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Home My WebLink About2003-P06171 - windows • PERMIT �ITY OF ORONO �750 Kelley Parkway - PO Box 66 Permit Number: Po61�1 Crysial Bay, Minnesota 55323 Per-mit Type: MinorAlterations (952) 249-4600 Date Issued: 4i22i2oo3 SITE ADDRESS: 2016 Shadywood Rd Wayzata,MN 55391 PID: 17-117-23-31-0002 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Pernut Class: Building Census Code O/S-Building Pernut Type: Minor Alterations Pernut Sub-type(s): Windows DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 97.25 Valuation: $ 4,000.00 State Surcharge Fee: $ 2.50 TOTAL FEE: $ 99.75 APPLICANT: GDS Design&Build(see notes) OWNER: Mr. &Mrs.Richard Kozicky 222 West Main St. 2016 Shadywood Rd Waconia,MN 55387 Wayzata MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND S'I'ATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �7 � ,� � I `i �'''u - L.-Q�✓j_ APPLICANT P I EE SIGNATURE [SSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 ` C;c�% . �— Total Fee: $ i / ' ��' Date Received: `� '�L�' (�j7 � Entered By: i=�,�'�. -� Permit#: � �}�,� i 7� -� � �ir�"�' y�` /:.�'l ��J _; CITY OF ORCSNO - BUILDING PERNIIT APPLICATIOl� All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT I5: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: r�[�1 ,� S/fA�J i>!.v n��►� �� ZIP: $�S"3 «/ NAME OF OWNER: �J L�,�;,. C� K�� PHONE: (home) �%5�--�/7/ i/9 0 (work) �J��-�� -3� c � MAILING ADDRESS: ��l� S hS��wE�� /Z J CITY: �, ZIP: s'13 �� CONTRACTOR: G-I� S �'vs�G,v � ,l�U� L c� PHONE: (�� 'to/6 --�-G / (� �e� CONTACT PERSON: ��L s�-�v� r%t MOBILE/PAGER: MAILING ADDRESS: ;).1� u,-�.,,�i-n�c,y.r .s�r. CITY: (,�, �—G GN/�F' ZIP: S" -3�� STATE LICENSE: # �;o o )7 S�}- ARCHITECT/ENGINEER: �!-7,S PHONE: MAILING ADDRESS: CITY: ZIP: NAME; REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteratio�� Land Alteration PROPOSED WORK(describe in detain: I��Pt..r}C r �/ ��,,,��o�:, s ,¢� r� y� o ✓� s rai;�S r� <�.��2 z.;��.�� STORIES: l SQ. FEET OF EACH FLOOR: �4 P�c�� /:��'>�' S� ��.� F��..,� NO. OF BEDROOMS: �_ GARAGE STALLS: ATT. x DET. ��. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��'� � I hereby apply for a building permit and I acknowledge that the information above is con7plete and accurate; that the work will be in conformance with the ordinances and codes of the Ciry 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: �1-I�' -�� NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. � t Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested dara withia the collecting'state agency, political subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any�own consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry 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 invesd¢arive dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the notice reauired under this subdivision in the individual income tax or properry tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content and meaning of chat data. Afrer an individual has been shown the private data and informed of iu meaning,che data need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsibie authoriry 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 acrual coscs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediate(y, 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 contest the accuncy or completeness of public or private data concerning himself. To exercise[his right,an individual shall nocify in writing the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the individual that he believes the data to be correct. Data in dispute shail be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinanon of the responsible authority may be appealed pursuant to the provisions of the admuustrarive procedure act re(adng 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 pemut 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 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 pernut 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. (. 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. �. Si ture CHECK OFF LIST FOR ISSUANCE OF PERMITS � FOR OFFICE USE ONLY ADDRESS OR LEGAL: z.o i� ��,d4w o�r� (L0/� PID: DESCRIPTION OF WORK: w i�v��s r4n,✓� .s� ►� /�'��e r �-c��02. ZO.�1Ni G RE'VIEW BY: � DATE APPROVED: BUII..DING REVIEW BY: � DATE APPROVID: �f-�!! � FEES TO BE CHARGED: Misc. Fees Calculated By: PERNIIT Yes �� No PLAN REVIEW Yes No �f SEWER COrtNECTTON STATE SURCHARGE Yes � No WATERCONNECTTON INVESTTGATION FEE � Yes No PARK FEE SAC Yes No SITEINSPECT'ION Number of SAC�Units OTHER (specify) ZONING CH�CK LIST zoning Districr. �uo C�-�,l . 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: Rear(Street): Left Side: Adjacent Structures: Wet and: Building Height: Def. Hgt. Pe Hgt. Lot Coveraoe: Grading: Staff Approval Date: B • Council Approval Date: Septic: Staff Approval Date: By Zoning File: # Resolution: # Resolution Date: Shoreland District: Avg. Setback: Bluff Setback: Lot Coverage: Existing Proposed Hazdcover: 0-75' 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes No Date of Council Approval: RENIARI�S(in house): 7 y BUII,DING REVIE�{r CHECK LIST �C' 2 � 3 � CONSTRUCTION TYPE: �//V _ Sq Footage $Per Sq Ftg � Basement � . . . x _ lst Floor x . . . _ . 2nd Floor x _ . Garage x _ . x = TOTAL Estimated Construction Value: $_ y�pQa� Inspections Required: `Dork Requiring Separate Permits: Site Plumbing Fire Hazdcover Removal Mechanical Water Connecdon Footing ' Septic Sewer Connection � _�Framing Fireplace Lawn Irrigation Insulation (Masomy) Other Wall Boazd � (Mfg.) Well(State Permit) —�F�� Grading/Filling Electrical(State Permit) Other REMAR��.S(IN HOUSE): . REVIEW BY OTHERS: DATE: N -��~ Access: Existing New . Access Approval: Date gY: � ---- -- -- ------------------------------------ REMARSS (TO BE NOTED ON PER1vII7�: 8 Cs�� ,, DATE TIME � CITY OF ORONO CALLED IN s� INSPECTION N$T C SCHEDULED /3-03 :GD PERMIT NO. / �7 COMPLEfED ADDRESS a0/!v �S�Z4�yL�.1oGd n�C. OWNER D /C/�' CONTR.��L s�� TELEPHONE NO. 6�1 " 70 -��T � DESCRIPTION l�� '� � ��a'��-'� . � 01 FOOTING 11 MECHANICAL 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 Z 04 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 v 07 DEMO-FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 BING FINAL _ / 36 FOUNDATIOWREMOVAL Q WNERI ONTRACTOR TO MEET YOU:VYES_NO y MENTS: W � � � [ - � J O � � O � W � Q � 2 W � W � � d W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFOREC�/ERINC, PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR 0 CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the nex inspection 24 hours in advance. (g52) 249-4600 OwnerlContr n e: Inspector. White Copyllnspector's Fi Canary Copy/Site Notfce