HomeMy WebLinkAbout1999- 011425 - restroom/window PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 FAI j
Permit Number:
Crystal Bay, Minnesota 55323 01 1 4
Date Issued :
(612) 473-7357 OS/12/99
SITE ADDRESS:
2160 WAYZATA BLVD
CH
P . I . N . ;
DESCRIPTION:
RESTROOM&WINDOW
D4ilding Pprmit TypP COM-ADD/REMODEL
uildnc4 Work Type OMMEKA1
UGC Occupancy
Con..Aruction Type VN
CPnsi4 Corie ALI . NO(‘-iRES .
REMARKS:
FEE SUMMARY:
VALUATTON $S, 000
FaP Scr:4 . 7F;
Plan Review $64 . 84
Surcharge
Total Fee $1f;7 . 09
CONTRACTOR: OWNER: -- Applicnt -
WEAR WILLIAM
31E0 WAYZATA BLVD
OR a\ MN SS:H.03
4 7
THE UNDERSIGNED HEREBY REQUESTS BERM ION TO MAKE THF REAL TMPROVFMFNP;
SPECIFIE0 AND AGRr& E i TL IN STRICJ COMPLTANLF WITH Ai CITY OF
ORONO ORnINANCFP; AND STATE OF MINNESOTA BUILDING CODE REQUTRFMFNIG .
; °
APPLICANT/PERMITEE SIGNATURE SUED BY:SIGNATURE /142
• Total Fee: S &,-;. 7 n) Date Received:
, Entered By: ,lam Permit#:
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 I CONTRACTOR
JOB SITE ADDRESS: A i 6 C Ida yZl ., f Tl V d ZIP: 5556
i
NAME OF OWNER: WI yl'( , �f PHONE: (home) Z11/3-4030
)_ //+ J (work)
l�/ , /1/0/CITY:
- ii SI
MAILING ADDRESS: /60 z , l vdCITY: /U/1/C 'A'e ZIP: 5.53'..5-
CONTRACTOR:
53 .5CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MA LING 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 det il): /JeXI 1 esr room /h �jl�►�1ci?� P pc
c-r�ea. ✓►d Lft 1 (( O win pa) DE CF POOR
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
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 wi e approved plan.
APPLICANT'S SIGNATURE: ;;.. DATE: ,c/ 5'
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
• Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. 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. Infirmettton required to be given imiliv1dtd. An individual asked to supply private or confidential data concerning himself
shall be informed of: (a)the purpose and jimmied 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)duo identity of otter persons or entities authorized by note 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 officer.
11 V �y1'i n i 1'. t-."..,.R:+ a.. 1 �, V •.11 1!. !'. J,.4tl. . ' i L'. N . l l.l1
11nstructions instead of on tie forma.
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 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 individael has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six mantes thereafter millets a duping or action pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authority dull 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 respooaible 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 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 legal holidays.
Subd.4. procedure when data b 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 authority describing the nature of the
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 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 if 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 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.
JIiIIrh k/c lke WeaCr
First
Last
2 6 / JK ✓ 'er I
i
AddressLE n .
MAI 5535 6 4115- 704-17(4)
City $1i1e ZIP phone . 4S {5 ( j
I understand my rights as stated above.
Afr
nature
6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z(( O W y z l (I y3
PID:
DESCRIPTION OF WORK: (1.0 0o--, -f CEJ vv o
ZONING REVIEW BY: N/g- DATE APPROVED:
BUILDING REVIEW BY: CQ��`�- DATE APPROVED: s' i z-
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes t/ No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECIION
INVESTIGATION FEE Yes No PARK FEE
SAC Ycs No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: IVO C hwv
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side
Rear(Street): Left Side:
Adjacent Structures: tland:
Building Height: Def. Hgt. P Hgt.
Lot Coverage:
Grading: Staff Approval Date: I�ay: Council Approval Date:
Septic: Staff Approval Date: $y:
Zoning File: # Resolution: # j Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac : — Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):_
• 26
BUILDING REVIEW CHECK LIST
UDC: `3 CONSTRUCTION TYPE: UN
&I Footage $Per Sq Fit
Basement x =
1st Floc x a
2nd Floor x =
Garage x =
x =
TOTAL
Eotlmated Contraction $ 5,00o 00
Inspection n Roq■ird; • Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
—Z. Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
oc Final Grading/Filling Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMIT):
27
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