HomeMy WebLinkAbout2000-P02068 - addn/remodel/repair � . � PERMIT
C I TY O F O RO N O permit Number:
2750 Kelley Parkway - PO Box 66 Po2o6g
Crystal Bay, Minnesota 55323 Pel'Clllt Typ@: Addition/Remodel/Repair
(612) 249-4600 Date Issued: 2�23�00
SITE ADDRESS: 2710 Pence La
EXCELSIOR,MN 55331
PID: 21-117-23-23-0046
DESCRIPTION: UBC occupancy R3
Construction Type VN
Proposed Use:
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution#:
Separate permits required: riumoing iviecnanic:ai Eiectricai �siaiej
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 391.25 Valuation: $ 25,000.00
Plan Review Fee: $ 254.28
State Surcharge Fee: $ 12.50
TOTAL FEE: $ 658.03
APPLICANT: John Kraemer& Sons OWNER: D E HABERMAN&H R HABERMAN
4906 Lincoln Drive 2710 PENCE LA
Edina, MN 55436 EXCELSIOR MN 55331
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-IE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MIN SOTA BUII,DING CODE REQUIREMENTS.
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AP ICANT PERMITEE IGNATURE iSSUED BY SIGNATURE �j}
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Copies: City,Applicant,Assessor,Finance Page 1
, Date Received: � "��� ��
Total Fee: $ (�,��°.p.�
Entered By: �-� ; Permit#: ��a0(d
CITY OF ORONO - BUILDING PERNIIT 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 CONTRACTOR
JOB SITE ADDRESS: 2"1�t 4 Pi�ir►Q+�, Lw�� ZIP:
NAME OF OWNER: Q 0+�+ ♦ t}-1�:a�. �0►�Or�['r`'►�►�► PHONE: (home) �'11'$�o Z ro
(work) a3 Z•'11 g$
MAILING ADDRESS: Z,">>0 '�'�►C+� 1..�. CITY: p C'0�0 ZIP:
CONTRACTOR: '�O�r► �fr►�•� �' S�`'�S PHONE: �SS•91 �0
CONTACT PERSON: C'�►�1f �rOiQ-w`-� MOBILE/PAGER: a O2-S S S
MAILING ADDRESS: ��IOPe i.��G01r• '�'• CITY: �C�: r►�► ZIP: SS y2 C
STATE LICENSE: # l y�
ARCHITECT/ENGINEER: �Arwt. ag G�~�PHO r
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PROPOSED WORK(describe in detai�: Rp�O�Q-I �wS�"� Q4"��` ��
��A1n��p► � w►�1 st' C�- �:�• ' ..1
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ZS� p 00.0�
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 t is is not a permit and work is not to start without a
permit; and that the work will b ' acco the approved plan.
APPLICANT'S SIGNATURE: DATE: 2-Z3—�O
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.
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Sec.13.04 RIGHTS OF SVBJECTS 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 re+�uired to be given individual. M individual asked to supply private or con6dential data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polirical 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 ro supply private or confidendal data;and(d)the identity of other persons or endries authorized by srate 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 mav olace the notice required under this subdivision in the individual income tax or provertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry, 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 srored private or public data on individuals shall be shown the data without any charge to hun 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 iu 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 crea[ed. 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 authoriry 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 rime, 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 hunself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreemenL The responsible authority shall within 30 days either: (a)correct the data found ro 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 determinadon of the responsibie authoriry may be appealed pursuant to the provisions of the administrative procedure act relating
ro 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.
G'o�. �b�^� �C`Q e+�"4r
First Middle Last
�{°1,0 ('o l�; �••`v1� 1pc� v�t
Address ��� �����
�l,: r►A
Ciry State Zip Phone
understand m igh ated above.
Signature
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z'i t O Pt��C�E CA rv C
PID:
DESCRIPTION OF WORK: �,�����-,c r2,,G—yv�.,��e�,
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ZONING REVIEW BY: CQ�n,.� DATE APPROVED• N IA
BUII�DING REVIEW BY: DATE APPROVED: Z-z Y- do
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes v No SEWER CONNECTION
STATE SURCHARGE Yes v No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTTON
Number of SAC Units OTHER (specify)
ZONING CHECK LIST zoning District: N�A NO C N�4ivGCr
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(L.ake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: W tland:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: y:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac : Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
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BUILDING REVIEW CHECK LIST
UBC: (Z • � CONSTRUCTION TYPE: V l�1
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Gazage x =
R =
TOTAL
Estimated Construction Value: $ 2-5�,v��m�'
Inspections Required: Work Requiring Separate Permits:
Site �Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing �Septic Sewer Connection
_�C Framing Fireplace Lawn Inigation
�Insulation (Masonry) Other
�Wall Boazd (Mfg.) Well(State Permit)
Final Grading/Filling � Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE:
` � Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
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DATE TIME
CITYOFORONO CALLEDIN `3 "3-'�� /�- ��
INSPECTION N TICE SCHEDULED 3-� va
PERMIT N0. D � 0 � COMPLETED '-5 f,--� `��v
ADDRESS �/ �?-�-'� °�'��
OWNER �+-o�C�J��- CONTR. - -�"' .
TELEPHONE NO. ��� — �-�a
� DESCRIPTION C ' �-t" �-� �
LL 01 FOOTING 1 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 I ION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Q 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
O5 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
4Qi 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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� OWNERlCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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�`�/VORK SATISFACTORY:PROCEED C PROJECT COMPLETE
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W L7 CORRECT WORK 8�PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� 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 next inspection 24 hours in advance. 249-4600
OwnerlContractor on site:
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Inspector. � �-� ��
White Copyllnspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE C I SCHEDULED S' I "C.�C� q '���
PERMIT NO. ����'e�+:' 2s COMPLETED � � ��
ADDRESS ��C� ��1'1�=�� �Ct--(lJ�.
OWNER CONTR. ,�C)I(1'1`�. u►�GL�'X�+'�
TELEPHONE NO. ��� (�3 S r���
� DESCRIPTION __ �l'YIa�Y
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q OS FINAL , 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 2� COMPLAINT
� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W��WORK SATISFACTORY:PROCEED �PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED / ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ;-. PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
i:� INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContra�r on��
Inspector.
White Copyllnspector's File Canary CopylSite Notice
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