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Home My WebLink About2002-P05111 - dock GITY�` OF ORONO PERMIT 2750 Kelley Parkway - PO Box 66 Permit Number: Posi i i Crystal Bay, Minnesota 55323 Permit Type: User Defined (952) 249-4600 Date Issued: s�3�2o02 SITE ADDRESS: 1875 Shadywood Rd Wayzata,MN 55391 PID: i�-i i�-23-z4-oo29 DESCRIPTION: Proposed Use: Residential Pernut Class: General Permit Type: User Defined Permit Sub-type(s): Dock DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: � 30.00 Valuation: $ 0.00 TOTAL FEE: $ 30.00 APPLICANT: Owner/Self OWNER: Mark&Gina Kosek � 1875 Shadywood Rd 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. � � /� i �,,.4 — ,,.�Lc. ��< <�'- C. �.,-`�`� APPLICAN PERMITEE IGNATURE IS EDBYSIGNATURE Covies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 ` �L'. � �' �,��,o?i ' Total Fee: $ - Date Received: Entered By: /'�'�� Permit#: �'0 �p q$ L i )�-; �,`I� `�,) j��. , , r- i. CITY OF ORONO - B G PERNIIT APPLICATION ('��`:s�- ��'��` All information must be submi£�ted in full before plan review will be started. (please print all information) ------------------------------------------------------ ----__------------------------------------------------------ THE APPLICANT IS: (circle one) OWNE R CONTRACTOR JOB SITE ADDRESS: �`b l� �1�/�1j`�1i'�'(�� I'�� ZIP: 5 �`'� ��f�`i�T� �,� NAME OF OWNER: 1�/lA-� �LOS�� PHONE: (tiome) �1��.-4"11 -i 0-l�l �1' G�INl�- �lN�' �D`r lG (work) (�i�-3o�-�0�� L.��'� MAILING ADDRESS: l�S�`� ��Yt,�i��;W�i!�� CITY: 'V�11-4�Z/�-Cl�-- ZIP: �� y CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: S�� f�� ,�t, . STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. 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 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: C � ! DATE: � (��- NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and City 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 confidential data concerning hunself 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 legaUy required ro supply the requested data; (c)any known consequence arising from his supplying or refusing to supply private or contidential data;and(d)the identity of other persons or entiaes 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 revenoe mav olace the notice reauired under this subdivision in the individual income tax or prooercv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. 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 conf'idential. 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 has 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 pending or addirional 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 authoriry 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 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 concerning himself. To exercise this right,an individual shall notify in writi�g the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)conect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipienu 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 determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 this application or permit. C,-�l-�i�.� �I f�l�_ �0�� First Middle Last �� '1 Address . ` '� `� 1 �1� �}� "� �� C��y � State Zip Phone I understand my rights as stated ab ve. Signature 6 . � CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: 1 �37 S � H,A�� c.,u o o ✓� �z�,c� PID: DESCRIPTION OF WORK: f]c�Gt� (sc_-�so�v,4�1 ------------------------------------------------- ------------------------- y 3 z ------------------------------------------- ZONING REVIEW BY: �� DATE APPROVED: v o BUII.DING REVIEW BY: DATE APPROVED: — ------------------------------------------------------------------------------- ----------------------------------------- FEES TO BE CHARGED: r��.�o �Misc. Fees Calcula ed 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: �t/D C Ff-r9r.�.e Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front (Lake): Right Side: (0 Rear (Street): Left Side: ( � Adjacent Structures: Wetland: Building Height: Def. Hgt. Peal: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 Setback: L.ot Coverage: Existing Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS (in house): 7 � BUII..DING REVIEW CHECK LIST UBC: — CONSTRUCTION TYPE: — Sq Footage $Per Sq Ftg Basement x = 1 st Floor z = 2nd Floor x � — � Gazage x = R = TOTAL Estimated Construction Value: $ /��`/� Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connection Footing Septic Sewer Connection Framing Fireplace Lawn Inigation Insulation (Masonry) Other Wall Board (Mfg.) Well (State Permit) �[_Final Grading/Filling Elecuical(State Permit) Other REMARKS(IN HOUSE): REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMITj: 8 r � _J v Y �r� �� . � . .. �.... .. � . [� _ 00 '00/ __ �4a.. � . S- `-�.J�i�{r . ✓ ` �/ ��:1 �.t � `! t � `; �.-'";� ` � �' _ --0.� �'�� : ; :�N � � '�� '�� ..�.. ; � � ,\ o�, .�. .... � � ' � �� .,\� � Z\ �,�� U r�-�t�t/ �'r' \„'�'U o r J^io� 0 5'?''�l -15 M�1.��--\ � 'V : C7- \\ �•.. �� o� G�`� i _ �"'O S ��7 �� , �-. ' �o� o \ 5 � -t/�� °TJ'S � �3'�� ..tSr•MI 7h�v ' . i ' o CJ1 O \� ..� ` / � O �,d � `� � 0 � -� p �''� �`d O � %d Zo- o - �.��} . .�,03 �°� �, :, . l. � � !�.6� � . g�, \� �AA �+ n C � � Q:1r v�tj°5rr"��i� � �� ;� /�1 ri�Z �=7'�oV� ' 5��s�':�� ,.�.I�ti�, �,�..0�' "� J --� �� t��'L� ..�. . � s�-o-s - >)�O(1 _Q=' �'c` `�d l� • ' � � ti ° -�-- � � ' P�l�,�"icf ��'�:�----�.-, ,c �.;5,�, - �\ $-�� --- ---- � ----��,�� t • 1�� ' � ��.�' `>,d M3�� ; � � . �l.r.. t- 1 . 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