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Home My WebLink About2007-P10852 - addn/remodel/repair PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P1o852 Crystal Bay, Minnesota 55323 Permit Type: (952) 24�v`4600 Addition/Remodel/Repair a Date Issued: 3/29/2007 SITE ADDRESS: 2730 Pheasant Rd Unit# Excelsior,MN 55331 P�� 21-117-23-23-0057 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: Separate permits required: Plumbing Electrical(state) NOTICES/REMARKS: Convert walk in closet to bathroom FEE SUMMARY: Petmit Fee: $ 111.25 Valuation: $ 5,000.00 Plan Review Fee: $ 72.31 State Surcharge Fee: $ 2.50 TOTAL FEE: $ 186.06 APPLICANT: Owner/Self OWNER: William Y Smiley III � 2730 Pheasant Rd. 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 ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. if�� -C C -�._C'? �-- �Y,� APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 ' Total Fee: $ ��'G ' D� Date Received: 3-'�� 7 Entered By: Permit#: �. /pBjr�_ • 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 ONTRACTOR � JOBSITEADDRESS:�I�O '��'��,N 1 (� 0 �X�.�G.L.SIO�ZIP: �� 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 Departnsent and City Council approval 60 days prior to the event. Shuttle bus service wi[1 be required unless applicant demorrstrates sufficient on-site parking is available. Non permitted events will not be allowed. NAME OF OWNER: � �tL, S S`1� L �,� PHONE: (home)��,�•y�11 •O�}9� �p - (work)_�1�- 8 41-�I 7 l�7 MAILING ADDRESS:�,13 O ��1��'E,(�S (a 1�T CITY: 'E.X C E L S l0 4� ZIP: �� CONTRACTOR: o W tu�� PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIItATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding,Windows) �_ Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detain: C o t� , C,A j V�1 ALtit -1 t� C L t� g�__i' '1� � dA"5' l�\0.00r� - AQD S ��nW"E� 'CO �I.t i � S � NK . • STORIES: � SQ.FEET OF EACH FLOOR: � NO. OF BEDROOMS: �-- GARAGE STALLS: ATTACHED DETACHED_ E5TIMATED CONSTRUCTION VALUATION(excluding land): $ �} � t5 r, '� 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: e DATE: � , "�� -d � 31 Sec.13.04 RIGHTS OF SUBJECTS 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 required to be given individual.An individual asked to supply private or confidential data concerning himselfshal I be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political 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 confidential data;and(d)the identity 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. 'rhP��„�„�a��ner of revenue mayplace the notice rgguired under this subdivision in the individual income tax or�ro er y tax refund instructions instead of on those forms. Subd.3. Access to data by individual.Upon requestto 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 ofthe content and meaning of that data. After an individual has been shown the private data and infortned of its meaning,the data need not be disclosed to him for six months thereatter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. 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. 1'he responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe 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 e�:ercise this right,an individ��al shall notify in writing the responsible authority describingthe nature of the disagreement.The responsible authoriry shall within 30 days either. (a)cortect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete date,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 determination of the responsible suthority may be appealed pursuant to the provisions of the administrative procedure act relating to co��tested 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. ' �v�d 1 t��,► r� r� ��`�{ R �.,�� S r"� 1 �.E `i �' First Middle Lest �.� � o PN �. RSn N -� t�b Address �,X L E �..; 5 1 o t'� `"�tJ S S 3 3 � Co 1 '�� 'b a �• �1`717 City Statc Zip Phone I understand ights as stated a ove. � Signeture Reset Form ' 32 �CHEC� OFF i�IST FOR ISSUANCE OF �ERMITS FOR OFFICE USE ONLY� . . A.DDRESS ORLEGAL; 2�3� PH�-�s�l^Jr ►7�a� --- PID: DESCR.�TTO�T OF WORK: i��w•�o�c� c�s�=� ,r��-o bw-�n� zO:�i TG REV:�EW BY: --------------------- DA.T'E APPROVED: gUI�DING R.E"VIEtiV BY_� _ ---�-----------DA.1'E APPROVED__�,��z9_c�------ F'EES TO BE CHARGED: Misc. Fees Calculated By: pEg�T Xes ✓ No PLAN REV�EtiV � � Yes _� No SEti�ER CONNECTION STATE SURCHARGE Yes �/ No WATERCONNECTION INVESTIGATION FEE Yes No _� PARK FEE SAC Yes No T� SITEINSPECTION Number of SAC�Units OTHER (specify) ZOYI1tG CI�.CK LIST Zoning District: ✓lJ0 G�/C�e , Fire Department: Post.Office: School District: • � _ Lot Area: Sq.ft. Acres ' Width Depch Survey Submitted:� Yes No Date oE 5urvey: k Proposed Setbacksi • � Froat(Lake): Rioht Side: . Rear(Street): Left Side: Adjaceac Struccures: � etland: Builclin�Hei;hr. Def. Hgt, ealt Hgt. Lot Covera�e: Grading: ScaEf Approval Date: Council Apgroval Date: ' Szptic: Staf� Approval Dace; By: Zoain� File: R Resolutioo: # Res lucion Date: Shorela.nd District: Av;. Setback: BluFf Setback: L,ot Coverage: Eustino Proposed Kzdco�er: 0-75' 75-250' 2�0-SCxJ' �oa-ioc�o� ��'��CGt�i tr c=i?�C.� ti2yL'!LPC: :25 1i0 n' _ r�C_'ni��ril An�r�y��: RE�L�S (inhou�e): BUILDING REVIEti� CKECg LIST . UBC: R' 3 ' CONSTRUCTION'�'XPE: VN . Sq Footaae $Per Sq Ftg ' � Basement • . .. x � . . Ist Flaor � z • _ . • . � � 2nd Floor x _ • �� . Garaoe X _ , z = TOTAL � Estimated Construction'value: $ ,s p D O� Insgections Requirec3: Work Requiring Separate Perrnits: Site �Plumbing Fire • Hardcover Removal Mechanical Water Coaaectian Footing � Septic Sewer Coaaectioa �• '� Fr��d • Fireplace Lawn Inigation _�Insuiatioa (Masoary) Other _�Wall Board (Mfg.) Wetl (State Permit) °'`' F�� Grading/Filli.ag _�Electrical (State Permit) Ocher REMA.RKS (IlV HOUSE): . '. - -- - - --------------------------------------------------- REY�tiV BY OTHERS: DATE: Access: Existing New . Access Approval: Date gy; � — -------------------------------------�-------------------------------------------------------------- RE1��ARh'S ('TO BE NQ'�ED Q�?pERil�; � i I7ECK WI I?All. 4" O.C. I'IGK�'('f5 WO N 51 LIQ-hl'S t01'iZAIL ' IZ ADOV�I' O 1�I25, / GOI.I.AI2� E I I 3� � — — — — 11 � '.X 6 WALLS � I �w2xi2rz�r�� . o I �� N- N�W 2 X 8 f2AF'f�12 � x N il � " � I 2��_�� ,� f 30 opr,w�� r�� S� F�� ;� tr' ;;:�,:, �A� �ryt��i�� }" X II-I/�t" MICI20LLAM LVl- � OC � ��..,r°1`�i ;. :��„►�n��W�LSII I J � CONGE n�LAN HM1G�i2 _ I I IL _ _ _ ��O = � �xis�nr��inr,�r�� r.�w 3-9 i i �� inc� Ann –- � x`� — " ��c, as�a�n � 3 � =I2C15� pOOM 20 �ATi c�.os�r � � 0 opr,w�� ; 1 10' — — — — � — — — ��0�� . �,C� �� '�C. �1 1�.� t��,� '�1 I� � 6 8 C�.O S � � eiT�� OF� `O�O��G F�,:.._��i a ��.��.�.�t�;- �€_�;�� :�v�Ew w�'r=,�c�_��._ a;�' --•-3-Z e-oZ-^-. - __- �'-F';r,;;-r;•��,��___ �i��..,r�.�.:�;�1�'1��L.�,�f�,'l�i�l�:i�4:�i �t_�i� � .__,.� ,.., ..��r1: ^T:��,1� r:� h1'. �7 f .. '. . .'1 ` .. ;i ,. ._..� � . � ' 7;,'}. �5�^ , 1. . � e � �Ei. - . ..; '�'.y'1�:.'(T�.' �J.:,�i-. .�:•. '. . -.I ��:' 'liii� . K'Ei_i'��f t-i�:i{'-'lAN SET O�ti �f1"C fiT�LL�i��w;�S � —�� (� DATE TIME � CITY OF ORONO�I��j'�� ✓cALLED IN INSPECTION NQ�'I��,S ,/ ✓sCHEDULED a Q v�} 9:3v PERMIT NO. 'r� 7" COMPLETED ADDRESS C� OWNER� CONTR. TELEPHO E NO. �� — ��/— �� I � � DESCRIPTION �l,G�`{��OD✓Yl I`�D�P� � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT J ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP ? ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J �LUMBING FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO AAEET YOU:_YES_NO � COMMENTS: � W a o � •0 � �Q�e�f�c>f' S R�Z Q��l'�C� � � ��(n.�N R ' � � ° c� c�r'Cx��., W � � � l'litt�i� D lL�c�r S �� C��- t��l�2 c� � d N �'c� ��' t3Q c� !'Op r,t.,� W � � � ❑WORK SATISFACTORY:PROCEED �ROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on site: Inspector. .r 1 ` White CopyAnspector's File Canary CopylSite Notice