HomeMy WebLinkAbout2004-P08134 - addn/remodel/repair � �
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Posi34
Crystal Bay, Minnesota 55323 Pel't711t Typ@: Addition/RemodeURepair
(952) 249-4600 Date Issued: io�29i2ooa
SITE ADDRESS: 3745 Shoreline Dr
Wayzata,MN 55391
PID: 2o-i i�-23-2i-oo2s
DESCRIPTION:
Proposed Use: Industrial ,;�� � ����
Buildin Census Code ,�.43�7 ,
Pernut Class: g
Pernut Sub-type(s): Addn/RemodeURepair
Permit Type: Addition/RemodeURepair
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
c_____�_`c___ r___c_�____ ._____t_
:'::::::::5:.::::::::: ::.:::.::G t:::::.li ..
FEE SUMMARY: Pernut Fee: $ 83•25 Valuation: $ 3,000.00
State Surcharge Fee: $ 2.00
TOTAL FEE: $ 85.25
APPLICANT: JMN Builders OWNER: Good Shepherd Lutheran Church
6550 Woodedge Road 3745 Shoreline Dr
Mound,MN 55364 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESI'S 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 BUILDING CODE REQUIREMENTS.
� �� ._ C �� �
APP ANT PERMITEE SIGNATURE I UED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
, , W `4
. as � �o��`�\1 '�-
Total Fee. $ 85 � Date Received: � oZ7
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 informatioiz)
THE APPLICANT IS: (circl one) OWNER OR ONTRACTOR
JOB SITE ADDRESS: .� �4 S �2���`�`- �2 i V� ZIP: �� �9 �
Will this be a Par e of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes No If yes, a special event permit is required with Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed. ��,�2
C/ ` _ C�-F-- ��2.�.��-►'1
NAME OFOWNER: C� ��'P�� �`'����� PHONE. (home) �-4�2 �Zl�-- �t
/�,, (work) qSL — 47 � - 33-c�c�
MAILING ADDRESS: 37���"`« U�.CITY: �✓�9'"/ �-- ZIP: 5`� ��i /
�/� ,�/ ���� y''i�/>��2�
CONTRACTOR: J b� / '`�-��'r� � J PHONE: �'7 S Z - `f 7z `- Si� o
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
Remodel/Alteration Land Alteration
PROPOSED WORK escribe in detai�: ��� /�/ J`-���"'�'�' 7� �v/�'��`�
t�'7�L�i 2 L�c.i� �.—�°l�r� o z.� f��-�i�✓�z.,lc
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ .� 0��
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 SIGNATUA:��� � �-�� DATE: �`� Z-� �
� t
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type oi 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. Information required to be given individual. An individual asked to supply private or confdential data 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 retuse or is legally required to supply the requested data;(c)any known conseque�ce arising from his supplying or retusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall
not spply when an indivldual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement otCcer.
The rnmmissioner of revenue mav olace the notice reauired under this su6division in the individual income tax or nroaertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to s responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classitied as public,prlvate or confidential. Upon hls further request,an iodividual who is the subject of
stored private or public data on individuals shall be shown the data without any charge to hlm and,if he desires,shall be informed of the rnntent and
meaoing oi 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 siz
months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been rnllected or created. The
responsible authority shall provlde copies of the private or public data upon request by the lndividual subject of the data.The responsible authorlty may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within fve days ofthe
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 iniorm the individual,and may have an additional five days wlthin which to comply with the request,excluding Saturdays,Sundays
and legsl holidays.
Subd.4. Procedurc whca data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himsel4 To exercise this right,an individual shall notify in writing the responslble suthority describing the nature of the disagreement. The
responsible suthority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or inrnmplete data,including recipients named by the indivldual;or(b)notify the indivIdual that he believes the data to be rnrrect. 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 provisions of 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 notired 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 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 Last
Address
City State Zip Phone
I understand my rights as stated above.
� ' �c...+�
Stgnature �
�"�'Ty�L ^ ���/�-�� '�7�vZi(.�j�
CHE CK OFF LIS T FOR ISS UANCE OF PEI�tiZITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 31`'�s S»n�"''�-�—�`"��= .�'Q--
PID:
DESCRIPTIO:V OF 6itO,RK: Fn�N•�a-na� '� *��`�= p�`�-
------------------------------------ --------------------------------------- -
ZO[YINGREVIEtVBX: C�-- DATEAPPROVED: /o •i8 -�Y
BUILDItYGREVIEWBY: .DATEAPPRO�'ED: �c�-Z�-��
--------------------------------
FEES TO BE CHARGED: h•Iisc. Fees Calccclated By:
PERI�IIT Yes ✓ No
PLAN RE vIE GV Yes '� �Vo v SEYVER GONiVECTION
� STATE SURCHARGE Yes � tVo tiVATER COtWECTlOtV
ItVVESTIGATlON FEE Yes tVo PARK FEE
SfLC Yes No SITE [NSPECTIOIV
Nticmber of SAC Units O�'HER (specify)
-------------------------------------------------------------------------------------------------
ZONI�YG CHECh'LIST Zorcing Disd•ict: N� f�lr4r/
Fire Depni•hnerrt: Post Off ce: School District: _..
Lot.�trea: Sq.ft. Acres Widd: Depth
Scovey Subniitted: Yes No Dctte of Su�vey:
P�•oposed Setbncks:
Fract(Lake): Right Side:
Renr(Sh•eet): Left Side:
Adjacent Structiu•es: G�etla d:
Buildi�ig Heiglit: Def. Hgt. Peak gt.
Lot Caverage: �
Gracfing: Staff Approvc�!Date: B, • Council�lpprovnl Date:
Septic: Stajf.�pprova!Dc�te: B �
Zatirig File: # Resolutio�:: # Resolcztion Date:
SJ:oreland Dish•ict:
Avg.Setback: Bluff Setbacl• Lot Coverc�ge:
E�isting Proposed
Hardcover•: 0-7�'
75-250'
250-500'
500-1000'
Hardcover Var•imtce Reqacired: Yes No Dccte of Co�incil Approval:
RE1I�IARKS(in liotcse):
31
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�D E � TIME
CITY OF ORONO CALLED w -�-1 .�
INSPECTION NOTIC SCHEDULED ` �v
PERMIT NO. �S�� � COMPLETED
ADDRESS .��y.'r� �/'tn�'�' l//� /���
OWNER CONTR. __ ��VI lL� ,��C1�S
TELEPHONE NO. �t��� - ��7 � �- �-�Lp�
� DESCRIPTION / G'G7T//L��
� 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
Z04 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED C_l PROJECTCOMPLETE
� ❑ CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (952� 249-4600
OwnerlContract� e:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice