HomeMy WebLinkAbout2004-P08157 - addn/remodel/repair PERMIT
CITY OF ORONO
2750 Ketiey Parkway - PO Box 66 Permit Number: Posis�
Crystal Bay, Minnesota 55323 P2Cllllt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: iiii2i2oo4
SITE ADDRESS: 3025 Casco Point Rd
Wayzata,MN 55391
P I D: 20-117-23-34-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/RemodellRepair Pernvt Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate perniits required: Yiumoing iviecnanicai nieciricai�siaie�
NOTICES/REMARKS:
FEE SUMMARY: PernlitFee: $ 391.25 Valuation: $ 25,000.00
Plan Review Fee: $ 254.28
State Surcharge Fee: $ 13.00
TOTAL FEE: $ 658.53
APPLICANT: Lemmerman Const. Inc. OWNER: Scott&Irene Standa
9037 Cty.Rd 17 SE 3025 Casco Point Rd
Delano,MN 55328 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 C�� �-t �1 �-���
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Revorts, 1-Assesstne, 1-Finance Page 1
Total Fee: , $ �58. J�3 Date Received: � � `� -O�C
Ente'red By: !��Yj� Permit#: �15�7
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please priiit all infor»aatioiz)
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THE APPLICANT IS: (circle o�re) OWNER O CONTRACTOR
JOB SITE ADDRESS: .j�ZS C�Sw Pl �� . ZIP� 5�.3� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No Zf yes, a special event perrrait is reguirecl witlt� Police Department and City
Coz�rzcil approval 60 days prior to tlte evertt. Non permitted events will riot
be czllotivecl.
9s� -��, -�'y��7
NAME OF OWNER: -�� � �e,�T7 �J�Ati�� PHONE: (home) �
(work) N i�
MAILING ADDRESS: �"'� �S p4�;E CITY: �a�.z�.-�a- ZIP: 55;��-
CONTRACTOR: L-E��"�F��`'�A^' l��w�t .�C� PHONE: �7�.3-`��Z-3�'� �i
CONTACT PERSON: `T�+vl MOBILE/P�6�R: `7L-,3 -- 2z`1 -L3��
MAILING ADDRESS: t1�,� c:C 12C� i7 S� CITY: ��aNi:� ZIP: -t�_553�-�,
STATE LICENSE: # y f;��
ARCHITECT/ENGINEER: � ` PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition � / Move
Remodel/Alteration V Land Alteration
PROPOSED WORK(describe in detai�: �i�E�acI;AT� (��57�� ���fi►'t � �j��'�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �.5;�C��=
I hereby apply for a building permit and I aclrnowledge 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 pe • nd that the work will be in accordance with
the approved plan. �
APPLICANT'S SIGNATURE: DATE: ���' C�
Sec.13.04 RIGHTS OF SUI3JECTS OF DATA �
Subd.l. 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. Intormation 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 thc requested data within the collecting state agency,political subdivision,or state�vide system;(b)
whether he may refuse or is Iegaily reyuired to supply the requcsted data;(c)any known wnsequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entitics authorized by statc or federal law to receive the data. This requireme�t shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law en(orcement of(icer.
The commissioner of revenue mav n�ace the notice required under this subdivision in the individual income tax or aropertv [ax refund
instructions instcad of on thosc 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 contidentiaL Upon his further request,an individual who is the subject of
stored private or public data on individuals shall 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 sho�vn the private data and infonned of its meaning,the data necd not be disclosed to him for six
months thereafter unless a dispute ar 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 wsts of malting,certifying,and compiling the copies.
Thc responsiblc authority shall comply immediately,iCpossiblc,with any request madc pursuant to this subdivision,or within eve days of thc
date of thc request,excluding Saturdays,Sundays and legal holidays,if immediate compliancc is not possible. If he cannot compl,y with the rcyuest within
that time,he shall so in(orm thc individual,and may have an additional five days within which to comply with the request,cacluding Saturdays,Sundays
and legal holidays.
Subd.4. Procedurc�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himselL To e�ercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement The
responsiblc authority shall within 30 days either. (a)corrcct thc data found to bc inaccuratc or incompletc and attempt to notify past recipients of
inaccurate or incomplete data,including recipicnts named by the individual;or(b)notify the individual that he believes the data to be corrcct. Data in
dispute shall be disclosed only if tl�e individual's statement otdisagrecment is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions o(the administrative procedure act relating to
contested cases.
DATA P1tIVACY 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 pernut 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 tliat:
1. The information you furnish will be used to determine your qualification for the pernut 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 pernut 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 Middlc Last
Address
City Statc Zip Phone
I understand my rights as stated above.
�����
Signature
CHECK OFF LIST FOR�SSUANCE OF PE.R1ti�fITS
FOR OFFICE USE O_NLY
ADDRESS OR LEGAL: 3�Z5 C►�sc.o P6 t�►T �-e�
PID:
DESCRIPTIO:�''OF Y��ORR': (�r wto��r2 /Vl/�5 Z=Z ►3��� --
--------------------------------- ------ ---------------------------
ZOtVINGREV.IEtvBY: D.ATEAPPROVED: /�-9-ay
BUILDING REVIEW BY: DATEAPPROti'ED: J1-� -oy
---- ------ - ---------------------------
FEES TO BE CHARGED: �tilisc. Fees Cc�lculated By:
PER�IIT Yes _,� ��''o
PLAN RE UIE YV Yes � �vo SEYVER GOtVNECTION
STATE SURCH.4RGE Yes // 1Vo ti�%ATER COtWECTIOIV
ItYVESTIG.4TIO�V FEE Yes tVo PARK FEE
SAC Yes �Vo SITE NSPECTION
Nccniber of SAC U�zits OTHER (specify)
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ZOrYI�YG CHEC.I�'LIST Zor<i,tg Disu�icr: N o c f
Fii•e Depa,•t,rte�rt: Post OfJtce: Scliool Dist�•ict: —_.
LotArea: Sq.ft. Acres 6Yidtl: Depth
St�rvey Subruitted: Yes No Date of Siuvey:
P�•oposecf Setbacl:s:
Fr•orct(Lal.e): Riglzt Side:
Rear (Sn•eet): Left Side:
Adjacent Struct�u•es: G�etla�ttf
Builcfi�rg Heigltt: Def. Hgt. Peak gt.
Loc Coverage: �
G�•adi,�g: Scaff.4pprovc�l Date: Bv Cocu2cil�lpp��oval Date�
Septic: Staff,�ppr•oval Date: BY.
Zorting Flle: # Resolutiai: # Resolcttion Date:
Sltor•eland Dish•ict:
Avg. Setback: Bla�ff Setbc�c/c: Lot Coverage:
Etisting Proposed
Hardcovet-: 0-7�'
7.7-Z�0'
250-500'
500-1000'
Hardcover� Var•ia�ice Reqccired: Yes No Date of Co�crzcil Approval:
,RE1I�IARKS (isi liouse):
31
B UILDI�VG RE L'IE tl'CHECh'LIST
UBC: �Z� Zj' CONSTRUCTIO�V TYPE: �(/J
Sq Foota,�e ,�Pe�•Sg Fta
Baser�ie�ir s =
1 st Floor � _
3rid Floor s =
Garage � _
.c =
TOT.�{L
Esti��iated Co�:struclio�t Va(ue: ,S
ZS.OoO�
Inspectiores Reqcci�•ed: 6Y'ork Reqcririrtg Sepa�•ate Perirtits:
Srte _�Pl�unbing Fire
Hardca��eJ•Re�r�oval _�tifec/ia�zical G�a[er Co�utectioii
Footirtg Sc.�ptic Se•.ver Conrrection
�C Framiiig Fu•eplace Latiwt lrrigatior�
��/75!(lC(1i011 (��lasorir}��) Other•
_� GY'all Boar•d (Nlf,�.) 6Ye11(State Peri�iit)
<.. Final Gradiitg/Fillin„ o� Elech•ical(Sta�e Permit)
Otlter�
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I'�.E'�titARIiS (I[V HO USE):
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REL7EtV BY OTHERS: DATE:
.4ccess: Existin,� rV'etiv
,-(ccess.=(pprovr�l: Date 8y:
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RE�I�i�RIiS (TO BE NOTED ONPERNIIT):
32
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