HomeMy WebLinkAbout2003-P06696 - stairway to lake PERMIT
C�T,Y �F ORONO Permit Number:
2750 Keiley Parkway - PO Box 66 Po6696
Crystal Bay, Minnesota 55323 P@I'CTllt Type: User Defined Surc Building
(952) 249-4600 Date Issued: g�29�2003
SITE ADDRESS: 1491 Shoreline Dr
Wayzata,MI�T 55391
P I D: 11-117-2 3-2 3-0008
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: User Defined Surc Building Pemut Sub-type(s): Stairway to Lake
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 38.75 Valuation: $ 1,000.00
Plan Review Fee: $ 25.18
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 64.93
APPLICANT: Owner/Self OWNER: 7anet&Richard Kiernan
� 1491 Shoreline Dr
Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN Sl'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
M1N�ES0 BUILDING CODE REQUIREMENTS.
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APPLICANT PE ITEE SIGNATURE ISSUED BY SIGNATURE
Covies: 1-File(Sienitures Required), 1-Anvlicant, 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
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Total Fee: $ � � � ' � Date Received: �� � �Q�j
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Entered By: �� 7�/� Permit#: �-(�j,�(��� (p
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CITY OF ORONO - BIJLILDING PERNIIT 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) OWiVER OR CONTRACTOR
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JOB SITE ADDRESS: '`; `�1 S��2x��e �• ZIP: s S � ( I
NAI�iE OF OWNER ,c �.ce��l �- �n�l� � �r�P1� PHONE: (home) ��� ��G --1� � �
n , (work) �vv�e
MAILI�i 1G ADDRESS: 1�� � ���J c'X��e ��L CITY: �'1��1Y1.C,� ZIP: SS 3�'r /
CO\"TRACTOR: � I'P�C �c�� C�,�N1S�rc�tC t-�✓I�PHONE:
COr�T'ACT PERSON: � rc� li�IOBILE/PAGER:
M.AII,I�i TG ADDRESS: CITY: ZIP:
ST�iTE LICENSE: #
ARCHTI'ECT/ENGINEER: PHONE:
MAII,ING ADDRESS: CITY: ZIP:
NA.1IE: REGISTRATION#
TYPE OF WORK: New x Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �J-��S ib � �� � �
Sc'c �.1���'� ����S
STOR.IES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: � � GARAGE STALLS: ATT. DET.
, � ;'�i
ESTL�LATED CONSTRUCTION VALUATION (exclud.ing land): $ ����_
I hereby apply for a buildin�permit and acknowledge that the information above�complete and
accurate; that the work will be in con��rma ce with the ordinances and codes of the Ciry and with
the State Buildin� Code; that I undekstan�is is n t a p rmit and work is not to start without a
permit; and that the work wiR be i�i or ance i � e approved plan.
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APPLICANT'S SIGNATURE:/� � DATE: � � Q �
.
NOTE! Parade of Homes events require separate permit approval by Police De�artment and
City Council 60 days prior to the event. Non permitted events will not be allowe'd.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA '
Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given individual, qn irMrv�dual asked ro svpply private or confidential data concerning himself
shall be informed of: (a)the purEwse affi intended use of the requested data within the collecting state agency,poliacal subdivision,or statewide
rystem;(b)whether he may refuse or is IegaUy required to supply the requested data;(c)any lrnown consequence arising from his supplying or
refiuing to supply private or con6dential data;a�(d)the idendty of other persons or enaaes authorized by srate or federal law to receive the dara.
This requirement shall not appiy when an individual is asked to supply invesrigadve data, pursuant to section 13.82, subdivision 5, to a law
enforcement o�cer.
The commissioner of revern�e mav olace the notice rewired under this suhdivision in the individual income taz or nrooerrv tax refund
instrucdons►nstead of on those forms.
Subd.3. Access to data by indiridual. 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 class�ed as public,private or confidenaal. 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. Aher an individual has been shown the private data and informed of iu meaning,the data need not be
d'uclosed to him for six months thereafter unless a dispute or acaon punvant to this secaon is pending or addirional 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 authoriry may require che requesdng person w pay the actual cosu of making,certifying,and compiling the copies.
Thz resporuibie 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 addiaonal five days within which to compiy 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 compieteness of public or
private data conceraing himself. To exercise this right,an uidividual shall noafy in wridng the responsible authoriry describing the nature of the
disagreement. The responsble authoriry shall within 30 days either: (a)correct the data found to be inaccuiate or incomplete and attempt to nodfy
past recipiencs of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy the individual that he believes the daca
to be correct. Data in dispute shall be disclosed only if the individual's sratement of disagreement is included wirh the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the adminisaaave procedure act relating
ro contested cases.
DATA PRNACY 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 fumish certain
private or confidential information.
You aze 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 pemut 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 �.�e(eC � �L�(/
First Middle �5�
1`l4l � ���v-P
Ad ress
VVt c�( 5 S�� � 7 S� �/�S— �65�
Ci State Zip Phone
I de my righ s ted above.
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S gnature ,
6 . ,
CHECK OFF LIST FOR ISSUANCE OF PERMITS
- FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I H g � s N u 2c��N�. 0�2 �
PID:
DESCRIPTION OF WORK: LA►Ck /�c�ss ��2s
ZO�TG REVIEW BY: � � N N DATE APPROVED: g-Z(�•03
BUII..DI�i iG REVIEW BY: DATE APPROVED; {g -t�3� - 03
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER1vIIT Yes ✓ No
PLAi�1 REVIEW Yes ,/ No SEWER CONNECTIOT,'
STATE SURCHARGE Yes �/ No WATERCONNECITON
INVESTIGATION FEE � Yes No ✓ PARK FEE
SAC Yes No � STTEINSPECTION
Number of SAC•Units OTHER (specify)
ZOIti�1G CHE.CK LIST Zoning District: C9�1� o�C N_(4. .
Fire Department: � Post OfFce: School District: • �_
Lot Area: Sq.ft. Acres ' idth Depth
Survey Submitted: Yes�_ No Date of Survey: �i� F�i!�-'
Proposed Setbacks: I/
Front(I.ake): Right Side: �/�- �� �.�
Reaz(Street): Left Side:
Adjacent Structures: Netlan .
Building Hei�ht: Def. Hgt. Peak H .
Lot Coverage:
Gradino: Staff Approval Date: By: Council Approval Da :
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # esolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Co�erage:
� Existina Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Appr val:
REMARKS (in house): ��
�
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� . . .
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BUII,DING REV,�yy C�Cg LIST
�C' � CONSTRUCTION TYpE; -
_ Sq Footage $Per Sq Ftg
� Basement � . , x
lst Floor . � x . . . - . . .
2nd Floor x - - � � � � .
Gazage - � � �
�F►�cE s�+�/LS x = .
96 s5 T x �v.o o = `y b o
TOTAL � �
Fstimated Construction Value: $ (,p o a�=
Inspections Required: , `York Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical
_�F���g - Water Connection
• Septic Sewer Connection
� ' Framing Fireplace Lawn Irri ation
Insulation g
. Wall Boazd ��0�'� Other
_�Final ' (Mfg•) Well(State Permit) - .._ ---_ ._ _-
Other Grading/Filling Electrical(State Permit) �
RE1tiiARKS(Ti1T gOUSE): .
___Y__
VIEW BY OTHERS; DATE: �� ---- -- __-----__
Access: Ezisting�_ New . �
Access Approval: Date
By: �
RENIARKS (TO BE NOTED O\T PERitiII1�; -��__ _ ~�_ _��_�------
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