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PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Po4999
Crystal Bay, Minnesota 55323 Permit Type: Minor aicerat�ons
(952) 249-4600 Date Issued: a�3�2o02
SITE ADDRESS: 880 Partenwood Rd
L.ong L,ake,MN 55356
PID: OS-117-23-43-0001
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residenrial Construction Type VN
Buildin Census Code O/S-Building
Permit Class: g
Permit T e: Minor Alterations Perniit Sub-type(s): Building-Re-Side
� W indows
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pe�tFee: $ g25.�5 Valuation: $ �s,goo.00
State Surcharge Fee: $ 37.90
TOTAL FEE: $ 863.65
APPLICANT: L.Cramer Design OWNER: Jerry&Cynthia Gray
5500 Lincoln Drive 880 Partenwood Rd
Edina,MN 55436 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.
/-'
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APPLICANT PERMITEE SIGNATURG ISSUED QY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-ApplicanL 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
=Mara29-02 07 : 28A '��� � P.02
�a►-1B-2001 03:16pm From-CITY OF ORONO 'L'-- T-946 P.Q05/006 F-ST3
�.` '�
� �
\ ��/ TocaJ Fee: $ r`��: 3� � `> ;
�, :ived:
��� Enter�d By: ����� f . ,. ,.� c� `�� �
I' "`� '� ., ��L.L�( , /
CITY OF ORONO - � ,- , ,.,> , ;, PLICATiON
All information must be submitted in full before plan review will 6e started.
(please pri�ir al(it}fonnarion)
----------------------------------------•----------------��_-- ---�- ------ - ------•
T� APPLICAI�TT IS: (circte vnej tiWNER UfL CUN'fKACTQ .�
JOB STTE ADDRE.SS: �`�O �e,��c-� c.�„d� �J ZIP: SS3 �7 I
NAME OF OWNER: �c�� �r�c, PHO1V�: (home)
(wurk) u�/z -��7' S35 3
MAYY.L�IG�'�DDRESS: ��lo �4 r��.�wo,.l 2J CYTY: 0•�.�s ZIP:_,�3_�
CONTIYACTOR: �C�,..��- I��s3„v � i3,.,�.-�� PHONE:. �S�-�J3S-�y� a.
CONTACT�RSON: f����4 cy,,,�,I,��MOBII,E/PAGER: �a - 39e6 �ss��
MAII,ING�AnnRESS: S3op L„�„�e 1,� ��,•Y� CYTY: Ed.•��, 7..IP: SSy3
STATE LICENSEr A` �' �p�y_
ARCHIT�CT/ENGIN�ER: E� �,o �� _ PHONE: ��� - 33� - l�3 y
MAII.INGADDRESS: _a�oo �os�,�.�. /�,,�� CTY"Y� M.;,,�4►P.t,-ti ZIP: .f".S-y4 �
NAME: �! REGISTRATION�J
TYPE OF WORK: New Addi�ion Accessory Stcucture �
Move itemodcUAlt�ration � Land Alteration
PROPOSED WORK(describe in detar�: I��.� I�,c� ��-,s ��� w..,J�„�s � s.J.
STORIES: SQ.FEET OF EACH FLOOR:
A'O. OF BEDR04:�iS: GARAGE STALLS: ATT. DET.
FS�'IMATED CONSTRUCTYON VAY.UATION (excluding land): $ 7.�8'�v �
I hercby apply for a building pe�mic and I acknowledge that the information above is complete and
accurace; [hac the work wil� be ia confonnance :vith.ti�e ordinances and c�des of tE�c City and wirh
the Stace Building Code; that I understand this is noc a petmi� and work is noc to scart �vithout a
permit; and thac the work wi11 be in accordance with che approved plan.
APPLICANT'S SIGNATURE: �� DATE: 3'�y -b�
NOTE! Pnrade of Aornes events require separute permit approval by Police Depq�ri,te�rt and
City Counc1160 doys prior to th@ event. Non permitted et�ents will nat be allvwed.
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: _ 8�3 U (��2c�i�,,��,� (�,o�
PID:
DESCRIPTION OF WORK: _�cAu: w c rv r,o�,.J s ,�.✓� s�►��n,b
ZOVING REVIEW BY: 1� �� ~NN DATE APPROVED:
BUII..DING REVIEW BY: DATE APPROVID: �- � -o z
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes �/ No
PLAN REVIEW Yes � No � SEWER CONNECTTON
STATE SURCHARGE Yes �� No WATERCONNEC'TION
INVESTIGATION FEE Yes No �' PARK FEE
SAC Yes No—� SITEINSPECTTON
Number of SAC�Units OTHER (specify)
ZONING CHECK LIST Zoning Districr. /�o G��/�N(,ts
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
Reaz(Sueet): Left Side:
Adjacent Structures: etland:
Building Height: Def. Hgt. eal: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 Set ack: I.ot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250.500'
500-1000'
Hazdcover Variance Required: Yes o Date of Council Approval:
REMARKS(in house):
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BUII..DING REVIEW CAECK LIST
�C� I�' 3 CONSTRUCTTON TYPEc �(]�I
Sq Footage $Per Sq Ftg
Basement . x =
lst Floor x _ _
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $_�5,gp���'-
Inspections Required: Work Requuing Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
. F���g � Septic Sewer Connection
_�Fr�g Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd � (Mfg.) Well(State Permit)
_�F�� Grading/Filling Electrical(State Permit)
Other
REMARI�.S(IN HOUSE): .
--- ------- ----------------------------�________�__
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
"""""'------ ---------------------------------------------- -
REMARI�.S (TO BE NOTED ON PERMI�:
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�Mar^29-02 07: 29A P.03
I�r-tA-Z002 03:19vs from-CITY OF OR�10 +D5224�1616 T-l16 P.006/006 f•!t3
Sce.1�.0a RiGH7S AF SUSJEC73 OF DwTw
5u0d, l. Trpr of d�ta. The ri�ha of individusl oe w�om tlrc daw e srored or m be sooced smll bt u sa fo�in diis�eedon.
Su�d.2. Wat�ioo rp�fe�d te be�rtn iadivid�d. M irdivW�yl�Ictd lo s�ply privtro ot eo�lidpiotl dtp coaeeniit�g I�self
iinU bt i11f0eftuQ Of'� (�dLe TupoiC iod�nded use af ihe reqrratod BSG�widun tb�oofleeei�so�e s�snc�r.polNiC�l lopd'Iv�iiOn,oi iaceMride
rysteaa:tb)whedur he fiay tetuse o�is 1*ia11Y nquired m suPPb���sc�dan:(c)s�U'Imoam wnsequeaca�rwi�troa�Aia wpplyin�ac
��t m�PpY P��coNfdremi dm:nd t�d�iQa�ry of odier persons o�enoda�oritee 6y mee or lMerat law to m.eive dsa daa.
Tbis rcq�sireaat ifio�nw appYy wheu�n jndividWu ii�sfaed m wpp�y invcsti�sqvs dut,pursuan[to secrion 13.8Z. subdivisjpn S.m�l�w
eNotaement otlker.
l�d.l�IDm1�ECr oI eeveeue nav die�rwioe�m�.�ned under dds n�ldivi.ien ,1,� ,,,��.,y,���
�� �11�i�7�ISfF 1�.�en�r'��A��r nv�......��
inStruerian�nsnrtid ePg�dn„{p�c
Subd.3. Aeem�o dsu by 1odi,�dua1, [fpon nques�m s ra.po�iao audmr;ti,an iadividus(aN1l hc in(ormcd vrAe�her pe u dfe
subjtu ot�aorod�on individu��,�td wl�et i�is elas�ilfed as publk.privaie or�nf�l. Upon his 14rmer reqv,ese.st��adiriaYst w0o
is tM svsjtc:ot�tmeG pri�a�e or pubu�:d�o on iMiri�shW be sl�owo die d�o wid�ou�r/q clur�t ro oim ond.if 1►e deaires.,�MU De idbrtaed
o!d�e eor�and meanir�ol d�c dara. Ahte aa indi�ridwl ly:bcen tTawn tAe pova�e mit�t10 iNo�pxd of it�n�air�.�e�Med Aot Oe
difeloiad a�Aim tot su niond�s diamhv uNa�s s dicpua o�urion puswru m�h;s Ycdoa u pe�or ad�0iriamf ds�oo�C indiridwi iw bten
eoUeettd or ene�d. The re�poRsibit wdfoeib�all peovids eo�s o(du prirue or publie dfa open rMw�b�'rhe indi.idenrl tubJeet ol rbe daa.
The ldsponsi0k swtw�i0'awY�����o1q'i P�non�o p0y dld iclual Cos[s Of a�akin`.anilyinj.u+d eon,W'1h�i d����.
The mpo�IDle wdw!fpr sR1411 cotRply imme�ely itpua�bk.widi atgr ieaues���de pyrAqnt ta�hlt�ubdlni�ion.o�wifAfn Ave days
ef die due ot dN te9�+�i.����S�O�td�ys.SYI10�yt snd�kpl nofWeys�i/immrdisoe complianca is nOt poKiWd. If M outtw�comply widi
che nqt::sc Wi�in oar ciroa,be s1nU so inforn►d�e ineivi0uai.W+d nuy love an nd0irienal tivc dtys within vrbkh ro eemQly ori�h du saquesc,
e,wlsdi.�Sasudays.SunOsys and it�at ial'�ri.
Suba.s. teoadun whes dsq k Doc seeur�lte��eaoplNt. M individu�l m�y eoawa the acwraer o�eompk�ass oF prc�lie oe
p�ivale dan COnCunl�hinitNf. ?o�ttfCiie IAis►i8ht.On individutl shill flDlily in wl'ltina the responi�Dle aahOtiry destrfbin�fhe eOAue of tttc
dFs�re�rsiK. Th�rsspOm�t�phoriry id�ll wGhlrt 30�rs eid�r: (a)oo�eec�t data�owd lo bC�Or blopeop�e�e�pd�e1�p ppi�,
pasc n:ipiann oP'vueeucue or iaoo�let dsn.iuclud�rt;rae;pi�a,u��aaKd by�ix indiridwi:or fb)mcty m.iMividwt ds�M aslis�es�Ae daa
fO bt COR�CL D�o�q dlspul0 fIW10�ditebf�d Oaly if d10 fediridtiai'!Sf�tl1lMnt 0(djfy�[L'CRieRt js IpG�lldCa W(�{���pyp�m�,
�ea awoa�wion ot a�a respom�bte�wdwrla msr�oDP�+��wrwu��oo a�e provaions or d�e ae,nimscraave rroeeaac�e uc r.iawq�
w com�sud c�sts.
�$gACY AAVY RY
Ia accord�nce with M.S. ]3.04.Subd. 2� 'Righss of subjeccs of daea',we would like to inform you�at youc
requtsc tor a permir or licensa from che Ci�y of Oro�o or aay ef ia depa�rtuients may nquir�e you to furnisl►esrc�,ia
ptiv�te or confidantisl inf�mation.
You ue nocit�ed cha�:
1. The infocmetion you fucaish wi�l be uttd eo detetsriiue yout qu�liScation for rhe permic or liceau
roquesud.
3. You atay refuu to aupp[y daa, but refuc�i a►ay require�6a�the Ciry deny the permii oc license.
3. Tbe information may be sbared with oduer lx�l. srace or federal a�encies to the excenc neeauary w
process rhe permit er license.
�. If your r�quested prraiic oc lic�st requurs Couocil ae�ion w approve.sotne iaformadon msy become
public.
i. You have ccitain righ�vadzr M.S. I3.Oa(svailable upoa nquestj t0 revuw ptivace data on yourself.
6. Yoar futl uaau is�quired w proctss Wis applica�ion or permic_
p�r.e. L. CRww�Ee n�,uN�,es
� �A w�t�H e� Nl I��L IZ + 4�s�oeQS
Fvu Middl� � •
S'S o c L=�v n„ ����^�gr�
,�mnse � --_. - ,
�ms;,.q- _ S sy 3 c 9.�Z- !3 5 -8yg�,
Gry
2tp ppo�
I uade my " s as scated
ru�
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