HomeMy WebLinkAbout2004-P07806 - attached deck PERMIT
C I�TY �F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07806
Crystal Bay, Minnesota 55323 P@ff111t Typ@: Addirion/RemodeURepair
(952) 249-4600 Date Issued: sii2i2ooa
SITE ADDRESS: 125 SmithAve
Wayzata,MN 55391
PID: o2-ii�-23-2i-oo1�
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Type: Addirion/RemodeURepair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 23.50 Valuation• $ 500.00
Plan Review Fee: $ 15.28
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 39.78
APPLICANT: Owner/Self OWNER: Bradley&Pamela Horner
MN 125 Smith Ave
Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICf COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
C �APPLICAN ITEE SIGNA'�URE SUED BY SIGNATURE
Couies: 1-File(SiQnitures Reauired).1-Atmlicant 1-Monthlv Renorts. 1-Assessine. 1-Finance Page 1
a ,
Total Fee: $ ,� Date Received: �Y�-�f-G'�
Entered By:�"12-- Permit#: _ �� 7�t��P
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�:t all iizfor»iatio�i)
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
� C/� . ZIP: � .3 �
JOB SITE ADDRESS: ��� �/�'� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �_ If yes, a special event permit is requir-ed wit1� Police Department ar�d City
Coz�jicil approval 60 clays prior to the event. Non perrriitted events will not
be czllowed.
NAME OF OWNER: ,�,� cY �I��� PHONE: home) �S�` Y������
- �
�--- (work) 3 -� -�5 �
MAILING ADDRESS: l v��� 9 /I�1 f ' ��'/f� CITY: Gl/ ZIP: �� Y
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 Accessory Structure
Addition Move
Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: {��G�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
��
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��� l�—�
I hereby apply for a building permit and I aclmowledge 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: c DATE: g � l ��
, �
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of lndividual 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 of 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 federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdlvision 5,to a iaw enforcement officer.
The rnmmissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or aroaertv tax refund
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 whether tt is classi�ed 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 deslres,shall be informed of the content and
meaning of that data. After an indivtdual 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
responsibie authority shali provlde copies of the private or public data upon request by the i�dividual subject of the data. The responsible authority may
require the requesting person to pay the actual costs ot maWng,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of thc
date of the request,excluding Saturdays,Sundays snd legal holidays,if immediate compliunce is not possible.If he cannot comply with the request within
that time,he shall so inform the individuai,and may have an additional five days within which to comply 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 completeness of public or private data
concerning himself. To exercise this right,an individual shall notify in writtng the responsible authority describing the nature otthe disagreement. The
responsible authority shall within 30 days either: (a)correct the datu found to be inaccurate or Incomplete and attempt to notify past recipients of
inaccurate or Incomplete datu,including recipients named by the individual;or(b)notify the indivldual that he believes the data to be correct. Data in
dispute shall be disclosed only If the individual's statement of disagreement is included with the disclosed datu.
The determinution of the responsible authority may be appealed pursuant to the provisions ot 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 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 ri hts as stated a ov .
�'' ���
S ature
a '
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
A.DDRESS OR LEGAL: I L S �S w�.�� ,4v-2
PID:
DESCRIPT�ON OF WORK: �Q��
ZO�G REV�W BY: DATE APPROVED: �—t2 -b�
BUII,DI�iG REVIE`V BY: DAT'EAPPROVED; $ -c i-u�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERIVITT Yes ,/� No
PL?.1�T REVIEW Yes c/ No SEWER C0ITNEC"IION
STATE SURCHARGE Yes ,/ No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CHE.CK LIST Zoning Discricc: .
Fire Department: Post O�ce: School District: �
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes 1� No Date of Survey: 9-2S-93
Progosed Setbacks: � �
Front('L�ce): I�`� Right Side: �7
� � '
Rear(�t): 6� Left Side: �
Adjacent Structures: �i� �Vetiand: Nl�
Building Hei;h[: Def. Hgt. N!� Peak Hgt. .vj/F
Lot Coverage: !3�o t
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # � Resolution: # Resolution Date: �
Shoreland District: /�� �
Avg, Setback: Bluff Setback: I.ocCoverage:
Ezistine Proposed
Hazdcover: 0-?5'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
, �
BUII,DING REVIEW CHECK LIST
v�ac: 2 - 3 � covs�rxvc�orr�E: •tvJ
_ Sq Footage $Per Sq Ftg
Basement x _
lst floor x . _
2nd Floor z =
Garage x = �
x —
TOTAL
v
Estimated Construction Value: $ $b0 �
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
_ C Footing ' Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
Insulation (Masoary) Other
`Vall Boazd • (Mfg.) Well (State Permit)
�F�� Grading/Filling Electrical (State Permit)
Other .
REMA]E2KS(.i�i t HOUSE): .
------------------------------------------------------------
REVIEW SY OTHERS: DAT'E:
Access: Ezisting New •
Access Approval: Date gy;
RENIA.RKS (TO BE NOTED ON PERivII'I�;W---�_N--------------------------------------------------
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CERTIFICATE 4F SURVEY F�R
BRAD H4RNER � ��
IN L4TS 64 AND 65,"aRaN� �RCHARDS" :` ��; � ����S�F,�� ,. '
; HENNEPIN G4UNTY, MINNESOTA ' ` '` ``' � �
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o : denotes iron marker 4� � ;
Al1 bearings are based upon an assumed datum . i
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LEGAL DESCRIPTION OF PREMISIS SURVEYED : - -- � " _ � �� '
� � - .._,.
; , ( - . __
_ __ _
_
Lot G4 and that part of Lot 55 lying Northerly of a line '
running from a point in the South��esterly line o�F Lot 70
distant 25 feet Southeasterly �rom the Northwesterly corner
o�i said Lot 70 to a point in the t�ortheasterly line o{ said
Lot G5 di. stant 7 feet Northwesterlv from the Southeasterly
corner thereof , ''ORONO ORCHARDS :� � �
This survey intends to show the boundaries of the above
described property and th� location of an existing house
and garage thereon . It does not purport to show any other
improvements or encroachments .
�� �
� - � `�., �/%�-C
'"'. I hereby certify that this survey was prepared b}' me or under my direct super- �A'��= 9-29-93
� � 1 � ' 1 � � vision, and that I am a duly registered Civil Engineer and Land Surveyor under
�t the laws of the State of Minnesota. a �
�� SCALE ! tQ-O
, ,,�
i�l'��'���=r =����"�-��
Mark S. Gronberg Minnesota License Number 12755 Jna NO 93-4-27