HomeMy WebLinkAbout2000-P02098 - addn/remodel/repair � ' PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Po2o9s
Crystal Bay, Minnesota 55323 P@I'CTllt Type: Addition/Remodel/Repair
(612) 249-4600 Date Issued: 4it iioo
SITE ADDRESS: 3745 Shoreline Dr
WAYZATA,MN 55391
PID: 2o-i i�-23-21-oo2s
DESCRIPTION:
Proposed Use:
Buildin Census Code 437
Permit Class: g
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Entrance Monuments
DETAILS:
Approved per resolution#: 4422
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 139.25 Valuation: $ 6,700.00
Plan Review Fee: $ 90.48
TOTAL FEE: $ 229.73
APPLICANT: Edison Signs OWNER: NW ENG LU1't�SYNOD
510 Brimball 3745 SHORELINE DR
Long Lake, MN 55356 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 BUII.DING CODE REQUIREMENTS.
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APPLI A T 2MITEE SIGNAT RE IS BY SIGNATUR
Copies: City,Applicant,Assessor, Finance Page 1
Total Fee: $ Date Received: Z- Z�g-na
Entered By: Permit#: �o aa 9�
CITY OF ORONO - BUILDING 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) OWNER OR CONTRACTOR
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0 JOB SITE ADDRESS: ^��y; ,�`j�;e�•r� ��—,'�L Z�� J�S.39/
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NAME OF OWNER: ��� s�� ��d ,(� ��.n PHONE: (home) �)/ $�/.�3
� � (work)
� � MAILING ADDRESS: �`�y��' _��� CITY: �(/q�,���� ZIP: ��/
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� `� CONTRACTOR: G�d,'so� S�'�.�s PHONE: �z3 7�/�i'9
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CONTACT PERSON: �om S�,•�1�,�_ MOBILE/PAGER: �$�$" ��/y z
C � MAILING ADDRESS: S/D l�r rri Li�/ CITY:�� �,� ZIP:
O �� STATE LICENSE: #
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� � � :�RCHITECT/ENGINEER: _�///.�- PHONE:
� � � �+IAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: N�w � Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �"„��y-!/ ,vew �/�X/o� �//���h,f-��
�c,�� '� 7`7�e. SFt��e D/,4�c .45. �I�I oNC
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BED OOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � , �OO.
I hereby apply for a building permit 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 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: �--a 7—��
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sea 13.04 RIGATS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be swred shall be as set forth in this section.
Subd.2. Information required to be given indivtdual. An individual asked to supply private or confidential daCa concerning 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 w supply the requested data;(c)any known consequence arising from his supplying or
refusing to suppty private or confidential data;and(d)the idenary of other persons or enaues authorized by state or federal law to receive the data.
This requirement shall no[apply when an individual is asked to supply invesdgative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The cortLmissioner of revernie mav nlace the nodce reauired under this subdivision in the individual income tax or nrooertv tax refund
insaucrions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a tesponsible authority,an individual shall be informed whether he is the
subject of stored data on i�ividuals,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 i�ividuals 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 to this section is pending or addirional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesring person to pay the actual costs of making,certifying,and compiling the copies.
The responsible 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 lega!holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he st�all so infortn the individual,and may have an additional five days within which to comply with the request,
excluding Samrdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data co�erning himself. To ezercise this right,an individual shall nodfy in wridng the responsible authority describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data foutd to be inaccutate or i�omplete and attempt to notify
past recipients of inacwraoe or i�omplete data,including recipienu named by the it�ividual;or(b)notify the individual that he believes the data
to be conect. 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 pmvisions of[he administradve 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�ity 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 fumish 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 Ciry deny the permit or license.
3. The information may be shazed with other local, state or federal agencies to the extent 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 required to process this application or permit.
First Middle ��
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signamre
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� CHECK OFF LIST FOR ISSUANCE OF PERI�IITS
FOR OFFICE USE O�tLY •
ADDRESS OR LEGAL: ;'1`�s`� -�'1� ►"� /� v l.� /�r� .
PID: ,;�� i I� I ' �� ,1- :i i � L�,=;��� _
DESCRIPTION OF WORK: � _ `;��`���'i���- �
ZO�fi'G REY��Y BY: �t ���t�t ���� ,�. �..����,.�j� DATEAPPROV�D: ;:- -i --�����';
BLZLDLYG REti�� BY: ' � �.,,.;_���, ,� DATE APPROVED; C�� �--��t�,��
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F'EES TO BE CHARGED: Misc. Fees Calculated By:
PER�tiIIT Yes 'n No
pLAN REVIEtiV Yes _� No SEWER CO��C'I'ION
STATE SURC�L4RGE Yes No �VATERCON�'ECIION
INVESTIGATIO?t FEE Yes No PARK FEE
SAC Yes No SITEI�i TSPECTION
Number of SAGUnits OTHER (specify)
ZO`Z�G CHECg LIST zoning Districr. �l��C�=
Fire Department: �L'l t` �.�. 4��` Post Office• � , � '1 School DSSict: _���-C�L�4'�'�f (:�J I�'YC��;
� .,
Lot Area: Sq.fr. Acres � Width Depth
Survey Submitted: Yes i`< No Date of Survey: �� �`�� % �+�
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Proposed Setback�:
Front(Iz<e): RiQh.t Side: � � � .
Rear (Stre�t): _`� � I.eft Side:
Adjacent Struccures: �Vetland:
Building Heio�:: Def. H�t. Pea.�Hgt. _
Lot Co�•era�e: '
Gradin�: Staf�y?proval Date: By: Council�ppro�-zI Date:
Septic: Staff Arrroval Date: By:
Zonin�File: � =�`� `� � . Resolution: � `�'�ZZ Resolution Date:
Shoreland Distric::
Av�. Se��ack: Bluff Setback: LotCo��ra�e:
� Ezistm� Progos�d
Hazdcove:: 0-?�'
-. 75-2�0'
250-500'
500-1000'
Hardcc�:er Variance R�quired: Yes No
Date of Coucci? Approval: �
RE`LAR�iS ('in house):
7
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BUII,DING REV�Z� CHECK LIST
�C� . � CONSTRUCTION TYPE:
Sq Foota�e �Per Sq Ft,
� Basement x _
�. lst Floor . � x . _
2nd Floor x _ .
Gara�e z _
x =
TOTAL
Fstimated Co�struction Value: $_ , `� '�"` '? `'
(�-, �t,�;, �- �;
Inspections Required: �ork Requiring Separate Permits:
Site ' Plumbin� Fire
Hardcover Removal blechanical Water Connection �
Foocin� ' Septic Sewer Cor.�ection �
� Framin� . Fireplace Lawn Irri;ation
Insulation (il4asonry) Other
WaII Board (Mga,� Well (Stace Perm.it)
F�� Grading/F'iliing Elec[ricai(State Permit)
Other
REl�L4RKS ( .l�i t HOUSE):
REVIEti�BY OTHERS• DATE: --- ---- ---
Access: Ezistin� New .
Access Approval: Date gy; �
REI�IARbS (TO BE NOT'ED ON PERitiII1�: N �� ~ �
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EDISON SIGNS � � ��,L�,�� �,�� ., ,,���
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510 BP.IMHALL AVE. � � :. �'�
LONG LAKE, MN 55356 '����� � �
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(612) 47�3-7::�9 � .�^e;.-.�� �`�
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