HomeMy WebLinkAbout2004-P07972 - pool outdoors in ground ' n � PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley f'arkway- PO Box 66 P07972
Crysta'�B�y, Minnesota 55323 Permit Type: Accessory Struchues
(952) 249-4600 Date Issued: loiii2ooa
SITE ADDRESS: 440 Stubbs Bay Rd
L.ong Lake,MN 55356
PID: 32-118-23-13-9998
DESCRIPTION:
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 329
Pernut Sub-type(s): Pool-Outdoors-In Ground
Permit Type: Accessory Structures
DETAILS:
Approved per resolurion#:
Separate permits required: Eiecmcai(siaie�
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 321.25 Valuation• $ 20,000.00
Plan Review Fee: $ 208.78
State Surcharge Fee: $ 10.50
TOTAL F'EE: $ 540.53
APPLICANT: Dolphin Pool&Spa OWNER: Tom Lindquist
3405 Highway169 North 4535 Roahoke Rd
Plymouth,MN 55441 Golden Valley,MN 55422
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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APPLICANT P RMITEE SIGNATURE ISSUED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-Aunlicant 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
� ,
Total Fee: $ �yo - `�=� Date Received: _ G/�-��` �?�
Entered By: ,�,,,� /�'�-�'=' Permit#: ,t-��,� �
� �,�.,�,�-'
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�zt all infornaation)
------------------------------------------------------------------------ -----=_=_====� ----------------------------
THE APPLICANT IS: (circle oire) OWNER R CONTRACTOR
JOB SITF ADD�SS: ��1� -S TUC3/� S i3�}; I�'a� � ZIP:
Will this be a Par de of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �No If yes, a special event perrnit is required witlz Police Depc�r-trner�rt and Ci.ry
Coirncil approval 60 days prior to tlae eve���t. Nor�peYnaitted everrts will riot
be allowecl.
NAME OI+ OWNER: ra� �...//�J()��y�S7' PHONE: (home)7�0 3 - 3 �l- u yo�
(work)
MAILING ADDRESS: CITY: ZIP:
CON'I'RA�'i'OR: �dLl�f-Ili� ���-S P�IONE: �(� 3 "� S`�Z --�d�;c�
CONTACT PERSON: � t-f��1 S ��o2��c= MOBILE/PAGER: 7G�3- 300 - �joc, j
MAILING ADDRESS: ��f0 S HI w�`f f(p°1 � CITY: fJ(y�y►c�7c�f 7IP: S�"30'�
STATE LICENSE: # �3C - 2c� Z Ca(P �fS"Z -�
ARCHITCCT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New _� Accessory Structure
Addition Move
Remodel/Alteration Land Alteration
PROPOSED WORK(descriGe iiz detai�: ��'`< <'2oL�'� Zv �`f� l�e n/� 1 L(iv���
�wi�n�t.� �i �U� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 2 v� �� v
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 � � DATE: �� 2d � v (
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. Thc rights of individual on whom the data is stored or to be stored shall be as set forth in this section. �
Subd.2. Information requlred to be given individual. An individual asked to supply prlvate or rnnfidential data concerning himself shali be
informed of: (a)the purpose and intended use of the requested data within the collecting state agency,politicai subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising Gom his supplying or refusing to supply
private or conCdential data;and(d)tlie identity of other persons or entities authorized by state or federal Iaw to receive the data. T6is requirement shall
not apply rvhen an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav alace thc notice reauired under this subdivision in the individual income tax or arooertv 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 it is classified as public,private or conTidential. 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 pr(vate,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 becn collected or created. The
responsible authority shall provide copies 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 authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the
date of the request,excluding Saturdaya,Sundays and legal holidays,if immediate rnmpliance is not possiblc.If he cannotcomply 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 compiete. An individusl may contest the accuracy or completeness of public or private data
concerning himself. To exercise this right,an individuai shall notify in writing the responsible authority describing the nature of the disagrcement.The
responsible authority shall within 30 days either: (a)correct the data found to be Inaccurate or incomplete and attempt to natify past recipients of
inaccurate 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[t 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 furnisli 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 Gcense 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 understa my rights as sta above.
G� �-- c---�-
Signature
�
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
, FOR OFFICE USE ONLY ,
ADDRESS OR LEGAL: �/�!0 �STL�
PID:
DESCRIPTION OF WORK: od
- ----- --- -- ----------------- Z
ZOYPi tG REVIE`V BY: DATE APPROVED: Q- Y-�y
BUII..DI�IG REV�`Y B • DATE APPROVED; �}- Z�l-d`�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERII�IIT Yes � No
PLAN REVIEW Yes � No SEWER CONIVECI'ION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC-Units OTHER (specify)
ZOi�TIl�iG 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: ON'r'�u=
Proposed Setbacks: �
Front(Lake): 2 oti� } Right Side: Z 3�� �=
Rear(Street): 2� � } Left Side: Y6�
Adjacent Structures: w � Netiand: Sa'
Building Hei�ht: Def. Hgt. Peak Hgt. —
Lot Coverage: /J�A
Gradino: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date: �
Shoreland District: /J(J
Avg. Setback: Bluff Setback: L,ocCoverage:
ExistinQ Proposed
e
Hardcover: 0-75' .
75-ZSO'
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REP�ARKS (in house):
7
BUII.DING REY�W CHECK LIST
�C� — � CONSTRUCTION TYPE: --
_ Sq Footage $Per Sq Fte
Basement x _ �
lst Floor x . _ .
2nd Floor x = �
Garage x _ �
x =
TOTAL
Estimated Construction Value: $_ Z o, c�o o "�'
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�Footing � Septic Sewer Connection �
' Framing Fireplace Lawn Irrigation
Insulatio❑ (Masonry) Other
Wall Boazd � (Mfg.) Well(State Permit)
—.�F�� Grading/Filling os Electrical(State Permit)
Other
REMARKS(.ni 1 HOUSE): .
REVIEW BY OTHERS: DATE:~N-----------------------------------------
Access: Existing New .
Access Approval: Date gy; �
--------------------------------------------------------------
RENIARI�S (TO BE NOTED ON PERivII1�:
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. 1355.27
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� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Z 04 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 SEPT! FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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