HomeMy WebLinkAbout2003-P06051 - addn/remodel/repair ` � PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 Po6osi
Crystal Bay, Minnesota 55323 Pel'CTllt Typ@: Addirion/RemodeURepair
(952) 249-4600 Date Issued: 2i2�i2oo3
SITE ADDRESS: 125 Smith Ave
Wayzata,MN 55391
PID: o2-ii�-23-2i-ooi�
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addirion/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate pernuts required: riumbing iviecnanicai r,iec�icai(sia�ej
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 583.15 Valuation• $ 44,000.00
Plan Review Fee: $ 379.11
State Surcharge Fee: $ 22.50
TOTAL FEE: $ 984.76
APPLICANT: Bradley&Pamela Horner OWNER' Bradley&Pamela Homer
125 Smith Ave � 125 Smith Ave
Wayzata MN 55391 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
c._,., ',/
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APPLIC ITEE SIGNATURE I D BY SIGNATCJRE
Conies: 1-File(SiQnitures Required), 1-At�plicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
t. � . .. � ,•��.
.
Total Fee: $ '''?� Date Received: ,�-;,� � - (}_5
Entered By: � � ��i12 Pernut #: I� c� (��C;'.S�%
i �r.' � �� �,�
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CITY �O� 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) WNE ;OR CONTRACTOR
JOB SITE ADDRESS: �� �A� ��� v ZIp: .��� _�
NAME OF OWNER: �"G�p� ��r'��j'' PHONE: (home)���'��c�— ��l�
(work) 6 —
MAILING ADDRESS: �oZ,� ,S��-�/o� CITY: ZIP:�r�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK(describe in detai�: G k � 4,.
!�K �2 ` v G!/ o ,Qy,
G.e�e� ,B � �
STORIES: SQ.FEET OF EACH FLOOR: F.Sb � �c+�wal�PtG�
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��, O od
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: � �.u,c-GL_ DATE: � —�g �-D 3
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.
9
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FQR OFFICE USE ONLY
ADDRESS OR LEGAL: /Z 5 5�'1'� i �l-� Av L
PID: .
DESCRIPTION OF WORK: _JZ�.,Nw p,e� .
ZONING IFEVIEW BY: DATE APPROVED: a, _-Z�s -o-3
BUILDING REVIEWBY.• DATE APPROVED: -Z_Z�_o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes r/' No
PLANREVIEW Yes ,/' No SEWER CONIVEC770N
STATE SURCHARGE Yes � No WATER COIVNECT70N
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: N o G�,.r�� �
Fire Depanment: Post O�ce: School District:
Lot Area: Sq.ft. Acres �dth Depth
Survey Submined: Yes No Date of Survey:
Proposed Setbacks: \
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wet
Building Height: Def. Hgt. Peak t.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By;
Zoning File: � Resolution: # esolution Date:
Shoreland District:
Avg.Setback: Bluff Setback: Lot Coverage:
Exisdng Proposed
Hardcover: 0-75'
75-250'
asasoo�
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RE:tIARKS(in house):
32
s ►
BUILDING REVIEW CHECK LIST
UBC: R ' 3 CONSTRUCTION TYPE: �//J �
_ Sq Footage $Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ N�{�dp��°=�
Inspections Required: Work Requiring Separate Permits:
Site _�'Plumbing Fire
Hardcover Removal _�Mechanical Water Connection
Footing Septic Sewer Connection
o( Framing Fireplace Lawn Irrigation
oc Insulation (Masonry) Other
�Wall Board (Mfg.) Well (State Permit)
_�Final Grading/Filling �Electrical (State Permit)
Other
REMARKS(INHOUSE):
REVIEW BY OTHERS: DATE: -----------------------------------
Access: Existing New
Access Approval: Date By;
�����----------------
REMARKS (TO BE NOTED ON PERMIT):
33
' � Sec.13.04 RIGHTS OFSUBlECTS OFDATA
Subdivision 1. Type ojdata The rights of irrdividual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Injormation required to be given individuaL An individual asked to supply private or confrdential 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;(6)whether he may refuse or is legally required 10 supply the requested data;(c)a�ry known consequence a�ising from his supplying or
refusing to supplyprivate or confrdential data;and(d)the identity ojother persons or entities authorized by state orfederal law to receive the data.
Thrs requirement shall not apply when an indrvidual is asked to supply imestigatrve data,pursuant to section 13.82, subdivision S,�to a law
enforcement o�cen
The commissioner ofrevenue mav place the notice required under this subdivision in the individual income fax or nropertv tax refund
instructions irrstead of on those forms.
Subd.3.Access to data by indivlduaL Upon request to a responsible authority,an indrvidual shall be informed whether he is the svbject
of stored data on individuals,and whether it is classifred as public,private or confidential. Upon his further request,an indrvidual who is Jhe
subject of stored private or public data on individuals shal!be shown the data without arry charge to him and,if he desrres,shall be informed of
the content and meanrng of that data. After an individua!has been shown the prrvate data and injorneed 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 perrding or additiona!data on the individual has
been co/lected or created. The responsible authority shall provide copies of the private or public data upon request by the irrdrvidual subject of
the data. The responsible authority may require the requesting person�o pay the actua/costs of making,cert�ing,and compiling the copres.
The resporrsible authority shall comply rmmedia�ely,if possible,with arry request made pursuant to this subdivrsion,or withrn frve days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. l,f he cannot comply wrth the
request wilhin that time,he shall so inform the individual,and may have an additronal frve days wrthin which to comply with the request,excluding
Sahudays,Sundays and legal holidays. ,
Subd.4. Procedure when data is not accurate or complete An individual may contest the accuracy or completeness ofpublic or prrvate
data concerning hrmself. To exercise this sight, an rndivrdual shall not�in writing the responsible authorrty describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)conect the data found to be inaccurate or incomplete and attempt to not�
past recipien�s of irraccurate or incomplete data,rncluding recipients named by the irrdividual;or(6)not�the rndividunl that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is ixcluded with 1he disclosed data.
The determinatron of the respousible authority may be appealed pursuant to the prwisions of the administrative procedure act relating
to contested cases.
DATA PRIVACYADVISORY
In accordance with M.S.13.04,Subd.2,"Rights ofsubjects oJdata';we wou[d like to inform you that your request for apermit orlicense
,from Jhe City of Orono or any oJits departments may require you to furnish certain private or confidential information.
You are notrfied that:
1. The information you furnish wrl!be used to determine your qualifrcation for the permit or licerue requested.
2. You may refuse 10 supply data,but refusal may require that the City de�ry the pernrit or license.
3. The information may be shared with other local,state or federal agencies to the extent necessary to process 1he permit or
license.
4. If your requested permit or license requires Counci!action to approve,some rnformation may become public.
5. You have certain rrghts under M.S.13.04(see following page)to review prrvate data on yourself.
6. Your full name is required to process this application or permit.
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All dimenslons..size designations given are ����' This is an original design and must not be Horner Designed: 1/25/02
subject w verification on job site and T CMNOIOGI a released or copied unlese applicable foe has Fp 1 Printed:2/1S/03
adjvstment to fit job conditions. bean paid or job order placed. Drawing#: 1
No Scale.
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Note:This drawing is an artistic ���'� Horner Designed:2/iS/03
interpretation of the general appearance of r cN o�oc�es Drawing#: 1 Printed:2/13/03
the design.It is not meant to be an exact
rendition.
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interpretation of the general appearance of 7icr,No�oc ea� Drawing#: 1 Printed:2/15/03
the design.It is not meant to be an oxact
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DATE TIME
CITY OF ORONO "` cA� iN �� �
INSPECTION NOTICE SCHEDULED �''
PERMIT NO. ���? (��D 5� COMPLETED
ADDRESS ��� �/L U�`_f ll 7¢C.�
OWNER ��I��'�Yll',2s� CONTR.
TELEPHONE N0. r 7�'�J " •`�7�CL' � ��7`U
� DESCRIPTION _s�c..�-.CGti.�-i�`Yt
� 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 OEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPT C FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEEf YO _YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnedContra e:
Inspector. �-
White Copyllnspector's File Canary Copy/Site Notice
✓
D(� E / TIME
CITY OF ORONO CALLED IN --�� �� ��,�,
INSPECTION NOTICE . j��' SCHEDULED �1�f6�P�(
PERMIT N0. �" COMPLETED
ADDRESS `� �'�
OWNER `- � U��-�"�.�" CONTR.
TELEPHONE N0. � /�'� �7 � --�/r. _
���
� DESCRIPTION C-� - �
� 01 FOOTING 11 MECHANICAL RI 18 XCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL B0. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUM8ING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR W{LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS.
Ca11 forthe next in ection 24 hours in advance. (952� 249-4600
OwnerlContr sit :
Inspector.
White Copyllnspector's File Canary CopylSite Notice