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Home My WebLink About2002-P04784 - addn/remodel/repair . �. PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P04784 Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/lzepair (952) 249-4600 Date Issued: liisi2oo2 SITE ADDRESS: 2660 Pheasant Rd Excelsiar,MN 55331 PID: 21-117-23-23-0022 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Buildin Census Code 434 Permit Class: g Permit Type: Addition/Remodel/Repair 1'ermit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution #: Separate permits required: r�umoing iviecnanicai r,iecRicai�siaiej NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 1,413.75 Valuation: $ 175,000.00 Plan Review Fee: $ 937.23 State Surcharge Fee: $ 90.00 TOTAL FEE: $ 2,440.98 APPLICANT: Lake Country Builders OWNER: Gregory&Gayle Hayhurst 339 Second Street 2660 Phesant Rd Excelsior, MN 55331 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 ORD[NANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � � c� �,",'�r� � �— ;-c_�7 � � -�<< ��_C� C��YV`- �e_.<%1 �� /APPLICANT P MIT SI NATURE —_' ISSUED BY IGNATURE � Copies: l-File(SiQnitures Reauired), l-Aoblicant, 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1 --� � � C-1 � ` �"i otal Fee: $ �'� ' �� '� Date Received: ��:-/ -7�'Z_% Entered By: � i � ; ; � i-� -i: , Pernut#: i - �� - ('/ �-��'��_ , ,, , 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 OR�ONTRACTOR Y � � �--- -�<-� � JOB SITE ADDRESS: ��i�j C� � �1 �?cti�c�.ti-L% ��U e��ZIP: � �--� � 5 � i ._{- NAME OF OWNER: ,� /x'° �t �c�• � C�.�.c. � -' �c �u�� IPHONE: (home) �� j- �l 7�l— 7/�� (work) MAILING ADDRESS: CITY: ZIP: CONTRACTOR: �C,��' �,1vii�i r/ l��G-r ��+��t i � PHONE: q S "� .� ��c/_ �/Z � CONTACT PERSON: �; L� Gi MOBILE/PAGER:�/;Z. - �/ !O ,:�(0 6,,2 MAILING ADDRESS: ;'"�G% ,�"`' j.{-,��.� - CITY:�� Xt f</s;�� ZIP: �3�3 1 STATE LICENSE: # ..�� `� (�; ARCHITECT/ENGINEER: n � PHONE: MAILING ADDRESS: ,� i "� CITY: ZIP: NAME: REGISTRATION# - TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration� Land Alteration PROPO5ED WORK(describe in detai�: `�y�-�e��c� Tr��a;=��l.f- � �� , .��t e,i�-� � ;��-{ ��C1� i�� ri��<< ��f 4�+"'��< ir -�l' l� � � STORIES: I SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. �_ DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � 7 � ��}� � 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 no; a permit and work is not to start without a permit; and that the work will be in accordance witl� e approved plan. : �. , APPLICANT'S SIGNATURE• ,-;�:� . .-7 ,� �c�,�.%� _- � DATE: � �", (,) . ` . r--� , ---_ NOTE! Parade of Home ents require separate permit approval by Police Department and City Couneil 60 days prior to the event. Non permitted events will not be allowed. 5 � • � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righu 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,polirical subdivision,or statewide system;(b)whether he may refitse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or co�denrial data;and(d)the identiry of other persons or entities 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 mav olace the notice reauired under this subdivision in the individual income tax orpro�ertv tax refund instrucrions 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 aud 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 secdon is pending or addiaonal data on the individual has been collected or created. The responsible authority shall provide copies of the privare or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu 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 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 conceming himself. To exercise this right,an individual shaii 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 determinafion of the responsible 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 �ity 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. ,T / r �� C- G��- /C 1�1J�� /,t I�f�L��'1 First � � � Middle Last � 3 �t x' �� }�- � E_� Address r — --�- � �-h��- i>;�� ,��.�� 5� �3 ��.5� �� /�`i-��I2 J Ciry State Zip Phone I understand my r' as stated above. �.> / , , � < �'�� -� / r-c�� `� �� gnamre -. 6 , : ' ` CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: ZL�p P��-r�sr4rvr �,4.r� - PID: DESCRIPTION OF WORK: ��u,o��z ZONING REVIEW BY: DATE APPROVED: /- /y- d2 BUILDING REVIEW BY: DATE APPROVED: / • i y-0 2 FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes ,/ No PLAN REVIEW Yes r/' No SEWER CONNECTION STATE SURCHARGE Yes �/ No WATER CONNECTTON INVESTIGATION FEE Yes No PARK FEE SAC Yes No ' SITEINSPECTION Number of SAC Units OTHER (specify) ZONING CHECK LIST Zoning District: N� C N�r�l�.Q Fire Departtnent: 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(Street): Left Side: Adjacent Structures: We and: Building Height: Def. Hgt. Pe Hgt. Lot Coverage: � Grading: Staff Approval Date: Council Approval Date: Septic: Staff Approval Date: B : Zoning File: � Resolution: # Resolution Date: Shoreland District: Avg. Setback: Bluff Setbac : L.ot Coverage: Existing Proposed Hudcover: 0-75' 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes N Date of Council Approval: REMARKS(in house): (��-�r /I.n av►� /Lt90 r S'i�c,rv�t.: `�° � -�`�ch c,.e�� 5 �s n1 o r� c�-v►s.� Q c= .v�c.�� 7 . - . , BI.TII�DING REVIEW CHECK LIST ' UBC: ,/Z• 'S CONSTRUCTION TYPE: Y/�. Sq Footage $Per Sq Ftg Basement x = 1st Floor z = 2nd Floor x = Garage z = x = TOTAL Fstimated Construction Value: $ l7,�;Odv �� Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connection ' Footing Septic Sewer Connection _�Framing Fireplace Lawn Irrigation ��Insulation (Masonry) Other �Wall Boazd (Mfg.) � Well (State Permit) Final Grading/Filling �Electrical(State Pemut) Other REMARKS(IN HOUSE): REV�W BY OTHERS: DATE: Access: Ezisting New Access Approval: Date By: REMARKS (TO BE NOTED ON PERNIIT�: , , 8 , DATE TIME CITY OF ORONO CALLED IN ^�1 INSPECTION NOTICE �j SCHE�ULED 'J"�O` /•' `'° .�l PERMITNO. ��76 Y COMPLETED (,f q A D D R ESS �.�(pD ��-�SG�-�" ��. OWNER CONTR. /�,./C.�' C� �%�77r: /��c��S. TELEPHONENO. ��r' :_�lv[�. �C7'S:�I ,r-- � DESCRIPTION__ f�I CL rL1 �^r�-.�1 � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAI 19 LAKESHORE/WETLANDS � 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z04 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 = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � J O �. � O � W � Q � 2 W � W � � J a W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-460� OwnerlContract n s' : Inspector. White Copyllnspector's File Canary Copy/Site Notice �/ DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. `'� COMPLETED �' -/y'-�� ADDRESS �� , f�3 5 `'`��" OWN ER CONTR. TELEPHONE N0. � DESCRIPTION l4 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 A#i 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 03 SULATI 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 O6 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 PLUMBING FINAL 36 FOUNDATION/REMOVAL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO Z D COMMENTS: � W � � � �_ � 0 � ��'` � � . �� C�G� o �� 1U , � � , Q � z W � W � � d ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W � ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O C CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN 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.473-7357 Owner/Cont ctor on site: Inspecto��lk�l�-�C.�� White Copyilnspector's File Canary CopylSite Notice