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Home My WebLink About2005-P08787 - addn/remodel/repair PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P�g�g� Crystal P��Y, Minnesota 55323 Permit Type: Addition/Remodel/Repair (952) 24�=4600 Date Issued: , 5/31/2005 SITE ADDRESS: 1966 Shadywood Rd Unit# Wayzata,MN 55391 PID: 17-117-23-24-0024 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Census Code 434 Permit Class: Building Permit T e: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair YP DETAILS: Approved per resolution#: Separate permits required: Electrical(state) NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 11125 Valuation: $ 5,000.00 State Surcharge Fee: $ 2.50 TOTAL FEE: $ 113.75 APPLICANT: Owner/Self OWNER: Jack&Kari Olson Iv1N 1966 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. r �l �._._ ` ,. ti�� c_�� c� �� 'J APPLICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 4 • Total Fee: $ Date Received: • Entered By: Permit#: 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 OR CONTRACTOR JOB SITE ADDRESS: �� L sh l,c��d( � ZIl': Sr�� Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes ❑NO If yes, a special event per•mit is required with Police Department and City Council appr-oval 60 days prio�-to the event. Shzrttle bzrs se�vice will be reqtrired unless applicant demonstrates sti�cient on-site parking is available. Non pennitted events will not be allowed. NAME OF OWNER: ��c t�l S� PHONE: (home) SSI-- �-�o- �C P! (work) MAILINGADDRESS: I�� S�. c,.....t �c CITY: a�'�,� ZIP: S� CONTRACTOR: 5-�-�� PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIR.ATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home RemodeUAlteration PROPOSED WORK(describe in detai�: rir�,.� G�,,,,,,,,� i\�v L,v.� S�ix�e . STORIE'S: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ S`OUc� I hereby apply for a building pemut 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 pernut and wo is not to start without a permit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: E DATE: S' 3�-�� 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. 5ubd.2. Tnfortnation required to be given individual.An individual asked to supply private or confidential data conceming 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 azising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities suthoriud 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�lace the notice requ3red under this subdivision in the individual income tax or�roperN 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 infoRned whether he is the subject of storeddata on individuals,and whether it is classified as public,private or confidential. Upon his further requesc,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 W 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 accual costs of making,certifying,and compiling the copies. The responsible suthority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saeurdays,Sundays and legal holidays,if immediate cornpliance is not possible.If he cannot comply with the request within that time,he shall so infortn the individual,and may have an additional five days within which to comply with the request,excluding Satucdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurste or complete.An individual may contest che accuracy or completeness of public or private data conceming himsel£To exercise this right,an individual shall notify in writing the tesponsible authority describing the nature of the disagreement.The responsible authoriry shatl within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify 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 administcative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,5ubd.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 fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to deternune 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 informarion may be shared with other local, state or federal agencies to the extent necessary to process the perniit 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. Fi Middle Last Address C�ty State Zip Phone I understa y rights as stated above. _ Signa e 32 CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY AD�RESS OR LEGAL: �9 t�cfl SHn4dJ�n,u od/J Ro� . `PID: DESCRIPTION OF WORK: Gc ,4r�,4r { � iv 7v �,t'� ��r�SA�9 c..Q ZO.vPtG REVIEW BY: N DATE APPROVED: BUILDING REVIE`V BY: DATE APPROVED: S -3�• 05- FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes �/ No PLAN REVIEW � Yes No r/ SEWER CO�TNECTTON STATE SURCHARGE Yes � No WATERCONNECITON INVESTIGATION FEE Yes No PARK FEE SAC Yes No � SITEINSPECTION Number of SAC�Units OTHER (specify) ZO�TI�TG CH�CK LIST Zoning District: � G[ Fire Department: Post OfFice: School Disuict: Lot Area: Sq.ft. Acres Width Depch Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front(Lake): Right Side: Reaz(Street): Left Side: Ad;acent Structures: W and: Building Height: Def. Hgt, eal:Hgt. Lot Covera�e: 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' 2�0-500' 500-1000' Hardcover Variance Required: Yes N Date of Council Approval: RE1�iARKS (in house): � . . � BUILDING REVIE`V CHECK LIST �` �C� - 12'3 CONSTRUCTTON TYPE: v� Sq Footage $Per Sq Ftg Basement x _ . 1st Floor x _ 2nd F1oor x _ Garage x = z = TOTAL Estimated Construction Value: $ S,o 0 0 ^ Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical � Water Connection F��g � Septic Sewer Connection _�Fr�g Fireplace Lawn Irrigation �_Insulation (Masonry) Other �Wall Board (Mfg.) Well (State Permit) '� F�� Grading/Filling �_Electrical (State Permit) Other REMARKS(IN HOUSE): . __----------------- ------------------------------------- REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date gy: ------------------------------------------------------------ RENIARKS (TO BE NOTED ON PERi�: 8 C � DATE TIME 'V CITY OF ORONO CALLED IN "��J INSPECTION NOT E SCHEDULED -� �3 l�,�oi� PERMIT NO. �f �COMPLETED ADDRESS �C/I� � _ � ��-�u.�`UO c� � OWNER � S(7�'�l CONTR. C�lLcJ�'l.��f TELEPHONE N0. �.S�ai � �O �l��I � DESCRIPTION �G�' , ly 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 0 LATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q OS 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 FINA 35 HARD COVER REMOVAL MBING FINAL � 36 FOUNDATION/REMOVAL OWNE CONTRACTOR TO MEET YOU: YES_NO � MMENTS: � W � � J O � � O � W � Q � Z W � W � � d W WORK SATISFACTORY:PROCEED CI PROJECT COMPLETE � CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL{NSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�0 Owner/Contrac ite: Inspector. White Copyllnspector's ile Canary Copy/Site Notice . (' � ,� ll�,��/l��- � D TE TIME ✓ CITY OF ORONO CALLED IN ' �� INSPECTION NOTICE ��✓1 SCHEDULED � �-'' �:�i— PERMIT NO. �� COMPLETED ADDRESS l�Cr'�v ..SG2c��c`'�''�"-�.-�-�-�,�'-f/ OWNER � �C'��'�- L�/�SG'�'� CONTR. TELEPHONE NO. �� `-� 7C �� %�� DESCRIPTION �� -" �C,mC�-C f t� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVA� 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 � 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 � OWNER/CONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � 0�'1'�-vt,,`��/1�;� " J � O �", � t� � i�/1�� / O � � W � r Q � � Z W � W � j d / W ORK SATISFACTORY:PROCEED PROJECT COMPLETE ✓ � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR FIEINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR � INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the nex inspection 24 hours in advance. (952� 249-4600 OwnerlContrac on i e: Inspector. � White Copyllnspector's File Canary CopylSite Notice