HomeMy WebLinkAbout2005 - P08844 - addn/remodel/repair PERMIT
C�TY �F ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p08844
Crystal Bay, Minnesota 55323 Permlt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
6/15/2005
SITE ADDRESS: 2695 Casco Point Rd Unit#
Wayzata, MN 55391
PID: 20-117-23-23-0003
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Repair Foundation as discussed with Lyle
FEE SUMMARY: Permit Fee: $ 9�.25 valuation: $ 4,000.00
State Surcharge Fee: $ 2.00
TOTAL FEE: $ 99.25
APPLICANT: OWNER: David Peck
2695 Casco Point 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. �
:�"- c L.�
� a�7�
�
tii'
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, I-Assessing,(If Septic, 1-Septic) Page 1
- PERMIT
C�TY �F ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p08844
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
6/15/2005
SITE ADDRESS: 2695 Casco Point Rd Unit#
Wayzata,MN 55391
P��� 20-117-23-23-0003
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residenrial
Census Code O/S-Building
Permit Class: Building
Permit T e: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
YP
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Repair Foundation as discussed with Lyle
FEE SUMMARY: Permit Fee: $ 9�.25 Valuation: $ 4,000.00
State Surcharge Fee: $ 2.00
TOTAL FEE: $ 99.25
APPLICANT: OWNER: David Peck
2695 Casco Point 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.
� � -
��
CANT PE E IGNATURE _ ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
Total Fee: $ Date Received: -
Entered By: Perznit#:
CITY OF ORONO - SUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please prifzt all i�ifor•frlation)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) ,�OWI�iER R CONTRA.CTOR
JOB SITE ADDRESS: � .F� �7S C��S�' v ��� �j� ZIP:
Will this be a Parade of Homes, RemodQlers Showcase Home or other Display Hotne?
❑ Yes � No If yes, a special event per•rnit is reqa�ired witl�Police Depai•tment and City Council approvol
60 days prior to the event. Shzrttle bz�s servi.ce x�ill be required unless applicant demonstrates
sz�cient an-site parking is ati�ailable. Nor1 J�ermitted events will not be allowed.
NAME OF OWNER: �G{ (i � ��� � PHONE: (hon7e)
�`�- (work)
MAIT�,INGADDRESS:����, C���`� �f G�U CITY: �G ZIP:
CONTRACTOR: �; �� �c %�`r� ��ix� ��c,�h � �exo�:��/� ��1 i ����'
CONTACT PERSON: 'c l� S �n ' MOBIL /PAGER:
MAILING ADDRESS:��//S,} r'c /'r� �%� / CITY: �c S�-�'� ZI�P: S� .�S 1
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
1ViAILING ADDI2ESS: CI'i Y: ZIP:
N��i�: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration �
PROPOS]EJD�VOJE2I�(clescribe an detail�:�c�'ll 1' ���r���-.��a-r� C S ��g'��f-�
S'�'��7'i�S: S�.�'E�'I'O�EACII�'�.,O�R:
NO. OF�EDROOi�IS: �ARAGE S�I"�LLS: A'T'I'A�H�'I3 �3ETACHEI�
<-��
ESTI'VI�,'TE� CO?VS'I'RUCTI01�VAL,IJA�'ION(excluding land): $ �/ G�� ^
, r•
I hereby apply for a bui?dinc permit and I acknowled�e that the information above is complete and accuratz;
that the work�vill be in conformance with the ordinances and codes of the City and with the State BuildinQ
Code;that I understand this is not a permii and work is not to start without a gemiit;and that the work wi11 be
in accordance with the approved p1an.
APPLICANT'S SIGNATURE.: ^ �'� DATE: � � � �`��
�1
Sec,13.04 RIGHTS OF SUBJECTS OF DATA
Subd. t. Type of data. The rights of individual on�vhom the data is stored or to be stored shall be as set forth in this section.
5ubd.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[he requested data�vithin the collecting state agency,political subdivision,or statewide sys[em;(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
priva[e or confidzntial data;and(d)the identity of other persons or entities authorized by state or federal la�v to receive the data.This requiremznt shall
no:apply when an individual is asked to suppty inves[igative data,pursuant to section 13.32,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav pllce the notice required under this subdivision in the individual income tax or nropertv tax refund
inscructions inscead of on those ferms.
Subd.3. Access[o 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 classifie�i as public,private or confidential. Upon his further reques[,an individual who is che subject ot
stored private or public data on individuals shalf be shown the data widlout any charge to him and,if lte desires,shall be informed of che content and
meaning of that data. After an individua]has been shown the private data and informed of its meaning,the data need not be disclosed to him for si�
months thereafter unless a dispute or ac[ion pursuant to this section is pending or additiona]data on the individual has been collected or created. The
responsible authority shall provide copies of the private or pubGc data upon requesc by the individual subject of!he data. The responsible authoriry
may require the requesting person[o pay the actual cos�s of making,ceRirying,and compiling the copies.
The responsible au[hority shail comply immediately,if possible,with any request made pursuant to this subdivision,or within fi�;e days oF
the date of the request,e�cluding Saturdays,Sundays and legat holidays,if immediate cornpliance is not possible, If he cannot comp!y with the request
within that[ime,he shall so inform the individual,and may have an additional five days«'idlin tvhich to complywith the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4, Procedure whert data is not accurate or complete. An individual may contes[the accuracy or completeness ofpublic or private data
conceming himsel£ To exercise this right,an individual shall no:ify in writing the responsible authonty descnbing the nahire of the disagreemenc. The
responsible au[hority shall within 30 days either: (a)con•ect the data found to be inaccurate or ineemplete and attempc to nocify past cecipients of
inaccurate or incomple[e data,including recipients named by the individual;or(6)notify the individual!hat he betieves che datz to be correct. Data m
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
"The de[erminaGon of che responsible authority may be appealed pursudn�to thz provisions of the administrative procedure act re(ating[o
contested cases.
DATA PRIVACY"ADVISORY
In accordance�vith M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inforn you that your request
for a pe�rnit or license from the City of Orono or any o`its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you fumish will be used to determine your qualif:cation for the pemiit or licens�
requested.
2. You may refuse to supply data,but refusal may require that the City deny the pem7it or Iicense.
3. The infor.macion may be sha:ed �vith other local, state or federal agencies to the extent necessary to
process the perniit or license.
4. If your requested permit or license requires Council act:on to approve, some infomiatior_may become
public.
5. You have certzin rights under M.S. 13.04(availaole upon request)to:evie�v private data on yourset_`.
6. Your full name is required to process this applicatien or permit,
'First Nliddle Last
Address
C�h, State Zip Phone
d underst mv ria ts as ated above.
e
�
Signat
32
. • '
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z�`� S G4 s� �o�.,.lr /�'�
PID:
DESCRIPTION OF WORK: ���,v/�r9-n ���
ZOVT�1i G REVIE`v BY: � �/�{ DATE APPROVED:
BUII,DING REV�W BY: __�� DATE APPROVED: 6—/�_N v�-__
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No � SEWER CO�tNECTTON
STATE SURCHARGE Yes _� No WATERCONNECT'ION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------------------------------------------------------------------------------
ZONI�IG CH�CK LIST Zoning District: /U J GC
Fire Departmen[: Post Offi : School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right S'de:
Rear (Street): Left ide:
Adiacent Structures: Wedand:
Buildin; Heioht: Def. Hgt. Peak Hgt.
Lot Covera�e:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zonin; F:ie: 1# Resolutioo: # Resolution Date:
Shoreland Dis[rict:
Avg. Setback: Bluff Set ack: I.ot Covera�e:
Eeisting Proposed
Hardcover: 0-7�'
7�-250'
2�0-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RE�IARKS (in house):
�
BUILDING REVIE`V CHECK LIST
�C� -- ��" CONSTRUCTION TYPE: ��'U
Sq Foo[age $ Per Sq Ftg
Basement x _
lst Floor z _
2nd Floor R _
Garage x =
R —
TOTAL
Od
Estimated Construction Value: $_ `�� (�U� r—
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing � Septic Sewer Connection
_D�Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
—�F�� Grading/Filling Electrical (State Permit)
Other
RENIA.RKS (IN HOUSE): — - --------
--------------------------------------------------------------------------------------------------------------
REVIE`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
----------------------------------------------------------------------------------------------------------------
REI�IARKS (TO BE NOTED ON PERitiII�:
8