HomeMy WebLinkAbout2004-P07244 - addn/remodel/repair t . �
F R N PERMIT
CITY O � � 0 Permit Number:
2750 Kelley Parkway - PO Box 66 P07244
Crystal Bay, Minnesota 55323 P@fCTllt Typ@: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 2iz6i2oo4
SITE ADDRESS: 2245 Shadywood Rd
Wayzata,MN 55391
PID: i�-i 1�-23-43-oi2s
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: i'iumoing niec;uicai�suuej
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 223•ZS Valuation• $ 13,000.00
Plan Review Fee: $ 145.08
State Surcharge Fee: $ 7.00
TOTAL FEE: $ 375.33
APPLICANT: Owner/Self OWNER: Kathleen Sather
MN 2245 Shadywood Rd
Wayzata MN 55391
Tf�UNDERSIGNID HF.REBY REQUESTS PERNIISSION TO MAKE THE REAI,IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUII.DING CODE REQUIREMENTS.
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/ APPLICANTPERMITEESIGNATURE -� ISSUEDBYSIGNATURE
Copies: 1-File(Sienitures Reauired). 1-Applicant, 1-Monthlv Reoorts, 1-Assessine. 1-Finance Page 1
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Total Fee: $ 375.33 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)
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THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: �a`yS �ha� �.����� ��� ZIP: �S� .����
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes �, No If yes, a special event permit is reqt�ired with Police Departrnent and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: �a>�,� � f'C�U� �v,�r�o r S PHONE: (home) �S a �'�/���'�`�
? work) 9Sa ��:;�- �:�'a/
MAILING ADDRESS: ��y�-�d,c«/��-,(,�o� CITY: � ZIP: i�=�-�
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 Accessory Structure
Addition Move
RemodeVAlteration_�� Land Alteration
PROPOSED WORK(describe in detai�: l rn e x, S�j> .-,v bec��„-, )n"� � �-��i��•�-, ,
� '7�S ' �
STORIES: �- SQ. FEET OF EACH FLOOR: o �
NO. OF BEDROOMS: 3-`,/ GARAGE STALLS: ATT. � DET.�_�
ESTI�IATED CONSTRUCTION VALUATION (excluding land): � ( �� Ot�O
I hereby apply for a building permit and I aclrnowledge 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: O�`- I�-�
� r
Sea13.04 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.
Subd.2. Informatlon required to be given tndlvidual. .+1n tndividual ul•ed to sa�pply private or confidenNal data concerning himseltshall be
(nformed of: (a)the purpose and intended use of t6e requested dara within the mUectiag state agency,political subdivisioa,or statewide system;(b)
whether he may refuse or Is legally required to supply the requested data;(c)an.•L-nowa consequeace arfsing trom his supph-Ing or refusing to supply
private or confidential data;and(d)the identiry of other persons or eatlHes authoraed b.state or federal law to recefve the data This requlrement shall
not apply when an iadiv(dual is asked to supply investigattve data,pursuant to sedion li.82,subdivision 5,to a law enforcement ofticer.
The rnmmiss(oner of revenue mav olace the notice reaaired under this subdi�ision in the indtvidual inrnme ta�or orooertv tax re[und
Lnstructions instead o[on those forms.
Subd.3. Access to data by Individual. Upoa request to a responsible acthorfc�,an individual shall be informed w6ether he ts the subject of
stored data on indfviduals,and whether it(s classifled as public,prn•ate or contidentlal. L'pon his further request,an indI�idual who(s tde subject of
stored private or public data on individuals shall be shown the data without any charge to him and,tf he desires,shall be Informed o[the content and
meaning of that data. After an indIvidual has been shown the pri��ate data and informed of its meaning,the data need not be disclosed to hlm fors(x
months thereafter unless a d(spute or action pursuant to thls secHou is pending or addl�nal data on the individusl has been colleMed or crested. The
responsible authority sha(I provide coptes of the p�tvate or publ(c data upon requat by the individust subject of the dsta. T6e responsible sut6orlty may
require the requesting person to pay the actual costs of making,artifying,and compili�the rnpies.
The responsible authority shall comply immediately,(f pnssible,wtth an.request made pursuant to this subdivistoo,or within[ive days of the
date otthe request,excluding Saturdays,Sundays and legal hollda�•s,if immediate eomplisnce is not possible.If he cannot comply w(th the requat within
that time,he shali so inform the individual,and may dave an additlonai tive days v�-ishlo which to comply with the request,ezcluding Saturdays,Sundays
and legal6ol(days.
Subd.4. Procedure when data(s not accurate or rnmplete.An lndividuil ma.contest the accuracy or rnmpletenas of public or prtvate data
concerntng himself. To exercise this right,aa indiv(dual shall notif�•tn writing the rapoaa'ble suthortty describiog t6e aature of the disagreemenG The
responsible authority shall within 30 days either: (a)correct the data found to be iaac�eurste or incomplete and attempt to notity past reciplents oC
inaccurate or inrnmplete data,including recipients named by the[adividual;or(b)uotif�the individual that he believes the data to be correcG Data in
dispute shaU be dlsclosed only if the ind(vidual'a statement of disagmment is taduded with the dtsclosed data.
The determinatton o[the responsible suthority may be appealed pursaant to tLe provistons of the administratl�•e procedure aM 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�ou that your request
for a permit or license from the City of Orono or an�•of its departmenu may require you to furnish certain private or
confidential information.
You are notified that:
1. The informatioa you furnish will be used to determine your qualification for the permit or licease requested.
2. You may refuse to supply dat$,but refusal may reqnire that the City deny the permit or license.
3. The information may be shared with other local,state or federal agencies to the eatent necessary to process
the permit or license.
4. If your requested permit or license requires Council acuon to approve, some information may become
public.
5. You have certain rights under M.S.13.0�3(available upon request)to review private data on yourself.
6. Your full name is requIred to process this application or permit.
�Q� ��i�i-- o�n Qr,S'
First Mlddle Last
� � �� �iUd t�a� L���?l
Address
� �G� y��� ��/ ��� y����
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: z zti 5 51-}v4✓J�w o��
PID:
DESCRIPTION OF WORK: (3t�.-tlrt �Z.Cwc�.c,pL-Z
ZO.�i 1G REVIEW BY: /� DATE APPROVED:
BUII.,DING REVIEW BX: DATE APPROVED; Z -z�( -��{
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes ✓' No SEWER CONNECTTON
� STATE SURCHARGE Yes � No WATERCONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECT'ION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: �vo c f-F,4.�v�..e .
Fire Department: Post O�ce: 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: Wetlan
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Set ack: L.ot Coverage:
Ezisting i Proposed
Hardcover. 0-75' �_
75-250'
250-500' �
500-1000' _�
Hardcover Variance Required: Yes 1�10 Date of Council Approval:
REMARKS (in house): `�
, 7
BUII.,DING REV�W CHECK LIST
�C� ��' 3 CONSTRUCTTON TYPE: V�
_ Sq Footage $Per Sq Ftg
Basement x =
lst Floor z _
2nd Floor x =
Garage x =
z —
TOTAL
Estimated Construction Value: $_ I 3,O 0 a �v
Inspections Required: `Vork Requiring Separate Permits:
Site �_Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing ` Septic Sewer Connection
�_Framing Fireplace Lawn Irrigadon
_�Insulation (i�iasonry,) Other
_�Wall Boazd (Mfg.) Well (State Permit)
� F�� Grading/Filling �_Electrical (State Permit)
Other
REMARKS(IN HOUSE): .
---- ------------------------------------------
REV�W BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
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REMARKS (TO BE NOTED ON PERivIIT�:
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� DATE TIME
CITY OF ORONO CALLED IN 3-
INSPECTION N ICE SCHEDULED 3-� //,'o 0
PERMIT N0. Z�� COMPLETED
ADDRESS ZZ�s J �--
OWNER ONTR.
TELEPHONE NO. �'SZ �7� 8��1�
� DESCRIPTION .
� 01 FOOTING 11 MECHANICAL 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANOS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL B0. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBINCa RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
2 OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
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� RKSATISFACTORI�PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE C�/ERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP OROER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next'nspection 24 hours in advance. (952) 249-4600
OwnedConV n i :
Inspector.
White Copyllnspector's File Canary CopylSite NoUce