HomeMy WebLinkAbout2000-P02959 - new structure _ ' PERMIT
C I T�`' �� Q RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P02959
Crystal Bay, Minnesota 55323 Permit Type: New st,u�ture
(612) 249-4600 Date Issued: 9�is�2oo
SITE ADDRESS: 1875 Shadywood Rd
WAYZATA,MN 55391
P��: 17-117-23-24-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use:
Permit Class: Building Census Code 101
Permit Type: New Structure Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution#:
Separate permits required: i'iumoing iviecnanic:ai rirepiace '"waieri.onnec,�iion �ewer i,onneciion irrigaiion Eieciricai
(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 1,844.95 Valuation: $ 251,835.96
Plan Review Fee: $ 1,228.43
State Surcharge Fee: $ 130.00
TOTAL FEE: $ 3,203.38
APPLICANT: MARK KOSEK OWNER: MARK&GINA KOSEK
1855 SHADYWOOD ROAD 1875 SHADYWOOD RD
WAYZATA,MN 55391 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 BUII,DING CODE REQUIREMENTS.
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AP LI ANT PER TEE I NATURE ISSUED BY SIGNATURE
Copies: City,Applicant,Assessor, Finance Page 1
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Total Fee: ' $ 3;,�,`3, ��_ Date Received: � -� �G��
Entered By: �� Permit#: Ff�� 'o���j`�
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) WNERIOR CONTRACTOR
�
JOB SITE ADDRESS: �`�l�j ��dd���y„��1d �.(jGi� ZIP: �S�'� �
�
NAME OF OWNER: _(1�(�k. �Lp�� cw'1p� C1�►��ti PHONE: (home) �5� - �}�i'I b�7�
F�Y�k �OS�k- �work) �i.�- .' ���4-�l��-
MAILING ADDRESS: � � � + CITY: �_�����^ZIP: ��,�-�'�l
CONTRACTOR: �WY1e.� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: ���P �����, PHO�TE: ��2 ' 3 4 S ,3
l�IAILING ADDRESS: CITY: ZIP:
NAi�IE: REGISTRATION#
TYPE OF WORK: New � Addition ✓ Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK (describe in detai�: � � P�W ��C� .
STORIES: � SQ. FEET OF EACH FLOOR: �='r� �4 i.2 �"'�:� _
NO. OF BEDROOMS: � GARAGE STALLS: ATT. �_ �T. C}
EST�IATED CONSTRUCTION VALUATION (excluding land): $_�,, Q�C�
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: `� �I (3�
NOTE! Parade of Homes events require. eparate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
9
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Sec.13.04 RIGHTS OF SLJBJECTS 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 conceming hunself shall
be infornied of: (a)the purpose and intended use of the requested dara within the collecting srate agency,polidcal subdivision,or stauwide 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 entides authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigaave data,pursuant to secdon 13.82,subdivision 5,to a law enforcement officer.
'Ihe commissioner of�evernie mav nlace the noace iequired under this subdivisinn in the individual income taz or oropem tax refund instiuctions
instead of on those forms.
Stibd.3. Access to data by mdividual. Upon request to a responsible authoriry,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�.ored
privare 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 has been shown the private data and informed of iu meaning, the data need not be disclosed to him for six months
thereafoer unless a dispute or acaon putsuant 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.
The cesponsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the
date of the tequest,excluding Sawidays,S�►�ays and legal holidays,if unmediate compliance is not possible. If he cannot comply with the request within
that time,he shall so info�rn the individual,and may have an addidonal five days within which to comply widi the request,excluding Saturdays, Sundays
and legal holidays.
S�bd.4. Procedure when data is not accurate or rnmplete. An individual may contest the accuracy or completeness of public or private data
conceming himself. To exercise this right,an individuat shall nodfy in writing the responsible authority describing the nature of the disagreement. The
cesponsble authoriry shall within 30 days either: (a)coimct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate
or incompleoe data,including cecipients 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 sratement of disagreement is included with the disclosed data.
The detemvnation of the msponsffile authoriry may be appealed Fwtsuant ro 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 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 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 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature
10
• CHECK OF'F' LIST FOR ISSUANCE OF PER��IITS
- FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I �31� �44 A(J`�1 W c�c��J 1?�iA�
PID:
DESCRIPTION OF WORK: �EW (2�5
.
ZO�'G REV�`V BY: DATE APPROVED: q - t 3- o0
BUII.DING REV�W BY: DATE APPROVED: y'- �� -oa
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ✓ No :�
PLAN REVIE�1 Yes ,/ No SEWER CONNECTION
STATE SURCHARGE Yes _�� No WATER CONNEC'ITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No �_ SITEINSPECTION
Number of SAC�Units ��—t�r-r F��. de.,,,,�.� OTHER (specify)
ZOVL�tG CH�CK LIST zonin� District: (..2-� L
Fire Depar[ment: y�,�,�����____ Post Office: ��1�1y'Z.A�TW School District: �r,J�,gTC►�N�c A
Lot Area: Sq.ft. 3(..v`1 U Acres • �2-7 Width �i(LEl,v(h!Z Depth
Survey Submitted: Yes_� No Date of Survey: 3-Z�-0 0
Proposed Setbacks:
�ro�st(La.ke): � -�1 Right Side: 99�
�as (Street): � � Left Side: '1 I �
Adjacent Structures: N ��- Wetland: �-- .
Buildin� Height: Def. Hgt. Z Z Peal:Hgt. Z�6
Lot Covera�e: �, �L
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zonin; File: # — Resolution: # Resolution Date:
Shoreland District: y�5 _
Avg. Setback: C���c. Bluff Setback: /ll I A- L,otCovera�e:
Ezistin� Proposed
Hardcover: 0-75' Z 3`1 Z'2'b
75-250' t�$ .(,1 z.2 a 3
250-500'
500-1000'
Hardcover Variance Required: Yes No �C Date of Council Approval:
RE�I.A_RKS (in house):
7
BUII.DING REVIEW CHECK LIST
UBC: (Z-3 CONSTRUCTION TYPE: V�
� Sq Footage $ Per Sq Ftg
Basemenc I`fIZ z -�► (�.1� = 2S"6�3•+��
lst Floor l`-11 Z. x $ 'T`{. ZZ = 1��l,11fd.f.`I
2nd F1oor ►4 t Z. x .�t 7`{• 22 = 1 v�1�'I�$.Ir�
Garage P�'ls x � t°t•l9fl = �6.b'z.S".00
R =
TOTAL ,�2� l� ��.�1(o
Estimated Construction Value: $ 25't� �3'� .�l�o
Inspections Required: Work Requiring Separate Permits:
Site �_Plumbing ' Fire
Hardcover Removal R Mechanical 0� Water Connection
_�Footing Septic K Sewer Connection
_� Framing _f�t Fireplace _�Lawn Irrigation
_�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:
REVIARKS (TO BE NOTED ON PERNII�:
8
� � � q� G�P� k���x _ _
��N� _ . � �o
V l
, HAI2DCC1'�ER CALCULAT�ON WOItKSHEE:'1 9-��GG /�a�'c/'�o
�-�� N�A�cc✓�
SETBACK ZONE: (CIRCLE O�YE) f�7�} 75-250' 250-500' S00-1000'
EXTSTING E=ARDCOVFR IN ZONE
A. House x = S.F.
lcngth �L'idth r
x = p,7 S.F. —ST�ONE V1A4
x _ _ �7 S.F. -R�UG WpL�
9.5 x S.S` ` = 9� s.F. -SµEP
B. Garage �_ x =- S.F.
C. Driveway x - q�' S.F.
x = S.F.
D. Sidewalk x __ = 7.6 S.F,
x - S.F.
E. Patio/Deck J__ _ x = __j��_ S.F.
� = S.F.
F. Landscape _ x - S.F,
Underlain ` x ___ _ � S.F.
By Plastic _ x __ = S.F.
G. Other _ — x �_.._ _ _....�_ S.F, -�/GiJ� (�jLOC�K�,
TOTAL HARDCOVER IN ZONE - /,39 ? S.F. A
� TOTAL PROPER1'Y AREA ]I�t ZOI�IE - f`��1 ZCj # S.F. B
A - B _____ x I00 = _�, 3�7, qa
I�ROPOSEll �YAR�COVER �'IaNE .
A. House x - S.F.
Lcngth Width
. x = 6 s s.F. rrm,vF �«
_ x = � 3� S.F. �aCK cc�.fcc.
X = 81 S.F. �1"/�FD
B. Garage x = S.F.
C. Driveway � x = S.F.
x = S.F.
D. Sidewalk ,. = S 6 S.F.
- -- ., — - - _ S.F.
E. Patio/Ueck x = /�D S.F.
x = S.F.
F. Landscape x = S.F.
Underlain x = S.F.
By Plastic x = S.F.
G. Ocher x = � S.F. wooD BCo�K�
TOTAL HARDCOVER IN ZONE - t�3� S.F. A
TOTAL PROPER7Y AREA IN ZONE - /9.12n S.F. B
A • B � lC10 = ?. Z6 %
13
� � � _ ���`:`� ' �����° ' f'oIFK
t��� k7 [4 1 r �'
1
� � ��`��' �+�Q��}VER CALCULATION WORKSHEEI'
7-J ao
�-�-oo /,cd�o,,Ea
SE7BACK ZONE: :C(RCLE OIYE) 0-75' 75-Z50' 250-500' S00-1000' �,,��e��✓6�c
gxrsTrnlG HARDC�?�ER= IN 7Q�y� � y-3� S.F.
A. House x -
Lcngth �1'idlh
x = S.F.
x = S.F.
� x __ T = t q s.F.—Ra,t w•ae.L
B. Garage x = S.F.
C. Driveway�l�vo017,pCoCkl X — � 2�'T S.F.
x = S.F.
D. Sidewalk x ^` _ ---��2- S.F.
x = S.F.
E. Patio/Deck _ x = __ 2_$� S.F.
x = S.F.
F. Landscape __`___ x - SZ S.F.
Undcrlain _ x u_ _ _ S.F.
By Plastic _ x = S.F.
G. Ocher ----_^ x �___ - __ S.F.
TOTAL F-IARDCi)VER IN ZONE - 3� 4$ S.F. A
� TOTAI, PROPERTY AR?:A IN ZONE - (�� Q�O _ S.F. B
A _ - B _ __ x 100 = _�� 61 %a
PRO OSEll �IARDCOVE�t IN 'LON�
A. House x __ = 23 Z O S.F.
Lrnsth Width
. x = S.F.
X = � S.F.
X = S.F.
B. Garage _ x = S.F.
C. Driveway x = !200 S.F.
X = S.F.
D. Sidewalk x = /OS S.F.E'��'y {jTE/J
x = S.F.
E. Yatio/Deck x = /2 d S.F.
' x = S.F.
F. Landscape x = S.F.
Underlain x = S.F.
By Plastic x = S.F.
G. Other x = S.F.
TOTAL HARDCOVER IN ZONE - .�7 `�5 S.F. A
TOTAL PROPERTY AREA IN ZGNE - /6, 9 ZO S.F. B
A - $ z !00 = Li. /3 %
I 3 I b;�z-O ,c z5`�o = y�3�
3
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A, r .;•,4• tiin. R-la c+own to frast deoth � �
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SLA� �H GRADE
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E1V'EYtG7t CODE DES�GN BY ACCEp'I`ABL�PRACTTCE
� Ta Decermine Compl�ance wi[h the Minucsota Eaergy Code
� (Scction 602 of thc State r�me�ed I983 Mvdel E.nergy�odi.)
{ This fozra is only applicable[o detached one-a�i two-family dwciliugs. The requiremcnts herein are basect an Tabte
1 No_ 6-11 in lien of chc crit�ria sgeci�ed in Sections 602.2.1, .2 and.3.
�ia�naa�� 18 7� � Y (���'�-,.�,� , �y 2�l r�1 __
CantraCtor or Owner��RK� ��� �pSL/<„�T
Ruildine Element "R" Values prca(acLftl �af Ext. W�i�g, �
����g Design Rcq'd�
Wall�(ext,�ri�r? Design Req'd,� . .
(wio fcln�
I+7onrs(ovCr unheated spaccs) UeSigu Req'd 2�
f'Wiadow3(ir�bld�s w/o besign Rec�'d�.
sliding glass doar) �Z��
'"Windows(in b2dgx wzth a �� �q'��
slidiq;glass dopr) ���,y�
�oundation Watls Dcstgtt�I�q'd�(whe¢iasnI�tin�fuIt depch AF faundatioa v�ral2j
; 1]iesign Req'd 10 (wben instilatfing only[o fr�ist depth and
e fiootings e.xtc:nel b�Iow) i
Stab-an-grade fiaors Desi�n^____Rcq`d_(See�igara No. 3) �
+*Ijoars(1 3J4"me[at taced) Dcsegn Req'd..�
'�Al!windc�ws sha11 t�dovbt�gtazed or have scrnm wirsdot�ts
**Cam�entional doqcs oth�er thaa metal require a storm door
s.� ��A�
1 hcreby ccrtify that I have completed the above informa[i,on and cha�it complies with the Miunesata State�nerg� .
Code. �
�
�ignatz�re 17ate I �
BCSD 3-89
GC1SMlSS
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Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPIAINT
� 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
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OwnerlContractor on site:
Inspector, a�/io.� G��-L�J
White Copyllnspector's File Canary CopylSite Notice
CITY OF ORONO CALLED IN ��-� �T�U �;T U 6
INSPECTION TI �- SCHEDULED �- -U0 ,-�o
PERMIT NO. � COMPLETED -� � ' ��
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
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v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
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Cali for the next inspection 24 hours in advance. 249-460�
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DATE T ME "
CITY OF ORONO CALLED IN /�Z- � �-��
INSPECTION N �b���SCHEDULED /-�-3—� �' �- 3'a
PERMIT NO. COMPLETED << �
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❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. 249-4600
OwnerlContract
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White Copyllnspector's File Canary CopylSite Notice
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DATE • ��P�
CITY OF ORONO CALLED IN o�c��'-0/
INSPECTION NOT SCHEDULED " 'O • a3o�M
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J 07 D -FI 15 SEPTIC INSTALL. 22 FOLLOW-UP
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❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-46�0
OwnerlContr tor on site:
Inspector.l�l�l2�G�U�
White Copy/lnspector's File Canary Copy/Site Notice
DATE TI �
CITY OF ORONO p�N l9-C�� f
INSPECTION TIC�, SCHEDULED ���
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l� 01 FOOTING 11 fv1ECHANICAL RI 18 EXCAV/GRADING/FI�LING
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Call for the next inspection 24 hours in advance. 249-46�0
OwnerlContracto on site:
Inspector. ���1/r �l�
White Copyllnspector's File Canary CopylSite Notice
� DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTI �1�I SCHEDULED _�,�'-�' G ,v ° ��►
PERMIT NO. COMPLETED "'�
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Q OS FINAL 14 SEWER HOOK-UP O6 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 FOUNDATION/REMOVAL
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INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP OROER POSTED.CALL INSPECTOR
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-4600
OwnedContractor on site:
Inspector. /'���,6�,I���-/,��
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White Copy/lnspector's File Canary Copy/Site Notice
y� DATE �'IME
CITY OF ORONO CALLED IN `-�"�`�'��� /' ��
INSPECTION�NA�T,ICE SCHEDULED - "�� �
PERMIT NO. 7 �i ���� COMPLETED � �� �-
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y 03 INSULATION 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 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
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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INSPECTOR WILL RETUFN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-4600
OwnedContr tor on site:
Inspector
White Copyllnspector's File Canary Copy/Sfte Notice