HomeMy WebLinkAbout2005-P09442 - addn/remodel/repair PERMIT
`CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p09442
�Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeUxepair
(952) 249-4600 Date Issued:
12/1/2005
SITE ADDRESS: 760 Brown Rd S Unit#
Wayzata,MN 55391
P��� 03-117-23-43-0004
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Addition/RemodellRe air Permit Sub-type(s): Addn/Remodel/Repair
Permit Type: P
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 181.25 valuation: $ 10,000.00
Plan Review Fee: $ 117.81
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 304.06
APPLICANT: Remodel&Repair Inc. OWNER: Mr. &Mrs. Browne
P.O. Box 454 760 Brown Rd S
Watertown,MN 55388 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.
, � ,j� - ,
__� ` _�����,1 ��Z�'��.�r��-�
PPL ANT R IG U ISSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, ]-Assessing,(If Septic, 1-Septic) Page 1
Total Fee: $ �C'�� ��'' Date Received: r I �Z�/vS�
Entered By: .��vV Permit#: �� �l yW�-
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforination)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (ci�•cle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 6 � �p ��D �✓� V��/1 ZIP:
Will this be a Parade of Homes, Remodelers Sho�vcase Home or other Display Home?
❑ YeS � �10 If>>es, a special evenl persnit is reqirir•ed tivith Police Deparh»ent and City Cormczl np�roval
60 days prior�to tl7e event. Shtrllle bus seruice will be reqa�ir-ed a�nless applicant demor�strates
si{fficie��t on-site parking is avnilnl�le. Non�e�-mrlted evenCs will not be nllowed.
NA1l�IE OF OWNER: L{,�Ov�✓� �r�'� PHONE: (home) �'S-< �73—��S 7
(work)
MAILING ADDRESS: �7�� �.���rn '�jl� CITY: �� v`� ZIP:
CONTRACTOR: ��'�c� a-���'� ��"�- PHONE: 6 �� 7��°'-�S�S—
CONTACT PERSON: J�� MOBILE/PAGER:
MAILING ADDRESS: ;! �3D ��.�-�d � v CITY: �/��"«`"�`� ZIP: %S3���
STATE LICENSE: # ��l vZ 3 q�l EXPIRA'I'ION DATE: � n�'�
ARCI-�I'I'ECT/ENGINEEIZ: /t�r.�v� � PHONE:
MAiLiNG ADDRESS: CI'I'Y: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
PROPOSED V6�ORK(describe irz detai�: �c�c0 �or v�-�r �;7,..d� �f��
Cr1 j/c'(� �>`� S t�� µ �Q B�f-�r�c�l✓y� L��'/�C�/.�� C��L1 �r 0—L�-00 G��t-,��c f"e
(-�d✓+J
S�'oR��'S: ��.�'�'�'���' �E����'����:
NO. OF �EI)ItOONIS: GAItA�E S'I'ALLS: A'["I'AC�IED I)E'1CACI�ED
�ST'I1ViA�'E�CONSTI�IICT'IOI�VA�,�1�1'�fION(exeluciing land): � l� do�
I hereby apply for a builcling permit and I acicno�vledge that the infonnation above is coinplete and accurate;
that the work will be in conformance witl� the ordinances and codes of the City and witl� the State Building
Code;that I understand this is not a pennit and tivork is not to start without a perinit;and that the work will be
in accordance with the approved plan.
-.--r`
�P��,I��a�r�°s s1��vA��� � �����: �l��-DS
31
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. Infoimation required to be given individual. An individual asked to supply pnvate or conFidential data conceming himself shall be
informed of. (a)the pucpose 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 frotn his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state oc federal law to receive the data.This requirement shall
not apply when an individual is asked to supply investigative data,ptn'suant to section 13.32,subdivision 5,to a law enforcement officer.
The commissioner of revenue maxplace the notice required under this subdivision in the individual income tax or propertv tax refund
inshUctions instead of on those fomis.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be inforn�ed whether he is the subject of
stored data on individuals,and whether it is classified as public,piivate or confidential. Upon his ft�rther request,an individual who is the subject of
stored private or public data on individuals shall be shown die data without any charge to him and,if he desires,shall be inforn�ed of the content and
meaning of that data. After an individual has been shown the priva[e 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 authoiity
may require the requesting person to pay the actual costs of makine,certifying,and compiling[he copies.
The responsible auUiority shall comply immediately,if possible,wifh any request made pursuant to this subdivision,or�vithin five days of
the date of the request,excluding Sahirdays,Sundays tmd legal holidays,if immediate compliance is not possible. lf he cunnot comply with die request
within that[ime,he shall so infonn the individual,und may have an additional five days within which to comply wid�the request,zxcluding Saturdays,
Simdays and legal holidays.
Subd.4. Procedure when data is not accurate or complzte. An individual may con[est the accuracy or completeness of public or private data
concerning himself. To etercise this righ[,an individual shall notify in w�iting the responsible�uthoiity describing[he nature of the disagreement.Thc
responsible authority shall within 30 days either: (a)conect the data found to be inlccw�ate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individttal;or(b)notify the individual that he believes the data to be coirect. Data in
disoute shall be disclosed only if d1e individual's statement of disagreement is included with the disclosed data.
The detennination 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 inforni you that your rec�uest
for a pern�it or license from the City of Orono or any of its deparmlents may require you to furnish certain private or
confidential information.
You are notified tl�at:
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 dlat the City deny the pennit or license.
3. The inforniation may be shared with other local, state or federal agencies to the extent necessary to
process the pe�7nit or license.
4. If your requested pennit or license requires Couucil action to approve,some information may become
public.
5. You have certain rights uuder M.S. 13.04(available upon request) to review private data on yourself.
6. Your full name is required to process this application or pernlit.
First �liddle Lask
Address
Cih� State 7i� Phoiae
� �+n�Prstand my rinhts as state� ai�ove,
Signature
32
- CHECK OFF LIST FOR ISSUAi�tCE OF PERiI�IITS
FOR OFFICE USE ONLY
_ ADDRESS OR LEGAL: �b C� sOv�� 3�?�N IZ�A-✓�
PID:
DESCRIPTION OF WORK: A r�� � n�..c � ,=' (J o av+-.�R
ZO.�tP1i G REV�`V BY: DATE APPROVED: /r- z5 -oS
BUILDI�'G REVIE`V BY: DATE APPROVED: 1,_ 2�, -oS
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ,�/ No
PLAN REVIEW Yes �/ No SEWER CONiVECTION
STATE SURCHARGE Yes � No `VATER CONNECTION
INVESTIGATION FEE Yes No / PARK FEE
SAC Yes No � STTEINSPECTION
Number of SAC Units OTHER (specify)
---------------------------------------------------------------------------------------------------------------------
ZO�G CH�CK LYST Zoning Distric[: (Lt2• I�(S
Fire Department: Post O�ce: School District:
Lot Area: Sc.ft. 3°�,S o� Acres .� Width 355• `a Depth
Survey Submitted: Yes _ �c No Date of Survey:
Proposed Setbacks: �` f
F�ee�-(Lake)� ' -� _ Right Side: / Sa � �
Rear (Street): �UO� "r Left Side: I 3`�� �'
Adjacent Structures: iv l,/�- `Vetland: �tJ/ q-
Building Height: Def. �-igt. /v0 u-1,4r�_�c Pealc Hgt.
d'
Lo[ �overa�e: nr� c,µ�,Q
Grading: Staff Approval Date: nro ���,q,.,� By: Council Approval Date:
Septic: S[aff Approval Date: N� G,-i-,,,,�,�� By:
Zoning File: � DS'3)►o Resolution: # Resolution Dace: b-27• d5
Shoreland Distric[: U QS
Avg. Setback Bluff Setback: �/l✓� Lot Coverage: N� GGh9��',�P
Eustin� Proposed
Hardcover: 0-7�' No G1�Q
7�-2�0'
2�0-500'
�0a-1040'
Hardcover Variance Required: Yes ivo oC Date of Council Approval: 6�z�•v�
�i��t�S (an hotise):
7
BUILDING REV�`V CHECK LIST
�C� i2' � CONSTRUCTIONTYPE: �.�7
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor R _
2nd Floor x =
Garage x _
R =
TOTAL
Estimated Construction Value: $ )D,c�0� ��
Inspections Required: `Vork Requiring Separate Permits:
Site o�C Plumbing Fire
Hardcover Removai ,C Mechanical Water Connection
Footing ` Septic Sewer Connection
�C Framing Fireplace Lawn Irrigation
X Insulation (Masonry) Other
_�Wall Board (Mfg.) Well (State Permit)
'` F�� Grading/Filling o Eleccrical (State Permit)
Other
RENIARKS (Pi 1 HOUSE): " ` � �—`_ --------
-----------------------------------------------------------------------------------------------------
REVIE`V BY OTHERS: DATE:
Access: Existing ?v�w,
Access Approval: Date gY:
---------------------------------------------------------------------------------------------------------------
RENIARKS (TO BE NOTED ON PERi�II'I�:
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White Copyllnspect 's file Canary Copy/Site Notice