HomeMy WebLinkAbout2008-P11999 (add./remod./repair) � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P11999
Crystal Bay, Minnesota 55323 Permit Type:
Addition/Remodel/Repair
(952) 249-4600 Date Issued: 4/30/2008
SITE ADDRESS: 3309 Casco Cir Unit#
Wayzata,MN 55391
PID: 20-117-23-43-0049
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Typc: Addition/Remodel/Repair Permit Sub-typc(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
Kitchen Remodel
FEE SUMMARY: Permit Fee: $ 574.25 valuation: $ 40,000.00
Plan Review Fee: $ 373.26
State Surcharge Fee: $ 20.00
TOTAL FEE: $ 967.51
APPLICANT: MHCS OWNER: Mr. &Mrs. Lawrence Brustad
3040 Casco Pt Rd 3309 Casco Cir
Wayzata,MN 55391 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 REQU[REMENTS.
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�; APPLICANT PF:R IT, S[ NA ISSUED BY SIGNA7 URE
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Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Scptic, 1-Septic) Page 1
Total Fee: $ ,� Date Received: �l- Z`�-v�
Entered By: Permit#: A ! t��9
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 OR CONTRACTOR
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JOB SITE ADDRESS: �"�> . '��� � ��S�(� ��l �C ZIP: `� I �
Will this be a P�fade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS �NO If yes, a special event permi!is required with Police Department and Ciry Council approval
60 days pria�to the event. Shuttle bus service will be reguired unless applicant demonstrates
suff cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER `(j`���� C�^i�'�U,,Y�l�9 �!�' "�HONE: (home .5 v�- � 7� -7� �/
�'n (work)`f5.�1-�3`f� -/) `F a
MAILING ADDRESS: ��e�}�Scc:u �r CITY:� • �c� ZIP: ,5.5,�l
.. `T�
CONTRACTOR: N` f-{ (�' � PHONE:`1.S;;i � `i�6 `{ - K�� I
CONTACT PERSON: � � ,,L;ct n 5 0 ,-� MOBILE/PAGER: y,5;;�- �f �5� ' ��(k I
MAILING ADDRESS: 7,v` � Lr.�c� �f� '��' d CITY: (,�;c��-�����c,�� ZIP: ,��- � � r� ("
STATE LICENSE: # v EXPIRATION DA'TE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home �mode Alteration (ie: Siding, Windows) � L �, J'1
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detai�: ���rn v c� � �� �- �� �
STORIES: r SQ.FEET OF EACH FLOOR: � �G G
NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED DETACHED
� —
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ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �(�, ��
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 wili be
in accordance with the approved plan:" -\ ---� , �� �
; ! �✓���_:, I l
APPLICANT'S SIGNATURE. ` Ct�%�L�� ��� U o� `� � �
ATE: �f
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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. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be
informed of. (a)the purpose and intended use of the reyuested 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 officer.
The commissioner of revenue may place the notice reouired under this subdivision in the individual income tax or propertv 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 shal I 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 publ ic 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 shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date ofthe 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 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
conceming himsel£ 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 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 bel ieves the data to be correct Data in
dispute shall be disdosed 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
confidential information.
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 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 und�nd my r'��ts as s ted�ve. �
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Signatur ; j
Reset Forn� 32
CHECK OFF LIST FOR ISSUANCE OF PERMITS
F R OFFICE USE ONLY
ADDRESS OR LEGAL: < < �
Ci t C�SCU C�� .
PID: .
DESCRIPTION OF WORK.• k�T c w=►>> �2 -
L� Q—i
ZONING REVIEW BY.• N)� DATEAPPROVED:
BUILDINGREi�IEWBY.• DATEAPPROTfED: ti-z�-o g
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes r/ No
I'�N��E�' Yes ✓ No SEWERCONNECTION
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE Yes No ,/ PARK FEE --
SAC Yes No �/ SITEINSPECTION
Number of SAC Units OTHER (spec�)
ZONING CHECg LIST Zoning District: �v�o�e +
Fire Department: Post Office: School District:
Lot Area: Sg;ft. • Acres 'dth
Depth
Survey Submitted.• Yes No te of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side: •
Adjacent Structures: Wetland:
Building Height: Def.Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date.•
Septic: StaffApproval Date: �/'T By. �_�—.
Zoning File: # Resolution: # Resolution Date:
Shoreland District.• MCWD Pe�•mit.•
Avg. Setback: B1uffSetback:
Lot Caverage:
F�isting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover i�ariance Reguired: Yes No
Date of Council Approval:
REMARKS(in house):
33
B UILDING REVIEW CHECS LIST
UBC: (Z'3 CONSTRUCTION TYPE: VN
Sg Footage $Per Sq Ftg
Basement x =
Ist Floor x =
2nd Floor x =
Garage x =
z =
TOTAL
Estimated Construction Value: $ ti���(�O �`—�
Inspections Required: Work Requiring Separate Permits:
Site }� Plumbing Fire
Hardcover Removal �c Mechanical Water Connection
Footing Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
�Insulation (Masonry) Ofher
Wall Board (Mfg.) Well(State Permit)
_ C,L Final Grading/Filling X Electrical(State Permit)
Other
REIIIARKS(INHOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMIT):
34
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