HomeMy WebLinkAbout2000-P02756 - addn/remodel/repair � PERMIT
C I TY O F O RO N O Permit Number:
2 7 5 0 K e l l e y P a r k w a y- P O B o x 6 6 P 0 2 7 5 6
Crystal Bay, Minnesota 55323 P2Pf111t Typ@: Addition/RemodeURepair
(612) 249-46!00 Date Issued: si3i2000
SITE ADDRESS: 2705 Pheasant Rd
EXCELSIOR,MN 55331
PID: 21-117-23-23-0013
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use:
Permit Class: Building Census Code 438
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Gazage/Attached
DETAILS:
Approved per resolution#:
Separate permits required: Eiecvicai(siaiej
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 461.95 Valuation: $ 32,000.00
Plan Review Fee: $ 300.27
State Surcharge Fee: $ 16.00 "�
TOTAL FEE: $ 77g.22
APPLICANT: LAKE COUNTRY BUILDERS OWNER: G&K JOHNSTON
339 SECOND STREET 2705 PHEASANT RD
EXCELSIOR,MN 55331 EXCELSIOR MN 55331
THE UNDERSIGNID HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII.,DING CODE REQUIREMENTS.
I ISSUED BY SIGNATURE
Copies:City,Applicant,Assessor,Finance Page 1
� Total Fee: $ `7 �7�• �a-- Date Received: �- ��J
Entered By: cU� Pernut#: _�d al 7��
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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 CONTRACTOR
JOB SITE ADDRESS: 2�J0 s �1����►��'C �Ja� ZIP: ��3�
NAME OF OWNER: C���� `� ���TK�� �`N*�LT�� PHONE: (home)
(work)
MAILING ADDRESS: �?�� ���►��"r� �o� CITY: �P�t�io ZIP: S�'351
CONTRACTOR: �A�� �'�v �"TR-Y �vt�� PHONE: `�S2 �7`� - �12I
CONTACT PERSON: `�g a+��— MOBILE/PAGER: l2 �o�'2a�1 �
MAILING ADDRESS: 3�`� S�('ors� 5���-t CITY: �-x��l-��Q P- ZIP: S��31
STATE LICENSE: # LZ���
ARCHITECT/ENGINEER: �Y�� Ce,�,�`i�-`(' ��U��t�-�PHONE: `�17 y- 71 z:�
MAILI`G ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition X Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �nb (1) a���i-T�aN��-- ST�.L j o �-'��T ��?
�� L��C�4� `" ��=�c E C�� �R-1�o i�a�;2S s�� L L�:�,`�c '�o W
STORIES: I SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �2�°��'
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 not a permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: ��''"�"� � � " `�') DATE: � r �� � 2���
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non perntitted events will not be allowed.
9
Sec.13.04 RIGHTS OF SCTBJECTS 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 secdon.
Subd.2. Information required to be given individual. M 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,polidcal 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 confidendal 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 investigadve data,pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer.
'Ihe commissioner of�everme mav place the nouce iequued under this subdivision in the individual income tax or pmpertv tax refund instructions
instead of on those forms.
S�bd.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 confidendal. Upon his fucther 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 and meaning
of that data. After an individuai has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months
theceafter unless a dispute or acaon pursuant to this section is pending or additional data on the individual has been collected or created. The responsible
authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the
cequestiag pecson to pay the actual costs of making,ceRifying,and compiling the copies.
The tesponsible authoriry shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the
date of the cequest,excluding Satuidays,S�ndays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request within
that dme,he shall so inforni 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
co�eming himself. To ezercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The
responsble authoriry shall within 30 days eithee (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate
or incomplere data,includiag recipients named by the individual;or(b)nodfy 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 derernw�aaon of the responsible authority may be appealed putsuant ro the provisions of the administradve procedure act relaring 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 aze notified that:
1. The information you fumish 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 pemut 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.
R����� �pw�� ��� �
First Middle Last
�� S�co�� ST'2.�
a,a ss t ( l`�� `(7`{� `1 f2 f
�IS�oC� 1 l+� 5���`�
Ciry State Zip Pho
I understand my ri hts as stated above.
� �����
Signature '
10
` � CHECK OFF LIST FOR ISSUANCE OF PER11�I'I'S
FOR OFFICE USE ONLY �
ADDRESS OR LEGAL: z-t c�s pt-�-�+ s�T �t..�A/�
PID:
DESCRIPI'ION OF WORK: C�A tZ�A�` A�p� T � c�N
, .
ZO�'G REV�W BY: p� r DATE APPROVED: 8-r -d�
BUII�DI1�iG REY�W BY: DATE APPROVED: g-( -d�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes f No ;,
PLAN REVIEW Yes � No SEWER CONNECTTON
STATE SURCHARGE Yes � No WATER CONNEC'TION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No � STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONL�iG CH�CK LIST Zoning District: LR-�!�
Fire Department: �e�,�t�p Post O�ce: G�cec.¢�a R School District: IM p v N�
LotArea: Sq.ft. 31�Sa3 Acres •��32- Width 132.65 Depth 23'7•�I`� A�G
Survey Submitted: Yes_� No Date of Survey: S -i 7 ``�5
Proposed Setbacks: �
Front(Lake): 91.5 � Right Side: I�� '�'
Reaz(Street): 121' � I.eft Side: l l�b' +
Adjacent Structures: p-�-puc.H E�p Wetland: N((� .
Building Height: Def. Hgc. __p.IL Peak Hgt. b.IC.
Lot Coverage: D.k..
Grading: Staff Approval Date: -- By: Council Approval Date:
Septic: Staff Approval Da[e: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: ��p S
Avg. Setback: N�_ Bluff Setback: /V pr Lot Coverage: —
Eusting Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No_� Date of Council Approval:
REbIARKS(in house):
7
BUII.DING REVIEW CHECK LIST
UBC: IZ-3� - CONSTRUCTION TYPE: V N
Sq Footage $Per Sq Ftg
Basement . . . x. _ .
lst Floor x =
2nd Floor x =
Garage x =
Z, = A
TOTAL
Estimated Construction Value: $__�'Z�pO��
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�Footing ` Septic Sewer Connection - �
oC Frami.ng . Fircplace Lawa Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
�F� Grading/Filling _�Electrical(State Permit)
Other
REI�ZARKS(IN HOUSE): .
REVIEW BY OTHERS: DATE:
Access: Eusting New
Access Approval: Date gy;
REVIA.RKS (TO BE NOTED O�i PERMI�:
8
DATE TIME
CITY OF ORONO CALLED IN g-8� 8'���7
INSPECTION N�TICE SCHEDULED `-� C,���
PERMIT NO. ��7�� COMPLETED �v g'�O�
ADDRESS ��7b� �heq��� �c�
OWNER CONTR. �,K�Cc�t'�z-/
TELEPHONE NO. ��%3 'b`�3`I�
� � DESCRIPTION F����'�.�-
� FOOTIN�a..j 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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Q OW ONTRACTOR TO MEET YOU:_YES_NO
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�� L7 CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� 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. 249-46��
OwnerlContr r on si •
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� DAT�_�� �IM�
CITY OF ORONO CALLED IN `�� �
INSPECTION NOTICE SCHEDULED � �
PERMIT NO. v���� COMPLETED � � �-� 3
ADDRESS �-'7U � ��rt-��S��'�-�' �-�
OWNER CONTR. �P.C'CPA'i�i'c./13�ti fc�.�
TELEPHONE NO. `��`1 � 7l�-!
� DESCRIPTION _ _ �cx-�'c�G� c����/j�(GL"7
Ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADWG/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q FINAL 14 SEWER HOOK-UP 06 PROGRESS
� `�07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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W
Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT 11NSAFE CONDITION WITHIN HOURS. ,— pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
C; INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContra t r on site:
Inspector��������
White Copyllnspector's File Canary CopylSite Notice
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rne boun,lar�es o} tf+�above O�scr�bed�u+d +nd of cne�ocac�on o� ai� bu�ld�nqs. �oZ�� •
DEMARS -c�s�a. 'f e^y, thereon, •nd .�� �,s,a� e�, chme�ti, �f .�Y ,,am a, o� S�,d �,�a P R E PA R E D FO R :
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�Q�p MUbp�LM�NO �—�, •
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COPYRIGHT LAKE COUNTRY BUILDERS 2000
If another contractor will be using the plans for construction, it will first be necessary
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For the home owivr to (i)pay all design fees due to Lake Country Builders, and
(ii) sign Lake Country Builders standard copyright license agreement, a copy of which
will be made available. When thoseiconditions are satisfied, the designs may be used
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without infringement on Lake Country Builders` copyright. ,
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COPYRIGHT LAKE COUNTRY BUILDERS 2000
If another contractor will be using the plans for construction, it will first be necessary
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For the home owivr to (i)pay all design fees due to Lake Country Builders, and
(ii) sign Lake Country Builders standard copyright license agreement, a copy of which
will be made available. When thoseiconditions are satisfied, the designs may be used
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garage stall addition drawings for the residence of
GREG & KATHYJOHNSTON
2705 PHEASANT ROAD, EXCELSIOR, MN 55331
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GREG & KATHYJOHNSTON
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