HomeMy WebLinkAbout2005 - P08814 - pool - outdoors - in ground PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P08814
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249:4600 Date Issued:
6/16/2005
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SITE ADDRESS: 2550 Woodhaven Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-41-0007
DESCRIPTION:
Proposed Use: Residential Census Code 329
Permit Class: Building
Permit Type: Accessory Structures Permit Sub-type(s): Pool-Outdoors-In Ground
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DETAILS:
Approved per resolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 542.75
Valuation: $ 40,000.00
Plan Review Fee: $ 352.79
State Surcharge Fee: $ 20.00
TOTAL FEE: $ 915.54
APPLICANT: Atlantis Pools OWNER: John&Suzanne Van Dyck
4321 68th Ave N 5353 Wayzata Blvd
Brooklyn Center,MN 55429 St. Louis Park,MN 55416
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.
O
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
Jun-07-2005 02:09pm From-CITY OF ORONO +9522494616 T-112 P.001/002 F-484
Total Fee:
5
S Date Received: ''
Entered By: _ Z� Ce-7/o/a 5 Permit#•
CITY OF ORONO -BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
TIDE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: , rw , t/41 12, ZIP: 5-s3SG
Will this be a Pa de of Homes,Remodelers Showcase Home or other Display Borne?
Li Yes ifyes,a special event permit is required with Police Department and City Council approval
60 days prior to the evens. Shuttle bus service will be required unless applicant demonstrates
sufficient an-site paring is available. Non permitted events will not be allowed.
NAME OF OWNER: z. U ' PHONE: (home) �5-;./ sS- 7C' .$
(work) ?,c,2 - - 7/ 6/
MAILING ADDRESS: ..�v we o//4 CITY: 0/2c),-)0 ZIP: SS Ys6
CONTRACTOR: , / /S /00_,„Ls. PHONE: 773-- SSG - 0(0 3
CONTACT PERSON: / Clc (9Atci1 5 MOBILE/PAGER: l/)- 7v2- G1.,
M ATL:LNG ADDRESS: i-I ( TIP ,41,-)L• AJ CITY: ik �C i r I :
STATE LICENSE: # EXPIRATION DAT :
ARCHITECT/ENGINEER: — PHONE:
MAILING ADDRESS: CITY: • ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration
•
PROPOSED WORK(describe in detail): _ S /1/1 k - /4:;)c) L
X./L-/
STORIES: _ SQ.FEET OF EACH FLOOR: - '
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED_
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 110/ c) 0 0
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
:n accordance with the approved plan.
APPLICANT'S SIGNATURE: - DATE:
31
JUN-7-2005 TUE 01:54PM ID: PAGE: 1
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ZSS-0 woob -t`A JtrN 02
PID:
DESCRIPTION OF WORK: Pool
ZONING REVIEW BY: �Q ( DATE APPROVED: '-ct -0 S.
BUILDING REVIEW BY: 3 DATE APPROVED: 4,•q -os-
FEES
sFEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes i/ No SEWER CONNECTION
STATE SURCHARGE Yes LV No WATER CONNECTION
INVESTIGATION FEE Yes No i/ PARK FEE
SAC Yes No i7 SITEINSPECTION
Number of SACUnits OTHER (specify)
ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes "C No Date of Survey: `d-Zy
•
Proposed Setbacks:
Front (Lake): i 7O Right Side: 65
Rear (Street): 1001 } Left Side: Ito ' t
Adjacent Structures: 3L, Wetland:
Building Height: Def. Hgt. n1 I A Peak Hgt. —
Lot Coverage: N I✓l
Grading: Staff Approval Date: N j By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: 111.7
Avg. Setback: Bluff Setback: 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):
•
BUILDING REVIEW CHECK LIST
UBC: CONSTRUCTION TYPE: —
Sq Footage $Per Sq Ftg
Basement x =
1st Floor x _
2nd Floor x
Garage x =
x =
TOTAL
Estimated Construction Value: $ �(O+60 p°St
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
&. Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
p( Final Grading/Filling y Electrical (State Permit)
Other
REMARKS (IN HOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
8
,;an-07-2005 02:09om From-CITY OF ORONO +9522494616 T-112 P.002/002 F-484
Sec.13.04 RIGHTS OF StIBJ$CI'S OF DATA
Subd 1. Type of data. The rights of individual on whom the data is stored or to be scored shall be as set forth in this section.
Subd.2. Information required to be given individual.Art individual asked to supply privets or confidential data concerning himself shall be
informed of (a)the purpose and intended use of the requested data within the oolieccin.g state agency,political subdivision,or statewide system;(b)
whether he may refuse oris legally required to supply the requested dam;(c)any known consequence arising from his supplying or refusing to supply
?^.vete er ce t dondal data;and(d)the identity of other persons or entities authorized by state or fedetal law to receive the data.This requirement shall
not apply when an individual is asked to supply investigative date,pursuant to Seorion 13.$2,subdivision 5,to a Inv:enforceinont officer.
z-j2 reaui .der .'• tib• I 'on'. ., in•'
ti •.•e. •r••' aTax .and
icati:rrio:s instead of on those forma.
Subd.1. r cK.ess to daft by individus!.Upon request t0 anesponsible 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 confrdentiat. Upon his further request,an individual who a the subject of
stored private or public data on individuals shalt be shown the data without any charge to him and,if he desires,shall be informed of the content and
meaning of that data. Atter et indi'+'idua:ins been tho'.vn the private data and informed of its meaning,the dam 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
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,nerd lag,and comthe copiesto this subdivision,orwithtn five bays of
The responsible authority shall comply immediately,if possible,with any request madepursuant
dr,fr trf 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 bdditioni.rive days within which to comply with,the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4.Procedure when data isnot=curate orcomplete. An individual may contest the acc•recyorcompleteness ofpublic orprivate dam
concerning himself.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible autiwTiy tis::Wit in 30 days either (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete dam,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Darn 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
. dcnt::l nfcrt atior..
You are notified that;
I. 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.
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 reviewprivate data on yourself.
6. Your full name is required to process this application or permit
•d� Last
First M
'
Address
City
State Zip Phone
I understand my right's as stated above.
signature
32
TUN-7-2035 TUE 01:54PM ID: PAGE:2
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CHECK OFF LIST FOR ISSUANCE OF P Tea _ 801
Address : c7/45:5V
Initial Area of Review Remarks
Building Code Review
:k Zoning Review
•
Access
a) , State
b) Hennepin County
c) City (Public Works Dept)
• d) Private Roads •
(Public Works Dept)
Utilities (Public Works Department)
a.) Sewer
b) Water
Septic Review
MCWD
• ----- LMCD
Special Grading Review
Engineer's Review
Attorney's Review
Special Assessments
Things to be noted on the permit:
DJAM ! 1TJJ MPG I IJRG n DMH
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•
•
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CITY of ORONO
r a w+ a Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
ej" •Y ! ` On the North Shore of Lake Minnetonka
►, �,t
DATA PRIVACY ADVISORY
In accordance with M.S. 15. 165, "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 inform-
ation.
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 reqires council
action to approve, some information may become public.
5. You have certian rights under M.S . 15. 165 to review
private data on yourself.
•
6 . Your full name, and date of birth are required to process
this application or permit.
• ,et.p .o/z4,
First Middle Last
6'5'9'0/ G2. ",)/4./ A /. - 7/2` //4't,/
Address
f-,2(1--
Date
-2v -.Date of birth (does not apply to building/general permits)
Phone
I understand my rights as stated above.
X ! �i
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
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