HomeMy WebLinkAbout2005-P08481 - addn/remodel/repair ; ' PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Posasi
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 3iio�2oos
SITE ADDRESS: 2175 Shlevlin Dr
Wayzata,��Ml�i 55391
PID: 03-117-23-34-0007 '
DESCRIPTION: L7BC Occupancy R3
Construcrion Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addirion/RemodeURepair Pernut Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#: .
Separate pernuts required:
NOTICES/REMARKS:
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FEE SUMMARY: Pernut Fee: $ 139.25 Valuation: $ 7,000.00
Plan Review Fee: $ 90.48
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 233.73
APPLICANT: Owner/Self OWNER: James&Amy Lloyd
M� 2175 Shevlin Dr
Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO LL W IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILD G COD REQUIREMENTS.
' ' c��-C�
PPLICANT PERMITEE SIGNATURE , ISS[JED BY SIGNATURE
I
Covies: 1-File(SiQnitures Required), 1-At�vlidant 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
Total Fee: $ a 33.7 3 Date Received: 3-a-o�'
Entered By: _��� Permit#: ff085�8/
� 0
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: (circte one) OR CONTRACTOR
" ,
JOB SITE ADDRESS: � �i � " ZIP: ,��
Will this be a Para e of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes No If yes, a special event permit is required with Police Depat-tment and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: �C � � PHONE: (home) ��(
.__ (work)
MAILING ADDRESS: � �' r,�,�/��1,t G� CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: I ' CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: �- o`�t PHONE:
MAILING ADDRES5: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration � Land Alteration ,
P OP ED WO des ribe in d ai�: � , �C
.�� U w �c
STORIES: �_ SQ.�'EET OF EACH FLOOR: I ��
NO. OF BEDROOMS:� GARAGE STALLS: AT� DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ -7,Dn�O°
I hereby apply for a building pernut 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 pernvt and wark is no to start witho t a ermit;and that the work will be in accordance with
the approved plan. ,
APPLICANT'S SIGNATURE: DATE: �/ ° � ��
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type of dats. The rights of Indivldual on whom t6e 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 prlvate or confidential dats conceraing 6imself shall be
informed ot: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether 6e may refuse or is legally required to supply the requested data;(c)any known rnnsequence arising from his supplying or retusing to supply
private or confidenNal data;and(d)the fdentity of other pereons or enUtles authorized by state or tederal law to receive the dats.This requirement shall
not apply when an individual is asked to supply invesUgative data,pursuant to section 13.82,subdivision 5,to a law en[orcement officer.
The commissioner of revenue mav ulace the nodce reauired under this subdivision in the individual income tax or orouertv taz refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upo�request to a responsible authority,an individual shall be informed whether he is the subJect of
stored data on individuals,and whether it is classi�ed as public,private or rnnfidential. Upon his turther request,an indivfduai who is the subject of
stored private or public data on individuals s6a11 be shown the data without any charge W him and,if he desires,shall be informed of the content and
meaning of t6at data. After an tndividusl has been shown the private data and informed of Its meaning,the data need not be disclosed to him for six
months thereatter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The
respooslble sut6ority shall provide copies of the private or public data upon request by the individual subject ot the data.The responsible authority may
require t6e requesting person to pay the actual costs of making,certitying,and rnmptling the copies.
TAe responsible authority shall comply immediately,it 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 c.ompliance 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,Sundsys
and legal holldays.
Subd.4. Procedure when dsta is not accurate or complete.An individual may conteat the accuracy or completeness of public or private data
concerning himself.To exerctse this right,an indivldusl s6a11 notify in writing the responsible ruthority describing the nature of the disagreemeat The
responeible authority shall within 30 days either: (e)correct t6e data found to be inaccurate or incomplete snd attempt to notify past recipients of
inaccurate or incomplete data,including recipients nsmed by the individual;or(b)notify the individual that he belleves the data to be�rrect Data in
dispute shalt be disclosed only if the indivldusl's statement of disagreement is included wit6 the disclosed data.
T6e determination ot the responsible authority may be appealed pursuant to the provisions ot 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 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 eatent 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 r quired to process this application or per 't.
First � � � � ����i�l� � Last
.�
�
Address
w s�3 � � �3�
City State Zip Pdone
I understand my rights a stated ove.
Sfgnature
CHECK OFF LIST FOR ISSUANCE Ok'PER1ti.fXTS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z(7 S 5 H��IL�� �(�-
PID:
DESCRIPTION OF yf�ORK: � ���^' f
------------ ------------------- -----------
ZOIVINGREVIEtVBY: DATEAPPROVED: �—S-6S �
BUILDIIVGREVTEWB : D�TEAPPR06'ED: 3-S -6S
-------------------------------------- -
,FEES TO.BE CH'ARGED: �l%tisc. Fees Cnlcctlated B}�:
PERNlIT Yes �� No
PLAtV RLT�IEYV �es � �Vo SEtiVER CONi�IECTIOrV
STATE SURCHARGE Yes � tVo yVATER COtVtVECTIO�V
. It�IVESTIGATlON FEE Yes �Vo PARK FEE
SAG .Yes tVo SITE NSPECTION
Number of SAC U�:its OTHER (specify)
------------------------------ ('.
ZO�YIIYG CHEC,£i'LIST Zor�ing Disd•icc: o C o 2 (t�
Fire Depnrhnerrt: Post Office: Sdiool Dish•ict: _..
Lot.�Irea: Sq.ft. �lcres �Yidtl► Depth
Su�-vey Subrriitted: Yes No Date of Seuvey:
Proposeci Setbncks:
Froru(Lal.e): R lit Side:
Renr•(Str•eet): Geft
Adjacent Structures: I�e nd:
Buildilig Height: Def. Hgt. Peak K .
Lot Coverage: � _ _
G�•aciing: Staf}'.4pp►'ava!Dccte: _ Bv: Counci!Approval Date:
Septic: StnffApprovRl Dnte: BY
Zonirig File: # Resalutian: # Resolution Dnte:
Shoreland Disd•ict:
Avg.Setback: : BI Setback: Lot Coverage:
�nng � Proposed
Hardcove�•: 0-75'
75-250'
250-500' �
500-1000' �
Hardcover Variance Required: Yes No' Di�te of Cvunci[�ipproval:
REMA.RXCS(in ltouse):
3
�, �
. . . . . .. � . . . . . � . .. �' ���� .. -
B UILDItVG.RE VIE tV CHECh'LIST �
UBC: _ �2',� � � CONSTRIiCTIO�V TYPE: Y/"
Sq Foatage .�Per Sq Ft�
Basernent � _
!st Floo�• x =
?nd Floor z =
GarcJe �
x =
TOTAL
Estimated Conscructio�c Va(ue: S 7,OOo�
Iaspectiais Required: if�ork IZeqc�iring Separate Perncits:
Sife Plumbing Fire
Hardco��er Rernovn! Il�fechantcal �Yater Cainecrion
_�Footing Septic Sewer•Connection
o� F�•amiitg Fireplace Lawn h•rigatia:
�Ins�dation � (Nlasonr};) Odie►•
��,Boar•ct (A�Ifg.) GVel1(State Perntit)
_�Final Gradi�tg/Filling Elecmical(State Perniit)
Odter '
R,E�tiIARIi S(,fN HO USE): �
RE f�IE W B Y OTHERS: DATE:
�Lccess: Existing New
Access Appr-ovc�l: Date By:
IlEtl?tlRh�S(TO BE NOTED OtV PE12N1XT):
32
`(J� D E TIME �
� ��
CITY OF ORONO CALLED IN �
INSPECTIO IOT SCHEDULED �� �
PERMIT NO � COMPLETED
ADDRESS /7���1.P�1�.t�v�
OWNER CONTR.
TELEPHONE N0. �G►�c� o� 7� g�S I
� DESCRIPTION '�' ` �
� 01 FOOTING 11 MEC NICAL RI 18 EXCAV/GRAD G/FILLING
Q 02 FRAMING 13 MEC NICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 W OD BURNER/FIREPLACE 34 TFEE REMOVAL
Z04 WALL BD. 12 WATE�i HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWE�i HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOILOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CAIL FOR REINSP�CTION TEMPORARY
V BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARHANGE ACCESS.
Cail for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContra 't :
Inspector.
White Copy/lnspector's Fie Canary CopylSite Notice
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