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CITY OF R N PERMIT
O O O
2750 Kelley Parkway - PO Box 66 Permit Number: Po23so
Crystal Bay, Minnesota 55323 P@CI111t Typ@: Addition/RemodeURepair
(612) 249-4600 Date Issued: 4�26ioo
SITE ADDRESS: 2825 Casco Point Rd
WAYZATA,MN 55391
P I D: 20-117-23-32-0008
DESCRIPTION:
Proposed Use:
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Buildings Windows
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 167.25 Valuation: $ 9,000.00
State Surcharge Fee: $ 4.50
TOTAL FEE: $ 171.75
APPLICANT: MARK EMPANGER OWNER: DAVID J YORKS& WIFE
4119 42ND AVE NORTH 2825 CASCO PO1NT RD
ROBBINSDALE, MN 55422 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROV EMENTS 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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APPLI ANT PERMITEE SI TURE ISSUED BY SIG ATU
Copies: City,Applicant,Assessor, Finance Page 1
� 'Y
Total Fee: $ Date Received:
Entered By: Perm.it#:
CITY OF ORONO - B�JILDIVG 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 O CONTRACTOR
JOB SITE ADDRESS: � �'� �� Cf1�v �c�i�7� ZIP: s���/� �
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NA�'�TE OF OWNER: �� a-c D�-�i� �f U�I�s Pgo�: �ome� 7 /� 71 �{�
(work) �'`7� ,s'��/
1�IAILING ADDRESS: �8�� C'RSCv �'�" CTTY: C'��'arva ZIP:�I
CON'TRACTOR: �f�.k-- i-e> �f'�����-�"fz._ PH0�1E: 7�,.j �36 .���c�
COi�1'I'ACT PERSON: S�m� MOBILE/PAGER �—�-- .
NIAILING ADDRESS• / `/ "` /�� /�u CITY: f���b,rsc�� zIP: 45"S'�-/�1�.:
STATE LICENSE: # � � 7 �
ARCHITECT/ENGINEER: PH0�1E:
1�IAILII�TG ADDRESS: CITY: ZIP:
N��,�. REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration�_ Land Alteration
PROPOSED WORK(describe in detai�: �v F d�1'� �(�S-�in ° �� /U ��a�"�
h ;f Nei,:� " rs ' �ve;n �v ° S
STORIES: I SQ.FEET OF EACH FLOOR:
NO. OF BEDROO�IS: _�`� GARAGE STALLS: ATT. DET.
ESTI�i IATED C
ONSTRUCTION VALUATION (excludi.ng land): $ ��L�� �
I hereby apply for a building permit and I acknowled�e that the informadon above is complete and
accurate; �hat 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 cordance with the approved plan.
APPLICANT'S SIGNA ��G��, �"` DATE: � t�?� ��"�—'
NOTE! Parade of Homes evert`ts require separate permit approval by Police Department and
City Couneil 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGKIS OF SL'BJECTS OF D:�Ta
Subd. 1. Type of data. 'Ihe righcs oi individual on whom the dan is srored or ro be storcd shall be as set forth in chis secdon.
Subd.?. Informadon reqirired to be�vm individual. �ln individual asked to suppIy privare or confidendal dara conceraing himself shalI
be informed of: (a)the purpose and inrnded use of the requested daca wi�hin the collecdag'stare agency,polidcal subdivision,or sracewide systm:
(b)whelier he may rfuse or is legaily cequired ro supply rhe requesud dara:(c)any known coasequeace arising from his supplying or refusing ro supply
priva[e or conf:dendal dara;and(d)[he idaaaty of ocher persons or enades au�horized by sca[:or federai law to receive the da�a. This requiremenc shall
not apply when an individual is asked to supply ia��esdeadve dam, pursuanc co secdon 13.82, subdivision 5, to a law enforcemenc o�cer.
"Ihe commissioner of re�enu riav pla- the nodr r�uired undec this subdivision in the individual income tax or prooem taz refur.d
instrucuons instz�d of on�hose forms.
Subd.3. access to data bp individual. Cipon requesc to a responsible auchoriry,an individual shall be informed whe�her he is�he subjec�
of scor_d data on individuais,and wherher it is ciassified as public, priva[e or confidendal. tipon his fur�her request,an individual who is the subjecc
of stor_d private or public dan on individuals shall be stiown che daa wichout any charge to him and,-if he desires, shall be iniormed of the con[enc
and meaning of chat dan. After an individua!hu 6rn shown che private da[a and informed oi its meaning,the data need no�be disdosed to hun for
siz monchs chereaiur unless a dispu�e or acrion pursuanc w �his secdon is pending or addidoaal da[a on the individual has been collecud or creared.
The responsiblz authoriry shall provide copies of d1e privace or public data upon requesc by the individual subject of che dara. "I"ne responsible auchoriry
may requir che requesring person to pay[he acnia!cose�of making.certifying,and compiling the copies.
The responsibla authoriry shalI comply immediacely, if possible, wi[h any request made pursuant to this subdivision,or wi[hin five days oi
the dam of che requesc,ezciuding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with rhe reques[
wi�hin chac[ime,he shall so inform[he individuai,and may have an addidonai five days wi�hin which to comply wi�h the request,excluding Sarurdays,
5undays and legsi holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest che accurdcy or compleceness of public or pri�•ate '
dara concerning himself. To exer:ise chis righc,an individual shall noafy in wriang che respoasible auchoriry dzscribing�he nacu;e of the disagctemeac .
The responsibla auchoriry sh�ll within 30 days eicher. (a)correu�he data found�o be inaccuracz or incomplete and aaempt to nodfy past tecipienu of
inaccura�e or incomple�e dac�, including recipienc�named by �he individual; or(b)aodfy �:e individual thac he believes the dan to be correcG Data
in dispu�e shall be disc!osed only if che individual's statemenc of disagreemenc is ir.cluded wi[h che disclosed dara.
The decerminaoon of the responsible au�horiry may be appealed pursuanc to the provisions of[hz administrarive procedure act reladng to
contested cases.
DAT� PRIVACY ADVISORY
In accordance wich�1.5. 13.04, Subd.2, "Rights of subjecu of data", we would like to inform you tha[your request
for a permit or license from che Ciry of Orono or any of ics departments may require you to fumish cercain private or
confiden�ial information.
You are notified that:
1, The information you furnish will be used to determine your qualification for che permit or license requested.
?. You may refuse to supply da�a, but refusai may require thac the Ciry deny the permic or license.
;. The information may be shared with ocher local, stace or federal a�encies 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.
�, You have cena.in rishcs under ;�f.S. 13.04 (available upon request) to review private data oa yourself.
6, Your full name is required to pcocess chis application or permit.
Fint �fiddlz Last
?.ddcess
Ciry State Zip Phant
I understand my ri�hts �s staced above. .
Signantro
DAT TI E
CITY OF ORONO CALLED IN o�1 � --�v ( . OJ
INSPECTION NO ICE SCHEDULED �o-/ '� �
PERMIT N0. a �D COMPLETED 'CYJ ,
ADDRESS r��� �-����
OWNER CONTR. � 'L�✓
TELEPHON E O. 7�' .3 5 � � � g O �O
� DESCRIPTION � �"� v
l� O1 FOOTING 11 N1E NICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICA�FINAL 19 LAKESHORE/WETLANDS
�
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
J 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_N
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W� �J WORK SATISFACTORY:PROCEED ROJECT COMPLETE
W lG CORRECT WORK&PROCEED ' ISSUE CERTIFICATE OF OCCUPANCY
4 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. _ pHOTO TAKEN
INSPECTOR WILL RETURN
CJ STOP ORDER POSTED.CALL INSPECTOR r CITATION ISSUED
C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContractor on site:
Inspector. �G't �f �- v�. �-S
White Copyllnspector's File Canary CopylSite Notice