HomeMy WebLinkAbout2003-P06147 - attached deck CITY OF ORONO PERMIT
275� Kelley Parkway - PO Box 66 Permit Number: Po614�
Crystal Bay, Minnesota 55323 P21'I'Tllt Typ@: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 4i21i2oo3
SITE ADDRESS: 1860 Shadywood Rd
Wayzata,MN 55391
P I D: 17-117-23-24-0018
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Pernut Type: Addition/RemodeURepair Pernut Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
n__.___� _ r___r�rr.v ��.rr�r
FEE SUMMARY: PernutFee: $ 83.25 Valuation: $ 3,000.00
Plan Review Fee: $ 54.08
State Surcharge Fee: $ 2.00
TOTAL FEE: $ 139.33
APPLICANT: Clark 7ohnson Inc. OWNER: William&Rhonda Omlie
2749 Blackstone Ave 1860 Shadywood Rd
St Louis Park,MN 55416 Wayzata MN 55391
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.
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�..ti ' �-=--._�— ✓`, �' ��YlCL1`I �G�
APPLICANT P TEE SIGNATURE SUED BY SIGNATURE
Cooies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
Total Fee: $ ���q,��j Date Received: �� �0 1 ���1
' Entered By: (d K Permit#:
` � CITY OF ORONO - BUILDING PERNIIT APPLICATIOIeT
I. N� `,
V �0� All information must be submitted in full before plan review will be started.
, �� lease nnt all in o»nation
�r� (� p f )
------------------------------------------------------ ------ -----------------------------------
THE APPLICANT IS: (circle one) R CONTRACT
JOB SITE ADDRESS: � 8�� ��DYWo 0 D F-U� ZIP:
NAME OF OWNER: �f����'tz+1�� D��� PHONE: (home)
n_ ,,,, (work)
MAII.ING ADDRESS: 1 g�� S��PY� I�'�v CI1'Y: Q�D ZIP:
CONTRACTOR: � � �l4�/ /� PHONE: �/�Z GI�¢ �� �\
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: t CITY: �r�wr s � ZIP: �4-f�
STATE LICENSE: # ��
ARCHITECT/ENGINEER: �,q-� v� PHONE:
MAII.ING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
E�A�o �,�GrovY ►-�
n� I.�uSE
TYPE OF WORK: New Addition_r� Accessory Structure �
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: E�P�o �i�y o� R����
�„- - - �- _ � �,���.:,;,�„�,��,�,.,.�.�-
i�r�� F�TAI a� r rs s r r ey sr' �i� ric.7►wi cYr�p�s•
�—T �
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
3,�o�`=
ESTIMATED 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 pemut and work is not to start without a
permit; and that the work will be in a e with the approved plan.
APPLICAN'T'S SIGNATURE: DATE: � �/�-�
NOTE! Parade.Qf H�, omes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGFTTS OF S[JB.TECTS OF DATA
Subd. 1. Type of data. The righcs of individuat on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information reqirired to be given individual. An individual asked w supply privau or confidendal data concerning himself shall
be informed of: (a)the purpose and inteaded use of the requested data wirhin the collecting�tate agency,political subdivision,or statewide rysum;
(b)whether he may nfuse oY is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)[he idendry 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 invesrigadve data,pursuant to secdon 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav piace the nodce�ewired under this subdivision in the individual income tax or oropertv taz tefund
instructions inscead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject
of stored data on individuals,and whe[her it is class�ed as public,private or confidential. Upon his fu►ther request,aa individual who is the subject
of stored private or public data on individuals shall be shown the data wi[hout any c6arge to him 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 its meaning,che data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuanc to this secdon 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 authoriry
may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible au[horiry 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 addidonal 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 conust the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing che nature of the disagreement.
The responsible authoriry shail within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including 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 determination of the responsible auchoriry may be appealed pursuant to the provisions of the administrarive 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 Ciry 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 shazed 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.
Fint Middle Lasc
Address .
City State Zip Phone
I understand my rights as stated above.
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
, FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I �6 O S H.4�t�t�o 0�0 �
PID: �
DFSCRIPTION OF WORK: �LZ{c t3x D.9•�sco N
ZO.�tI�i TG REVIEW BY: DATE APPROVED: �,/-�y-a3
BUII.,DING REVIEW BY: DATE APPROVID; Y-��/-a 3
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �� No
PLAi�T REVIEW �es �/ No SEVYER CONNEC'IION
STATE SURCHARGE Yes _�� No WATF.R CONNECTTON
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No 3TTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: N o C�w�e
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres � idth Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks: ' �
Front(Lake): Right Side:
Reaz(Street): Left Side:
Adjacent Structures: Wetlan :
Building Height: Def. Hgt. Peal:H t.
L.ot Coverage: -
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Eusting Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): �'� p�lo ADo�.�,•� � G x,sn^�l oL� - o�-�. r_=���%�•�5
/�b9ll.rJ Gaw<-� - �Ilo Zo�•«n � s s�.�-e s
7
BUII,DING REVIEW CHECK LIST
�C� 2� 3 CONSTRUCTION TYPE: �!/�1
_ Sq Footage $Per Sq Ftg
Basement x _
lst Flaor x _
2nd F1oor x _
Garage x _ .
x =
TOTAL
F.stimated Construction Value: $_ 3,poo d=
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_p�Footing ' Septic Sewer Connection
�c Framing Firepiace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
—�F�� Grading/Filling Electrical (State Permit)
Other
REMARKS(Pi 1 HOUSE):
-- ----------------------------------------------------------
REV�W BY OTHERS: DAT'E:
Access: Ezisting New
Access Approval: Date gY:
------ -------------------------------f—�----—�--------------
REl1'IA.RKS (TO BE NOTED ON PER1v1IT�: P�.fw,,,, ,S ��,� �� � o „i
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%��#l" �
� j DATE ? TIME
CITY OF ORONO CALLED IN �'�''� � �
INSPECTION NDTI E SCHEDULED 5�3 t._j %L�.' !
PERMIT NO. ��"G�<<-� l COMPLEfED
ADDRESS I�G; L� S���f�Z���,�����•r��' �-c�
OWNER CONTR. �IC�Y'IL!�C�"1�'I.SCTY1 ��'?C
TELEPHONE NO. �- f � `��- `�� � � �� �
� DESCRIPTION �GC��-l E'l�/ 1 Z� ���C-�--�-`�
� 01 FOOTING 11 ME NICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WAIL 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTORTOMEETYOU:��,YES_NO
� COMMENTS:
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� �WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W O CORRECT WORK&PROCEED ❑ISSUE CERTiFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PEAMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 h urs in advance. (g52) 249-4600
OwnedContractor on site:
Inspector.
White Copy/lnspector's File anary CopylSite Notice