HomeMy WebLinkAbout2003-P06992 (add/remodel/repair) � � PERMIT
C I TY O F O RO N O Permit Num ber:
2750 Kelley Parkway - PO Box 66 Po6992
Crystal Bay, Minnesota 55323 Per-mit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: iiii2i2oo3
SITE ADDRESS: 1525 Bay Ridge Rd
Wayzata,MN 55391
P I D: 10-117-23-34-0009
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residenrial
Buildin Census Code 434
Permit Class: g
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: �iecuicai(siaiej
NOTICES/REMARKS:
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FEE SUMMARY: PernutFee: $ 139.25 Valuation• $ 7,000.00
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 143.25
APPLICANT: Bob Mack OWNER: Virginia Sveeggen
314 Buchanan NE C/o Mary S. Humphrey,Cons.
Minneapolis,MN 55413 19 Westwood Rd
Minnetonka,MN 55305
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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PPLI ANT P TEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signitures Required), 1-Apolicant, 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 information)
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: / �� � ���� �'r,� �pZIP: ������
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ No If yes, a special event permit is required with Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: ,8�� �.�� PHONE: (home) — —���''�
(work ` ���.,.�t,�63
MAILING ADDRESS: � (f C C'/ �+4J�N jTY: � L��, ZIP: �3
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 NTove
RemodeUAlteration_� Land Alteration
PROPOSED W describein detai�: lv,�� �,(J� J���(�/� ���� � pG����
� O �-- �b O"I�N� ON L�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ i,G�v`'�
I hereby apply for a building permit and I aclrnowledge 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 pernut and work is not to start without a pernut; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: ���'r����� DATE: �1—'1 aC.,"D�
Sec.13.04 RIGHTS OF StiBJECTS OF DATA
Subd.1. Type of data. T6e 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 o[: (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 o[other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asl:ed to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement ofticer.
The commissioner of receaue mav place the notice reauired under this subdivision in the individual income tar or nrooertv tar refund
instructions mstead 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 indi�iduais 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 indi�idual 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 coliected or created. The
responsible authority shall provide rnpies of the private or public data upon request by the individual subject of the data. The responsible authority may
require the requcsting person to pa}�the actual costs of making,certifying,and compiling the copies.
The responsible authority s6all comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the
date of the request,excluding Saturda}s,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy 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 ezercise 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)wrrect 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 y�ou 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}-ou 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.
First Middle Last
Address
C�tY State Zip Phone
I understand my rights as stated above.
Signature
CI3ECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: t S�5 �,�q� (`I r�v c_:. i��
PID:
DESCRIPTION OF WORK: i?��v���Z
ZO�1G REViEW BY: D�TE APPROVED: i� -1 2 -�3
BUII�DING REVIE`V BY: ', D�TE APPROVED: � � � Z -�7
FEES TO BE CHA.RGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No ,:/ SEWER CONNECTION
STATE SURCHARGE Yes :/ No SVATF.RCONNECI'ION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District: �i C _��fi4it.C:J �.
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Sun'ey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): I,eft Side:
Adjacent Structures: Wet and:
Building Hei?ht: Def. Hgt. Pe •Hgt.
L,ot Coveraoe:
Grading: Staff Approval Date: y: Council Approval Date:
Septic: Staff Approval Date: y:
Zoning File: # Resolution: � Resolution Date:
Shoreland District:
Avg. Se[back: Bluff Setb k: L.ot Coverage:
Ezistina Proposed
0
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes o I?ate of Council Approval:
REMARKS (in house):
7
BUII,DING REVIEW CHECK LIST
��' - � � CONSTRUCTIO�T T�'PE: �i�
- �1 F��Se $Per Sq Ftg
Basement x
lst Floor x —
2nd F1oor z _
Garage z —
z
TOTAL
Estimated Construction Value: $ �G v� �`
Inspections Required: `Vork Requiring Separate permits;
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
r�c Footing ' Septic Sewer Connection
� Fr��g Fireplace Lawn Irrigation
x" Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
—�F�� Grading/Filiin� ,� Electrical (State Permit)
Other
REMARKS(I�'HOUSE):
---------------------------------------
REVIEW BY OTHERS: DATE: ---------
Access: Ezisting New
Access Appro��al: Date
$Y�
RE1�Z4RKS (1'O BE NOTED ON PERivII�: ----------------- ---------------------------
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� ` ` j � i t�O'V�£TrZEATED PLATES WF�3.�N
� � LAYED ON C0�1C�2ETE '
��� �
DATE TIME
CITY OF ORONO ALLED IN �I I-Y
INSPECTION N IC SCHEDULED !!-/3-n� �a'O
PERMIT N0. �9Z-- COMPLETED
ADDRESS I�LS CX�.I`—C c.r�c �
OWNER � �'1.�.� CONTR.
TELEPHONE NO. �"/Z Z?� 'S 7� �
� DESCRIPTION �
� 01 FOOTING 11 MECHANICAL I 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� �`W�ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W �'cORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP OROER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Ca11 forthe next inspection 24 hours in advance. (952� 249-4600
OwnerlContra 't .
Inspector. �- `-.L
White Copy/lnspector's File Canary Copy/Site Notice