HomeMy WebLinkAbout2005-P08305 (add./remod./repair) ,. .
PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P08305
Crystal Bay, Minnesota 55323 Permit Type: aad�t�o�Remodevxepa�r
(952) 249-4600 Date Issued: 1i��2oos
SITE ADDRESS: 3133 Casco Cir
Wayzata,MN 55391
P I D: 20-117-23-43-0030
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Yiumoing iviecnanicai Eiecaicai�siaiej
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 951.75 Valuation: $ 93,740.00
Plan Review Fee: $ 618.73
State Surcharge Fee: $ 47.40
TOTAL FEE: $ 1,617.88
APPLICANT: Doug Dzurik Construction OWNER: G Becker&T Marchessault
12855 Hwy 55 3133 Casco Cir
Plymouth,MN 55441 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.
. � .l ��
-���'��... �.i���� c����
PLICANT PERM E SIGNATURE [SSUED BY S[GNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
` ' ���e �— Y-oS"
Total Fee: $ ���7• �g Date Received: ��- ��- C��/
Entered By: �'�:�� Permit#: �D�,3(�5
CITY OF ORONO - BUILDIN�G PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it all infor»tatio�i)
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THE APPLICANT IS: (circle one) OWNER OR��ONTRACTOR J
,
JOB SITE ADDRESS: �� -j_� ���5['�' �i V��- ����� ZIP:
Will this be a Parade of Honnes, Remodelers Showcase Home or other Display Home?
❑ Yes ,�.; No If yes, a speciczl evei�t pernzit is f•equii�ed witl� Police Depai�tmerzt and City
� Courrcil approval 60 dc�ys prior•to t7ae eve�7t. Non�permitte�l evei�ts will not �
be allowed.
NAME OF OWNER: �L" ;L��G��(� PHONE: (home)
/ (work)
MAILING ADDRESS: ���� �sC G ��,�i-r_ /� CITY: ��{�� - ZIP: 5�.}_��/
CONTRACTOR: - -��c.(Cf �Zu�"��•C��t��`ruc;�`i�'v�( , r�C. PHONE: (��ld - �:?( - �/��'/
CONTACT PERSON: u�° MOBILE/PAGER: /=��) -;�-�1 -?y-3/
MAILING ADDRESS: _�S �;� ,5,5� CITY: y`��i%, �� i ZIP: _��5 y�/
STATE LICENSE: # b��; �� :.�„3T�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
Remodel/Alteration ,�J Land Alteration
� �
PROPOSED WORK(d�sc ibe i�x detai�: .,��5i� � �'����Z � � � �1�``� , Gl f� /`�2�C.�J`�P�
I � K D
- � (—�a�� '/� !':�CCI �C��' �i2 �?�'j2 t�,l � •� L � t L�.ly✓IGl'v�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��, l��I
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 with
the approved plan. �
APPLICANT'S SIGNATURE:� � - / "% 2 DATE: c7 /
—— .-�-
Sec.13.04 1ZIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on�vhom the data is stored or to be stored shall be as set foi�th 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 Iegally 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 ot 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 officer.
The commissioner of revenue mav placc the notice required under this subdivision in the individual income tax or nropertv tax refund
instructions instead of on those torms.
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 classifed 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 shotivn the data without any charge to him and,it 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 sis
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 immediately,if possible,with any requcst made pursuant to this subdivision,or within five days of the
date of the request,excluding Saturdays,Sundays and Icgal holidays,if immediate compliancc is not possible.If he cannot comply with thc request within
that time,he shall so inform the individual,and may have an additional[ive days within which to comply with the request,excluding Saturdays,Sundays
and legal holidays.
Subd.4. Proccdin�c when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himsdf. 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 eithci: (a)correct the data found to bc inaccurate or incompletc and attcmpt to notify past rccipicnts of
inaccurate or incomplete data,including recipients named by tlie 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 ma,y be appealed pursuant to the provisions of the administrative procedure act reluting 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
f'or 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 qualitication 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
City State Zip Phone
I understand my rights as stated above.
\ � �7 ����� C
Signa7ar
CHECK OFF LIST FOR ISSUAIVCE OF PER1tiIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 313� Cb45� G��c�
PID:
DESCRIPTION OF Gl�O.Rh': R���'G�-
-- - --------------------------------------,-,/-� - - - - - - - - - - --------------------
----- --------------------D.A TE APPR O VED: /- Y- o S
ZONING RE vIE YV B Y: UG�—
BUILDIIVGREY7EWBY: � DATEAPPROC'ED: /- `f -05'
-----------------------
FEES TO BE CHARGED: htisc. Fees Calcaclated By:
PER.��IIT Yes ✓ No
PLA�V REVIEGV Y"es �/ No SEYVER COIVNECTIO�V
STi�TE SURCH.4RGE Yes � No YVATER CO�Vt1/ECTIOtti'
I�VVESTIGATI01v FEE Yes No ✓ PARK FEE
SAC Yes No �/ S�TE NSPECTION
tVcc»26er• of SAC U�iits OTHER (specify)
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T_ONItYC CHECK LIST zor�irig Disrricc: /1/v Gf�i4rV�-{
Fire Departrrient: Post Office: School D(strict: ___
Lot.�(reR: 5q.ft. Acres GYidtlt Deptlt
Swvey Su6niitted: Yes No Date of Suivey:
Proposed Setbac(;s:
Front(Lalre): Right Sicie:
Rear•(Sfreet): Left 5ide:
Adjacent Sh•uc[�u•es: Wetlancl:
Buildiirg Heiglit: Def. Hgt. Peak ffgt.
Lot Coverage: �
Grc�ding: Staff.4pprovccl Date: � By: Coce�icil Appirova! Date:
Septic: Stnff,4pprot�al Date: BY�
Zorting File: # Resolutio�2: # Resolc�tion Date:
Shoreland Dish•ict:
Avg. Setbnck: Blc�ff Setback: Lot Coverage:
Existt�ig Proposed
Har•dcover•: 0-7�'
75-2.i 0'
Z50-500'
500-1000'
Kardcover Yariance Reqc�ired: Yes No Date of Coeuacil�Ipproval.•
RE11�fARKS(in hotcse):
31
B UILDIrVG.RE VIE i�CHECK LIST
UBC: �'3 COr`�STRUCTIO�VTYPE: 'V�
Sg Faota,�e .S Pei•Sg Ftg
8asentertt x =
!st Floor x =
��icf Floor t =
Gar•��e s =
� _
TOT.�(L
Esti�uated Constructior� Value: S �'13,7`{�
ad
Lispectioits Requir•ed: G��'ork Requir•in�Sepai•ate Per�itits:
Site � Pl�unbing Fire
Hardcover Reuioval iC Mechanical Water•Cor:riection
i-feaf+rr� Septic Seu-er Coiutection
_b�Framiitg Fireplace Lawn. lrrigatiai
�_lnsula[ion (r�lasanr}�) Od�er
� GY"a!!Board (A�lfg.) GVell (S�ate Permit)
_�Firial Gracfiiig/Fillirig oc� E(ecn•ical(State Peri�:it)
Otlrer
-------------------------------------------------------------------------------------------------------------------------------------------
R.E�tiifl RICS(IN HO USE):
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REG2'EtV BY OTHERS: DATE:
.4ccess: Existin,� iVew
,=tccess Appi•oval: Date B�•:
------------------------------------------------------------------------------------------------------------------------
RE�l�i�1RIiS (TO BE lVOTED O�YPE.R[tiilT):
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P0.BOX 245�SPRIf�PARK, MINNtSOTA ��
C"
' (' DApTE TIME
CITY OF ORONO CALLED IN ��I�7 '�}S`
INSPECTION TI E_ SCHEDULED ��- � S ���
PERMIT NO. � � '' C�� COMPLETED
ADDRESS � ' S c � '
OWN ER CONTR. jJ l��«'�_` � .'��1C ���rS�',
TELEPHONE NO. �' �� �c� / r��I��
� DESCRIPTION
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION-`� 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z ^" �.t.-?:."�'c6�^o^--- 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORKSATISFACTORY:PROCEED C] PROJECTCOMPLETE
W ❑ CORRECT WORK 8 PROCEED �� ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITNIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-46��
Owner/Contracto ' e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� I � DAT /� TIME �
CITY OF ORONO CALLED IN _"J
INSPECTION NO�IC 3US SCHEDULED ' - � fU.'�
PERMIT NO. lJ COMPLETED
ADDRESS ��--SCv ''C l
OWNER CONTR. � U � u�, 'd t.
TELEPHONE N0. ��-� �-2/ ��3�� C_Ta���
� DESCRIPTION �P.i'VL (.�/ -
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
OS FINA 14 SEWER HOOK-UP 06 PROGRESS
� EMO-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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMME S:
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W� WORKSATISFACTORY:PROCEED C� PROJECTCOMP�ETE
W ❑CORRECT WORK 8 PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED
C INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS.
Call forthe nex inspection 24 hours in advance. (952� 249-4600
Owner/Contra r � e:
Inspector. `�' �
White Copyllnspector's File Canary Copy/Site Notice
\ c I� � DATE TIME "
(' \\CITY OF ORONO CALLE� Z- -� 7 flS
l� INSPECTION N !� SCHEDULED z Zc�S �, 3t;
PERMIT NO. � v� 30� COMPLETED
ADDRESS � �-� � ��� ��� � '
OWNER CONTR. ��u- � ' �7�
TELEPHONE NO. -��� `� `� � � ���
� DESCRIPTION `����� ����
ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W ORK SATISFACTORY:PROCEED CI PROJECT COMPLETE
� ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REOUiRED.CALLTO ARRANGE ACCESS.
Call forthe ext inspection 24 hours in advance. (952� 249-4600
OwnerlCon site:
Inspector. �
White Copyllnspector's Pile Canary CopylSite Notice