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Home My WebLink About2000-P02958 - addn/remodel/repair w - � PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Po29ss Crystal Bay, Minnesota 55323 Pel't111t Typ2: Addition/Remodel/Repair (6'!2) 249-4600 . Date Issued: 9i2s�2oo SITE ADDRESS: 13$0 Rest Point Rd MOUND,MN 55364 P ID: 07-117-23-33-0007 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Census Code 434 Permit Class: Building Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Single Family DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 993.75 Vatuation: $ 100,000.00 Plan Review Fee: $ 646.03 State Surcharge Fee: $ 50.00 TOTAL FEE: $ 1,689.78 APPLICANT: J W WILLIAMS CONSTRUCTION INC OWNER: DAVID K BLODGETT 2936 QUAIL AVE NORTH 1380 REST POINT RD GOLDEN VALLEY,MN 55422 MOUND MN 55364 TI-�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. �!�J'-' i'` -„ [ (_ " L �?'"x1'S'� /�L"7 PPLI ANT PERMITEE ATURE SSUEDBY SIGNATURE Copies: City,Applicant,Assessor, Finance Page 1 � . �G� . - �;:-=, t u ' Total Fee: $ 1 ��.7�`_� Date Received: � ' �3 "�� „ �D ' F��" � Entered By: Pertnit#: �!�;1�{��'j , `-�`�``, CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------------- ------ -------------------------- i THE APPLICANT IS: (circle one) OWNER OR"CONTRACTOR JOB SITE ADDRESS: I 3CJV l�� I�(�L� �(� ZIP: -�.;3� / NAME OF OWNER: � PHONE: (home) ��1-`�y�� (work) MAILING ADDRESS: ��j� �Z� �' j��, CITY: ��r�r ZIP: ��`� CONTRACTOR: �Uv W� C,01�• C� = PHONE: /� -O � CONTACT PERSON: i,�J �_ MOBILE/PAGER: 7�/- C� MAILING ADDRESS:��:� � ' �,�,c� i�(n� CITY: ZIP: � � ST:�TE LICENSE: #�-Q%a-S(O7 � � i - �;�� ARCHITECTlENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYP i: OF WORK: NPw Addition Accessory Structure Move Remodel/Alteration � Land Alteration � PROPOSED WORK(describe in detai�: � ,� � � �J � ' �'t.� _�,. G_ �x. STORIES: � SQ. FEET OF EACH FLOOR: I �00 r�(,�,� f0_�s F�a,�f F,�„� NO. OF BEDROOMS: �� GARAGE STALLS: ATT. �_ DET. � ESTI�IATED CONSTRUCTION VALUATION (excluding land): $ � {}� �� '� 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 accordan e ' t approved plan. APPLICAI�TT'S SIGNATURE: � �?, � DATE: . /�- ��'� NOTE! Parade of Homes events require separate pernzit approval by Police Department and Ciry Council 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 rights 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. An individual asked to supply private or confidentiai data concerning himself shall 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;a�(d)the idenary of other persons or enrities 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 rewired under this subdivision in ihe individual income tax or oronertv tax refund instrucdons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be inforcned whether he is the subject of stored data on individuals,and whether it is class�ed as public,private or co�denaal. 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 and meaning of that data. After an individual 6as been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pe�ing 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 authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority 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£ve 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 tlus right,an individual shall notify in writing the responsible authoriry 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 nodfy 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 determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating 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�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 ttus application or permit. First Middle Last Address Ciry State Zip Phone I understand rights a stated above. Signamre 6 .- � .. - CHECK OFF LIST FOR ISSUANCE OF PERMITS - ' FOR OFFICE US� ONLY ADDRESS OR LEGAL: �,3�O �� <<�� ^� PID: DESCRIPTION OF WORK: �Zh�� — -------------------------------------------- - -------------------------------------------------------------------- ZONING REVIEW BY: DATEAPPROVED: �- Zv -v� BUILDING REVIEW BY: DATE APPROVED: � -� .-csu FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes ✓ No PLAN REVIEW Yes � No SEWER CONNECTION STATE SURCHARGE Yes �/ No WATERCONNECTION INVESTIGATION FEE Yes No �� PARK FEE SAC Yes No � SITEINSPECTION Number of SAC Units OTHER (specify) ZONING CHECK LIST Zoning District: n�v c�,p 0 Fire Depaztment: Post Office: School District: Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front (Lake): Right Sid : Reaz(Street): Left Side Adjacent Structures: etland: Building Height: Def. Hgt. eak 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 Setba k: Lot Coverage: Existing Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Vaziance Required: Yes No Date of Council Approval: REMARKS(in house): A � '1 BUILDING REVIEW CHECK LIST UBC: IZ' 3 CONSTRUCTION TYPE: V� Sq Footage $Per Sq Ftg Basement x = lst Floor x = 2nd Floor x = Guage x = x = TOTAL J Estimated Construction Value: $ C `V C'j U aU v�— Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connection Footing Septic Sewer Connection pc 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: Ezisting New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMI'1�: 8 _.. O.�%` � �.� �55.9� �.� �a � .z ��,5 ��/�/�JP `� � �� - � r •s �•ti x� , � ,�� ,o�� ,/_h� ~C � �J'1 4 J�,,:r pR �� 0%�.J �� F > L ��:�iail 5 � �/ � - , � �J �. ��a.� ,� �►.� O�� / �r4�� 5.2 �q��, Q / s ,o �' \ l� ~p � Q �� X �. p�F �'� �.��\\ �� h �� rJy I �� ' O � o+", ,x �`� ��.r'PJ . � ' a�p Q � ��C' /�k <� s-� '��(�� `� �\ ��Gy �� 950.26�t � '`�� c' ��' � • (�O � � c . yk�--•►s � \. �y4`1.76 ��f�""^-�' �(�� \ y�+� r � �'9A�'S.lfo / A�'I- A�l • .9 0�� I� � .�h•�'� �� 'vy 1�o �f- . � D--O� Q�\ 9�{1.'ib yA S . �(�t�9 �f�h \� \ �'°J� � �`�' 1 � � Z/� � � 933,$(0 , �o �� s� � I hereby certify that this is a �� true and correct representation +�> 4. . of a survey of the boundaries of: � ��_ Lot 6 and westerly 40 feet of Lot 7, � ''�_ � subdivision of Lot 14, REST POINT PARK''` � Hennep i n Couty, M i nnesota. �� '' � /� `L P 932.06 10� � �0�`` And of the location of all buildings, if any, thereon, and all visible �/ ��\� encroachments, if any, from of on ` �� said land. As surveyed by me this � 20th day of May, 1987. / �� —Lake ��e,V0.'�10►1 � 9zS•2�O Y� —H a�.rd cover' iS 2Z.fo8 % O-F �ota.l �. fi-. ,of l0'1". ,�_ �,� ,_. f' � � ,, . ,�; ,� y �., ��. ,,� .,� Thomas . Bergquist Registered Land Surv , � � ' `�� ` Minn. Lic. No. 7725 `�;- � �', ' '��- �; """�i r�Eas s�q��` °CA��_3O' CERT I F I CATE OF SURVEY W N SATHRE-BERGQUIST, INC. woK �c FOR : { 108 SOUTH BROAOWAY�WAYZATA,MN 55391 71 � F'�E"o. DON RUSSELL TELEPHONE812•478-B000 .�rJ�..r� ,, 3 �� .� �� A` ,