HomeMy WebLinkAbout2004-P08195 - addn/remodel/repair C1TY °OF �ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Posi9s
Crystal Bay, Minnesota 55323 Permit Type: aaa�t�o�Remoaevxepa�r
(952) 249-4600 Date Issued: i2iii2oo4
SITE ADDRESS: 3460 Birch La
Wayzata,MN 55391
PID: 08-117-23-43-0027
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:
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 181.25
Valuation: $ 10,000.00
Plan Review Fee: $ 117.78
State Surcharge Fee: $ 5.50
TOTAL FEE: $ 304.53
APPLICANT: Lund Homes OWNER: Douglas&Deborah Ingvalson
74219 318th St. 3460 Birch La
South Haven, M?�I 55382 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RI COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MI A BUILDING ODE REQ IRE NTS.
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APPLICANTPERMITEESIGNATU E SSUGUBYS[GNATURE
Copies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Reoorts, 1-Assessine. 1-Finance Page 1
� 525��-�"
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Total Fee: $ o� �� �� Date Received: f����� �� � ��
� � �i: �..
Entered By: `�'' Permit#: 'I% i (�° �`
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it all i�iforniatio�i)
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THE APPLICANT IS: (circle oi:e) OWNER O ONTRACTOR
�_.._
JOB SITE ADDRESS: �`1�.� �V���=� ��N� - ZIP:
Will this be a P ade of Homes, Remodelers Showcase IIome or other Display Home?
❑ Yes No If yes, a specic�l event permit is requirecl witlr� Police Depnrtrnent and City
Council czpproval 60 days prior to the everzt. Non perrraitted events tivill not
be allowecl.
NAME OF OWNER: t,�� �N �V�`��� PHONE: (home)
� (work)
MAILING ADDRESS: �� �.-�1�� �--��ITY: ZIP:
CONTRACTOR �—��f�'�O �(���1�`�� PHONE: ����"� �j"�'Cc� �
CONTACT PERSON: � � J MOBILE/PAGER: � � -- �
MAILING ADDRESS: � ' � � CITY: ���> �1� ZIP: '-ac>> >�,
STATE LICENSE: # �
� �
ARCHITECT/ENGINEER: � PHONE:
MAILING ADDRESS: CITY: 7IP:
NAME: REGISTRATION#
TYPE OF WORK: New � Accessory Structure
Addition Move
Remodel/Alteration Land Alteration
/� �, L
PROPOSED WORK(descrihe iiz detain: ��'i�'� t�JV���
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ f��-�� G
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 an with the State Building Code; that I
understand this is not a permit and work i to start with t a permit• an at the work will be in accordance with
the approved plan. i� ;
/%
APPLICANT'S SIGNATURE: —✓ DATE: �� � ��
�
Sec.13.04 RIGHTS OF SUBJECI'S OF DATA .
Subd.1. Type of data. Thc rights of individual on whom the data is stored or to be stored shall bc as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confdential 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 statewide system;(b)
whethcr he may refuse or is legally required to supply the requcsted data;(c)any known consequence arising from his supplying or refusing to supplJ�
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to reccive the data. This requiremcnt shall
not apply when an individual is asked to supply imestigative data,pursuant to section 13.82,subdivision 5,to a law enforcement of[icer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or oro�ertv tax refund
instructions instcad of on thosc forms.
Subd.3. Access to data by individual. Upon reyucst 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 m•con(idential. Llpon his further req�est,an individual who is the subject oC
stored private or public data on individuals shall be shown the data widiout any charge to him and,if he desires,shall be informed of the content and
mcaning of tliat data. Aftcr an individual has been shown thc private data and informed of its meaning,the data necd not be disclosed to him for six
months thereafter unless a dispute or action pw�suant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall pirovide copies of the private or public data upon rcquest by the individual subject of the data. The responsible authority may
rcyuire the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possiblc,with any request madc pursuant to this subdivision,or within fivc days of thc
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.I(he cannot comply with the reyuest within
that time,he shall so infonn the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays
and Icgal holidays.
Subd.4. Yrocedure when data is not accw-ate or complete. An indivi�ual may contest the accuracy or completeness oC public or private data
concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagrcement Thc
responsiblc authority shall within 30 days either. (a)correct thc data(ound to bc inaccuratc or incomplcfc and attempt to notify past recipients of
inaccurate or incomplMe data,including recipients named by the individual;or(b)noti[y the individual that hc bclicves the data to be correcL Data in
dispute shall be disclosed only if t6e individual's statement of disagreement is included with the disclosed data.
Thc dctermination of thc responsiblc authority may be appcalcd pw•suant lo the provisions of thc administrativc procedure act rclating to
contested cases.
DATA NRIVACY 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 arc notified tliat:
L 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
tlie pernut or license.
4. If your requested permit or license requires Council action to approve, somc 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 pernut.
First Middle Last
Address
City State Zip Phone
I understa ri hts as state ove.
. �
� .
Signatu�e
. '
CHECK OFF LIST FOR ISSUANCE OF PER1tiIITS
FOR OFFICE USE ONLY
ADDRESSORLEGAL: 3'i�o (3t2c�� L�qN` ——
PID:
DESCRIPTIO:V OF G[�ORh': (::/YT2� �Zoor�
------------------------------------- ------------------------------------------------------------------------------ -
ZO��'IIYGREI�IEY�BY: ,,._ D.-4TEAPPROVED: l� -zf-oy
BUILDIrVGREVIEWBF': DATEAPPRO6'ED: i�-zti-oy
---------------------------
FEES ?'0 BE CHARGED: 1L'Iisc. Fees Calca�f�cted By:
PERttiIIT Yes ✓' No
PLAN RE vIE GV Y"es J �Vo SE YI'ER CONNECTION
STATE SURCH.4RGE Yes � ��Io tiVATER COtVNECTIOIV
I�ti'VESTIGATIO�V FEE Yes No P�lRK FEE
S.�C Yes tVo SITE NSPECTIO�V
�Va�»zber� of SAC U�iits OTHER (specify)
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ZO[YIl�'G CHECh'LIST Zor�irtg District: G2-�C.
Fire Depa,•hnerrt: Post Of?ce: Sclxool D(strict: __.
Lot.�(ren: Sq.ft. •�13 Aa•es �43.�`70 6Yidth (u0� Depth
Sw-veu Sc�b�rcitted: Yes ldo Date of Su�vey:
Proposed Setbncl;s:
F�•ortt(Lal.e): �� t 2.9 ' Rig/at Side: �6
Rear(Sh•eei): � Left Side: 3b
Adjacent Structures: A-7'TI4GN� G�etla��d: i✓/�
Buildi�ig Height: -Def. Hgt. U•�� Peak Kgt.
Got Coverage:
Grading: Sraff,4pproval Date: �I/i9 By: Council r1p/�rova! Date:
Septic: Staff,�{pproval Date: � ��' BY'�
Zortii:g File: # Dy-306Y ResolL�tior2: # Resolt�tio�i Dale:
Shoreland Dish•ict: PS
Avg. Setback: �j� Blc�ffSetbnck: /J �� LatCoverage:
E�isti�ig Proposed
Hardcover: 0-7�' I• S' �•5
7.5-250' s�vs' sZ-2
250-500'
500-1000'
Karcicover Variance Reqc�ired: Yes oc No Date of Cowacil Approvc�l: 1- 2 Z'�
RE�I�IARKS(iri lioicse):
31
G�
�(.LII1Rl�d A�O Q3.LOA�3S O.Z) S'I2t'NI�lT3?I
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CITY OF ORONO CALLED IN �
INSPECTION N TI E Q SCHEDULED /-7"� �� a
PERMIT NO. ���`7 � COMPLETED
ADDRESS �5��� ��G� L�J
OWNER CONTR. �-�L� �f'�
TELEPHONENO. � ��Z �� ����
� DESCRIPTION �raGrl/�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL F�NAL 19 LAKESNORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP O6 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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W ❑CORRECT WORK&PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITNIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (952� 249-4600
OwnerlContra it -
Inspector.
White Copyllnspector's Fil Canary CopylSite Notice
� DATE TIME V
CITY OF ORONO CALLED IN
INSPECTION N C SCHEDULED 1,a�� ll
PERMIT NO. ��Is COMPLETED ��
ADDRESS�;� �JUC.G'�-� �J
OWNER CONTR. �L�--�7"�t7 7'l�4.�--�
TELEPHONE NO.
� DESCRIPTION D�`!�L ?
l� 01 FOOTING 11 MECH AL RI 18 EXCAV/GRADWG/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q �FINAL 0���� 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/CONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
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W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑ CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR '�CITATION ISSUED
O INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-46QQ
OwnerlContract s' :
Inspecto
White Copyllnspector's File Canary CopylSite Notice