HomeMy WebLinkAbout2004-P07631 (addition, remodel, repair) PERMIT
CITY OF ORONO
275� Kelley Parkway - PO Box 66 Permit Number: Po�631
Crystal Bay, Minnesota 55323 PeC'llllt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 6i23�2ooa
SITE ADDRESS: 1461 Bay Ridge Rd
Wayzata,MN 55391
P I D: 10-117-23-34-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: viner-�i�icd ny Fsruce,no pian review needed or zoning issuesj
NOTICES/REMARKS:
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FEE SUMMARY: Pernut Fee: $ 83.25 Valuation: $ 2,400.00
Plan Review Fee:
State Surcharge Fee: $ 1.70
TOTAL FEE: $ 84.95
APPLICANT: Owner/Self OWNER: David&Kari Flick
MN 1461 Bay Ridge Rd
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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APPLI NTPER [TEESIGNATURE ISSUEDBYSIGNATURE
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Copies: 1-File(Sze'nitures Required), 1-Applicant 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
_ Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforrnation)
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THE APPLICANT IS: (circle oize) OWNER gR CONTRACTOR
JOB SITE ADDRESS: � � ZIP: ���j,�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a speciczl event permit is required with Police Department and City
Council approval 60 days prior to the event. Non perinitted events will not
be allowed.
NAME OF OWNER: .���±ca ��;�� PHONE: (home)(�'�� 4�S��
(work)
MAILING ADDRESS: ) ��1 �q� ��^c-� � CITY: c��+�cZ ZIP: '���`j
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�: _ ��u r -�� ��� C' .\ ��cs.r�n �f,� �f,�,rc ��J���
�w ��a r i� ���I� � � 1�> �j �1�, i`��t C� E= I l�� � I a F�� V� c� V�� -E�.�_ f�l'`
�,
� <.-( (,��C���c� < <_„���c. :�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��..1=
I hereby apply for a building permit and I acknowledge that the infonnation 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 pernut 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: ��_��
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. 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,subdivision 5,to a law enforcement otficer.
The commissioner of revenue mav D�ace the notice required under this subdivision in the individual income tax or proaertv 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 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 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 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,certifying,and compiling the copies.
The responsible authority shall comply immediate(y,if possible,with any request made pursuant to this subdivision,or within Gve 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 requestwithin
that time,he shall so inform the individual,and may have an additional�ve days within which to comply with the request,excluding Saturdays,Sundays
and legal holidays.
Subd.4. Procedure when datu 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 authority describing the nature of the disagreement. Thc
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 datu to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagrecment is included with the disclosed data.
Thc determination of the responsible authority may be uppealed 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 noti�ed 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(icense.
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.
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First Middle Last
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City State Zip ^ �h'G�� a I�r ,� ^
I understand my rights as stated above. � r ��
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Signature
D T�j TIME �
CITY OF ORONO CALLED IN ��✓
INSPECTION N TI SCHEDULED -D _����
PERMIT NO. D � COMPLETED
ADDRESS � � �
OWNER , CONTR.
TELEPHONE NO. ��2' �Z � 0 D(�
� DESCRIPTION ��� —'
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLWG
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED � ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALI INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i spection 24 hours in advance. (g52) 249-4600
OwnerlContrac�i e
Inspector. �
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