HomeMy WebLinkAbout2004-P07911 - pool outdoors in ground . �
ITY F R N PERMIT
�' � � � � Permit Number:
2750 Kelley Parkway- PO Box 66 P07911
Crystal Bay, Minnesota 55323 Permit Type: Accessory Struchues
(952) 249-4600 Date Issued: 9i13i2ooa
SITE ADDRESS: 115 Smith Ave
Wayzata,MN 55391
P I D: 02-117-23-21-0016
DESCRIPTION:
Proposed Use: Residenrial
Pernut Class: Building Census Code 329
Pernut Type: Accessory Structures Pernut Sub-type(s): Pool-Outdoors-In Ground
DETAILS:
Approved per resolurion#:
Separate perxnits required: �i�m�i�siaie�
NOTICES/REMARKS:
FEE SUMMARY: Pemut Fee: $ 492.25 Valuation: $ 35,000.00
Plan Review Fee: $ 319.98
State Surcharge Fee: $ 18.00
TOTAL FEE: $ 830.23
APPLICANT: Atlantis Pools OWNER: Criag Hertzenberg
4321 68th Ave N 115 Smith Ave
Brooklyn Center,MN 55429 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 BUILDING CODE REQUIREMENTS.
l
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-AUnlicant, 1-Monthlv Ret�orts, 1-Assessin¢, 1-Finance Page 1
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: //5 5/h � TN /�u�=
PID:
DESCRIP'IZON OF WORK: cvGll.o.,+V o 0
ZO�iG REVIEW BY: DATE APPROVED: �i-r� • �-(
BUII.DI�i IG REY�`V BY: DATE APPROVED; 9 -(o. �'�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERIVIIT Yes � No
PLA��T REVIEW Yes No SEWE.R CO�TNECTION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC-Units OTHER (specify)
ZO�TING CHE.CK LIST Zoning District: �,
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes_� No Date of Survey: 1 �� ' 0�3
Proposed Setbacks: �
Front(Lake): �y�� = Right Side: `'��� � �
` �' � �
Reaz(Street): I l� Left Side: � $
Adjacent Structures: �0' * Netland: --
Building Hei�ht: Def. Hgt. -- Peal:Hgt.
Lot Coveraoe:
Gradina: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: � BY:
Zoning File: # — Resolution: # Resolution Date: �
Shoreland District: /\t d
Avg. Setback: Bluff Setback: _ I.ot Coverage:
EzistinQ Proposed
0
Hazdcover: 0-75' .
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council A�roval:
REI�ZARKS (in house):
7
BUII.,DING REVIEW CHECK LIST
�C� — � — � CONSTRUCTION TYPE: �
_ Sq Footage $Per Sq Ftg
� Basement . . . x _
lst Floor x . _ .
2nd Floor x =
Garage x _ �
x =
TOTAL
Estimated Construction Value: $ 35,o 00 °�=
Inspections Required: `vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
, _�Footing ` Septic Sewer Connection �
� Framing Fireplace Lawn Irrigation
Insulation (Masunry) Other
Wall Boazd � (MfgJ Well(State Permit)
—�.F�� Gradiag/Filling _�Electrical(State Permit)
Other
REIVZARKS(Pi I HOUSE): � .
------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New .
Access Approval: Date gy; �
--------_______________�____--_________ __ --------------------------------------------------------------
RENIA.RK.S (TO BE NOTED ON PERNII7�:
8
Total Fee: $ Date Received: i' ' �����
Entered By: Permit#: /2_/���/
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: (circle one) OWNER OR ONTRACTO
JOB SITE ADDRESS: �I�j sn�i(th, �{�� , (�r�f M(�j ZIP: �,�39/
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes Q 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.
NAME OF OWNER: r PHONE: (home) 95a-�73�717,3
n (work)
MAILING ADDRESS: �l� �XYru� ��•c°� CITY: ��d ZIP: � /
CONTRACTOR: �oo�S' II`fCi PHONE: '7�Q(� O/p�
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: �,�Z/ (���{�,-p JU. CITY: _ZIP: `�
STATE LICENSE: #
ARCHITECT/ENGINEER: �D�,�,� �Qn� �n,�, PHONE: 7(��51�p 4!p �
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New x Accessory Structure
Addition Move
RemodeVAlteration Land Alteration
PROPOSED WORK(describe in detai�: ��.I qroc�� l 8 x 3(o �Suv n.t�in ��n(�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��� pp�
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 pernut;and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: � DATE: �I�IO7
����
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type of data. The rig6ts 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 confidential data concerning himself shall be
informed of: (a)the purpose and intended use ot the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or tederal law to receive the data. This requirement shall
not apply w6en an individual is asked to supply lnvestigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or oroaertv tax retund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and w6ether it is classifed as public,private or confidential. 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. 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 additional data on the individual has been collected or created. The
responsible authority shall provide rnpies of the private or public data upon request by the individual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible aut6ority shaii 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 additional five days within which to comply with the request,excluding Saturdays,Sundays
and legsl holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest t6e accuracy or completeness of public or private data
concerning himself. To exercise this right,an individual shall notify in writing the responsible suthority describing the nature of the disagreement. The
responsible authority shall wit6in 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by t6e individual;or(b)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included wit6 the disclosed data.
The determination of the responsible aut6ority 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 notified that:
1. The information you furnish will be used to determine your quatification 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 eztent 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
�,r
Address
�
City State Zip Phone
I understand my rights as sta�ed above.
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Signsture
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LEGAL DESCRIPITON- OF PREMISIS SURVEYED:
Lot 63, ORONO ORCHARD�S •
o : denotes iron marker
.411 bearings are based upon an assumed datum. . �
This_ survey intends to show the boundaries � of the above described
property and the location of an existin4 house �n�i o�ra�P An�r
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�' TH1S BROCHURE IS �QR ILLUSTRATlVE PURPOSES ONLY �;
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pool is oniy as good as the
. � quali�y of materials�liat go
• �A
into(ts planning and design. --
Throug l lhe enUre ianufacluring process, . .. :--"' ' � �. '�� � y�'��.
. ' • � �,, � ,�..�.�.
' nolhin�• is becn ��rcd in a Signature Edilion ��. ° Y> �k � �t ' ., ,:.: � ,,
Pool.Th assure you o(the highcst qualiry '��� � , n� � .•.'"�'��-�"•���~•'- ���
:�:E' •; ••r,�:�•r?.�:7'�t:�� '.� • -�
� I • ' .•,�•` • "��''1�')'��•. t'•... • •.�^;�,,._ ..
poo for ycars q(carc(ree(uri. ..' y,.. i•• ';•�• ••^ +t: �� ' •�'
� .,. '�.���;���.` ..�.. ..
wall anels are conslructed sin r � r`'` , ' .'• •`'.'���r � ` 3�
P u g stu dy < �j+ '��'�` '•., 't• , • �
•. ..
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14• au c alvani;ed steel rotected b a t(nc 1 � f �.�'�'�? , . ,.
K B 8 P y •-�. . ,��. �.•� i? ;�
�� • '' ,;}s �+'�r .c+�' �
coating,an�suppoiud with sleel A•frame t'� .:! `�: �{••
. ����y� ��,
brocing for streng�h. �.
In�ddiliOfl,a series of specialized suppons
s�gni(icamly�cJds Io Uu quality and durobility
. of your pool.Oeck br�ces help suppon the
wci61��o(tl�e surrounJing deck anJ prevcnt
shif ling under thanging soil conditions. L G�M.nlred S(cc/Wall Panels 11 G�uge,Ro�eC G235
Skimmers have tluir own special mounting y,Steel�l•fnme brtce wirh Oplion�lMchorPL�te
bracket.Jigs both align and support the ladder ?
J.�lu�omatk Sklmmer
and I�andrail for strength and sa(ety. ' -
All liners feature a handsome tile and print Yy - � �•Concfef�r�onCoc�m
pauern and are construeted from premium S.Numinum Receptor Coping �
. grade 20 mil v(rgln vinyl.FiltraUon and 6.Deck
circulation systems as well as aluminum
7.Nnyl Uner wi1A Tile Qader in0 Prinf Qo1�om
coping are fabricated(rom a variety of • �
� " " advanced technology malerials which are 8.SreelDeck Or�ce(Opr;onal) �
cxtremely resistant to corcosion. 9.Rerum Une '
' THE SEABLLI E POOL SYSTEM:
,�
� � ENGINEERED TO LAST
FOR GENERATIONS
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DATE TIME �/
CITY OF ORONO CALLED IN �����
INSPECTION NO IC SCHEDULED !O���
PERMIT NO. COMPLErE�
ADDRESS /�5 S/I/L/`i�GL. j-r�'ci�
OWNER CONTR. ��I�j�,�c��S
TELEPHONE NO. �lf� �CoD ��O �
� D RIPTION �O�I
ly 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
h 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOILOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WlLL RETURN
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Call for the ne t inspection 24 hours in advance. (J52� 249-4600
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