
White Copyllnspecto�'s File Canary CopylSite Notice
✓
DATE TIME
CITY OF ORONO CALLED IN 3"`fV�
INSPECTION NOTICE SCHEDULED �- 1 i�0�f EE3�=�A,fi�'�
PERMIT N0. ���_7 COMPLETED
�
ADDRESS �CQ � �c:�--4F�1 r.��� �
OWNER CONTR. �I2�o��� �I��r"S ,
TELEPHONE NO._ C D�� ���� � � lCC
� DESCRIPTION ��Il(�C� -.
� 01 FOOTING 11 MECHANICAL RI 18 EXCA�//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 5 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 O-SITE 27 SEPTiC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FI L 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTfON REQUIRED.CALLTO ARRANGE ACCESS.
Call for the nex 'nspection 24 hours in advance. (952� 249-4600
Owner/Contr o n i :
Inspector.
White Copy/lnspector's File Canary Copy/Site Notice
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