HomeMy WebLinkAbout2006-P10000 - addn/remodel/repair 1 �
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: pl0000
Crystal Bay, Minnesota 55323 Pel'I711t Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
7/10/2006
SITE ADDRESS: 625 Spring Hill Rd Unit#
Wayzata,MN 55391
PID: 25-118-23-33-0003
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Mechanical Electrical(state)
NOTICES/REMARKS:
New Office, Enriy Addition&Porch Addition
FEE SUMMARY: Pemut Fee: $ 1,693.75 Valuation: $ 225,000.00
Plan Review Fee: $ 1,100.94
State Surcharge Fee: $ 115.00
TOTAL FEE: $ 2,909.69
APPLICANT: Venture Builders OWNER: Van Zandt&Elizabeth Hawn
11309 Fettelly Rd.W 625 Spring Hill Rd
Minnetonka,MN 55305 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.
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APPLICAN ITE NATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
1 �
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Total Fee: $ � � 1 DateReceived: �i"���( Z-����'
Entered By:� ^,� � Permit#: �- %L�_��'�1
CITY OF ORONO - BUILDING PERMIT 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: (ci�•cle o�ie) OWNER O CONTRACTOR
JOB SITE ADDRESS: loZ-s S!��ll2G �/GL. �D. ZIP: SS 3� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS � No If yes, a specinl event perniit is reqaiir•ed ivith Police Department and City Council approval
60 cla}�s prror�to the event. Shzrttle bzrs se�-vice will be regzrired arnless applicant de��zonstr•ates
sa ffieient on-site pa��king is available. NoJz-pernzitted events lvill not be allotived.
NAMEOFOWNER: y�(�/�/ ����YJ�'' PHONE: (home) SZ.��r��LD91
(work) G/Z- 3�17 D!Sy �
MAILING ADDRESS: l/�y Cjp.�/� �/G� JZ1� CITY: �B/I. ZIP: • 5� 39�
"�
CONTRACTOR: ���/?�7/,�C f�U/���-S PHONE: �/� �S� 03g�
CONTACTPERSON: jco tf"' JL,C�'O�'I'�C MOBILE/PAGER:
MAILING ADDRESS: //.3�9'F��,r-�y� �D. w. CITY: /?77'��l ZIP: S�S
STATE LICENSE: # z0 S3 7G.v3 EXPIRATION DATE: 3 3���7
ARCHITECT/ENGINEER: 5�k/,9TLZA-r'T n��/L/J PHONE: 9SL�170 -8�/�7
MAILING ADDRESS: y!�/ Z njD�7' CITY: ��«�S/0�-- ZIP: 5533�
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition � Accessory Structure _
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits !
PROPOSED WORK(descrihe in detain: ��w OF�iC�'�C'�?>"�% AnAr/'/Ol'I,�SSo sF�
/�Ew ,�o���- /a�i�io�l l/7o sF >
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHEI) DE�'ACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): � �ZS�f�Oc`�
I hereby apply for a building permit and I acknowledge that the infonnation above is complete and accw�ate;
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: � /�T O
31
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Sec.13.0A RIGHTS OF SUBJECTS OF DATA
Subd. I. Type of 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 confidential data conceming himselfshall be
informed of: (a)the purpose and intended use ofthe 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 con6dential 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,subdivision 5,to a law enforcement ofticer.
TI,P��mmissioner of revenue may.place the notice reouired under this subdivision in the individual income tax or orooertv 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 infoRned whether he is the subject of
stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of
stored private or publ ic data on individuals shal I be shown the data without any charge to him and,if he desires,shal I be informed of the content and
meaning of diat 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 pursuaat to this section is'pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe data. The responsible authoriry
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shal I 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. Ifhe 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 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 writing the responsible authoriry describing the nature ofthe disagreement. The
rEsponsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
i�laccurate or incomplete data,including recipients named by the 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 skatement 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 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 e�ctent necessary to
process the permit or license.
4. If your requested permit or license requires Council action to approve,some information may become
publia
5. You have certain rights under M.S. 13.04(available upon requ�st)to review private data on yourself.
6. Your full name is required to process this application or permit. �
First Middle Last
���' -7`�/�?r9 S ��/�'vn?� li/z ?5�035�7
Address �
��3 �' �'E-�'`�"�lP�./ ,�. t�• y717�'�.�.iG'�/I. �3�
City State Zip Phone
I understand my rights as s bove.
Signature
Reset Form �2
� t
CHEC�K OFF i,IST FOR ISSUANCE OF �'E�'VIITS
FOR OFFICE USE ONLY
ADDRE�S OR LEGAL: C��S 'S�t%�C� (� i �I �c�
PID:
DESCR�'I'ION OF WORK: <SG' A�( -�sa�'!'Yi src(�
c�t (ivl
11YJ�:...►'�..�.�tx.m A�/�/LL?.JG"`_ ------------------------�--------------------
------ _S_1 -----------
ZO�G REVIE`V BY: �� DATE APPROVED� 7
BULLDING REVIEtiV BY: �,,,�,__ . DATE APPROVED: (, - z S - a �
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIE`�1 Yes � No SE�VER CONNEC`ITON
STATE SURCHARGE Yes _f� No tiVATERCONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
----------------------------------_---------- --
ZONl1�tG CHE.CK LIST Zoning Districr. L.� ' I I� �,
Fire Department: Pos[Office: Schaol District:
�ht�1n•co.
L,ot Area: Sq.ft. Acres `f; 7f5 Widch Depth
5urvey Submitted: Yes ✓ TIo Date of Survey: ���4 _ + � S��
{��ticllK� �'"'"` .
Proposed Setbacks: �,��" s � .
Froat��}-- 114 q�L�tSide:
S`"' ,,,ic.s�-
Rear (Street): �G I�e€t Side� ����+
�P.,r Crn t Wetland: s.�p1'Id� C��.S hd� ��,,�
Ad;a....... 1c Cure_: — �'J��1`p lo�
Buil�ling HeiGht: Def. Hgt. /'1�) Peak Hgt.
�s J2r�tL'�'�evtf S
Lot Covera�e: h/3
Grading: Staff Approval Date: By: Council Approval Da[e:
� ,�� � C, ,(' �� f- /�
Septic: Staff Approval Date: (�Q•v��'3 "D�' �Y: ( .t_/v \
c. .
Zoaing File: � Resolutioa: � Resolution Da[e: � �
Shoreland District: �
Avg. Setback: /l� Bluff Setback: L.ot Coverage:
Ecistin� Proposed ,ta!lU i7¢gy(•y Al�v�
Hardcover: G-7�' �1/�� �'IGuS� /5 �h
75-250' `l�1 5 OC�-/ooc� � z��
2�0-500' no cl�r►o� h0 �(cs �1'1
500-1000' � �t(�. b�' ���
is n�wk.u'�rwa-r 3s9v
Hardcover Va:iance Rzquired: Yes No Da�e of Council Approval:
�EtiL�RKS (in house):
� ,
BUII..DING RE'�W CHECK LIST
��� �" 3 ' � CONSTRUCTION TYPE: �(iJ .
Sq Footaoe $Per Sq Ftg
Basement � . . .. x _ .
lst Floor � x � _ . • � .
2nd F1oor x = �
Garage x = �
z =
TOTAL
Estimated Construction Value: $ �z S,v�o `�`2
Inspections Required: �York Requiring Separate Permits:
5 ite Piumbing Fire
� Hardcover Removal � Mechanical. Water Coaaection
`�,f Footing ' Septic Sewer Connection •
� aC Framiag Fireplace Lawn Ircigation
� Insulation (Masonry) Other
pl Wall Boud (Mfg.) Well (State Permit)
_2 F�� Grading/Filling �^Electrical (State Permit)
Ocher
REMARKS(IN HOUSE): '
--------------------------
RE'VIEW BX OTHERS: DAT'E:
.
Access; Existing New �
Access Approval: Date By; '
---------------
REI�IARKS (TO SE NOTED ON PER11�II'I�:
8
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Water/Wa�tewater-ISTS431 /�� ',,�'
Compliance Inspectioo Form for Existing `�l�
� Individual Sewage Treatment Systems
v-
This form reflecis the requirements of the 1996 version oj MNRules Chapter 70$0
iVIinnesota Pollution Control Agency
Note:Local inspection standards may be•more or less cestricrive than the state requirements. These differences must be made available by the Local
Unit of Govemment.
Date of Inspectio�' ��� �� .�s
Properiy Owner(s) � � Telephone( )
Person requesting inspecri n(if diff owner) Telephone(�;.r� _-�t���'
Reason for inspection:
Site Address `� ' C�h,�_�����,�_,,,
Zip Code Unit of ovemment Regulating this property___�,�.,,,s�- �
Fire No. Parcel No. Township Name f�-.���r�e.�- '
Towaship �,n.r,'�yl,�^'�" Range Sec4on Quarter
(Check appropriate sewer system component and indicate Iocalion on site sketch).
Tank S Soil Treatment S stem: Other(briefly describe): Flow Meter
�Septic tank/D�L' �Rock trench� � _Altemative system
Aerobic tan Gravelless pipe crenc � Experimental system Yes I'�I
_Pump tank _Chamber trench _Warrantied system If yes, �
_Holding tank _Seepage bed Exp.Date:
_Other _Mound _ Other _
_At-gade
System Ciassification
System Built Prior to April 1, 1996 and not Located in Any System located � Shoreland or Wellhead
Shoreland or Wellhead Protection Area or Serving a rotection Area or Serving a o� , erage or odging
Food, Beverage or Lodging Establishment Establishment, plus all systems Built after
April 1, 1996
is the system an imminent public health threat(IPHT)?Up�rade Is the s stem an IPHT? U rade
1.Discharge of sewage to the gmund surface? YES NO 10 mo 1.Discharge of sewage to the ground surface? YES 10 mo
2.Discharge of sewage to draintile 2.Discharge of sewage to draintile or
or surface waters? YES NO 10 mo surface waters? YES '� 10 mo
3.Sewage backup into dwelling? YES NO 10 mo 3.Sewage backup into dwelling? YES �NO 10 mo
4.Situation with the potential to immediately and 4.Situation with the potential immediately and
adversety impact or threaten public health or advezsely impact or threaten public health or �
safety? YES tV0 10 mo safety? YES O 10 mo
Is the system failing? Is the system failing?
5.Less than TWO feet of vertical separation between 5.Less than THREE feet ofvertical separation between
system bottom and saturated soii or bedrock? YES NO LGU" system bottom and saturated soil or bedrock? YES NO LGU'*
6.A seepage pit,cesspool,drywell,or leaching pit? YES NO LGU'�' 6.A seepage pit, cesspool,drywell,or leaching pit?YES LGU*"
'*LGU=Local Unit of Government ordinance must specify the time period within which the system must be upgraded
STATUS OF THE SYSTEM
Based on the compliance criteria above the system status is (check one)L�in compliance(functioning)�failing�an imminent threat
therefore,t6is document is a(check one)�Certificate ofCompliance ❑Notice ofNoncompliance.
Page 1 of 2 wq-wwists4.31
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What methods were used to make the detem�inations f the compliance inspectio ? �
�
Please attach the foRowia¢:
1) Site sketc6. Suggested items for diawing include:Well,well setback to system,dvvelling or othc establishment,tank(s),soii ueatrnent system,
reserved soil tc�unent area,curtain drain,property lines,watervvays,and buried lines(t�ose NOT installed by the utility). include sizes and
length a�approximate distances 5vm fi�ced reference points'such as s�eets and buildings.
2) Soil b�ing logs,showing each horizoa Indicate the texture,structure>color,depth of each diffe�ent soit type,evidence of mottling,bedrock
and standing water and whether the materiat is fiU. Locate each boring a�attached site sketch.
3) A list of any and ail reqt�+*e*±+P�ts ofthe local ordinance that are different than the�te requirtments refeired to on this form.
CERTIFICATION
A. I hereby catify that all the infomiation I ha vi regazding the individual sewage h�eat�nt system is true,accurate,and complete.
Property Owner GL��"0�7�� ���� Date -�7J
B. I hereby certify as a state of Minnesota Gcensed Inspector andlor Designer I or Qualified Employee Inspector and/or Qualified E loyce
Designer I that I conducted an investigation in accordance wit6 applicable requiiema►ts that accurately deteimined the compliance status of this
system and that my observations recorded are accutate as of this date. No dete�mination of future hydraulic performance has been nor can be
made due to anki►ovm conditions during systcm constructio�;�abuse of the system,inadequate maintenance,or future water usage.
Inspector's name(print)�i�M C.,��. �r� � Phone
License and/or Re gisaation Numbcr Address � � ����'f�Q-�
Employed by - Address' �
Valid until��,unless the system b�omes an imminent th�eat to public health or safety as defined at Minn.R.7080.0020,subp.19a,before
that ricrbe. �
Signature Date L� -' a+�� ~ l'�
UP91'dd@ i'I�t'la
Minnesota Statutes§115.55("law")Upgrade Requirements
Any situatiorr with the pofenffal to immediately and adversely affect or th�eaten puWic heal�or safety,must be upgraded,replaced,or
fts use discontinued within fen�nths of receipt of this notice or within a sho�ter period of time if r�equi�ed by iocal oMinance.
It the/ocal unit of govemment with jurisdicfion over the system has adopted an adinance containing altemative local standards,ths
existing system must compiy with the ordinance. lf the system does not compty with the ordinance,it must be upgraded,repfaced,or
its use discontinued acao�ding to the ordinance.
!f a seepage pit,drywed,cesspool,or leaching pit exists and the bcal unit of govemment witli jurisdiction over the system has not
adopted loca!standaids to the contrary,the system is failing and must be upgraded,replaced,or its use disco�inued witi►in the time
required by local ordinance.
Jf the system fails to provide sufllcient groundwater protection,then the local unit of govemment or its agent shall order that the system
be upgraded,replaced,or its use disconSnued wffhin the time requfred by n�le or the loca!adinance.
lf an existing system is nof failing as defined in/aw,and has at/east Mro feet of design sal separation,then the system need not be
upgraded,repaired,replaced,or its use discontinued,noiwithstandir►g any Aoca!adinance that is moie strid. This does not apply to
systems in shoreland a�as, wellhead protection areas,or thase used ip cavrnectlon wlth food,beverage,and lodging estaWfshments
as defined in law.
p:lists�pm�devlexmp9.�c-6/99 Page 2 Of 2
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Site Sketch:
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Suggested items for site sketch: Wdl,well setback to system,dwelling or other atablishment,tank(s).soil treatment rystem,
reserved soii uratmmt arrd,curtain drain,propeny liaes,waterways.and buried lines (those NOT installed bx tho utility).
Indude sizcs and length and approximate d'rstances from fixed reference points such as sueeu and buildings.tPiease attach
p�evious as-built drawings,inspeccion reports,Certificate(s)�of Comptiance and Notice(s)of Noncompliance-
Soil Borings(SB{#}: Locate each boring on the map above, indicate on the right of the columns
�low the texture, structure,color,depth of each different soil type,evidence of mottliiig;bedrock and
.,nding water. Also indicate if the material is fill.
SB # SB# SB#
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