HomeMy WebLinkAbout2004-P08017 - adn/remodel/repair CITY F R N PERMIT
O O O O Permit Number:
2750 Kelley�Parkway - PO Box 66 Pogoi�
Crystai Bay, Minnesota 55323 P2C'fTllt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 10�6�2004
SITE ADDRESS: 3460 Birch La
Wayzata,MN 55391
P I D: 08-117-23-43-0027
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/Remodel/Repair
DETAILS: '�
Approved per resolution#:
Separate permits required: Eiec;fficai�siaiej
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 391.25 Valuation: $ 25,000.00
Plan Review Fee: $ 25428
State Surcharge Fee: $ 13.00
TOTAL FEE: $ 658.53
APPLICANT: Lund Homes OWNER: Douglas&Deborah Ingvalson
74219 318th St. 3460 Birch La
South Haven,MN 55382 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVENIENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
� -� G��C'� �'/� ��
APPLICANT P MITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Reauired), 1-Applicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
/ r . C �7
Total Fee: $ � � � -' Date Received: 4-30-D S�
Entered By: ,z�� Permit#: �{O $0/7
. ,��,% �� ��/
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CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
_-��� 1� ����,�(please print all informatio�z)
� '"rk_'r� --------------------------------------------
- _______ L_________________________
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: �j�l�� ��C�" � ZIP: ��
Will this be a P ade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �No If yes, a special event permit is required with Police DepaYtment and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
Ti���
NAME OF OWNER: � . ��� PHONE: (home) 2� � 1
(work)
MAILING ADDRESS: :�Z��Q��{- (..,�1-�.� CITY: ZIP:
CONTRACTOR: __ �..�.J� ��'� _ PHONE: %�'�{��Z
CONTACT PERSON: '��D �..,c3ti3� MOBILE/PAGER:
MAILING ADDRESS: 7�-Z.�,� 3��j �S'(' CITY: So. ZIP: �Z
STATE LICENSE: # �
.
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
5 i��
TYPE OF WORK: New _�_ Accessory Structure
Pa�-r�.. Addition �_ Move
RemodeVAlteration Land Alteration
PROPOSED WORK(describe in detai�: % �
. �
vJa-(�--�' T���F.,�- V �.. �, .
STORIES: _� SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT.� DET.�C
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ���� 'r
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 w�th the State Building Code; that I
understand this is not a pernut and work is to start without a permit; and th the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: - DATE: �' 8'�
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 concerning himself shall be
informed of: (a)the purpose and intended use of the requested 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 suppiying or retusing to supply
private or confdential 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 entorcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or property 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 f�rther 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 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 public data upon request by the individual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of maldng,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe
date of the 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 otpublic or private data
wncerning himself. 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 believes the data to be correct. Data in
dispute shall be disclosed 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
City State Zip Phone
I understand my rights as stated above.
Signature
` CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS ORLEGAL: 3H6o ��zG+ c,�.�.
PID:
DESCRIPTION OF WORK: O�.—U� t- f�=S�����
ZO�PIG REV�`V BY: _ DATE APPROVED: �o- y-�`t
BUILDI1i 1G REV�`V BY: DATE APPROVED; �� -�1-o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERI�IIT Yes ✓ No
PLA1�I REVIEW Yes �' No SEWE.R CO�INECITON
STATE SURCHARGE Yes __�� No WATERCONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
Z01�1I�1G CHE.CK LIST Zoaing Districr.
Fire Department: Post Office: School Distric[:
Loc Area: Sq.ft. Acres Widch Depth
Survey Submitted: Yes � No Date of Survey: �(–/`d -� 3
Proposed Setbacks:
Fronc(Lake): I 20� � Right Side: 3 3� +
Rear (Street): ��� �` Left Side: (�Z; '=
Adjacent Structures: q��aci+�� �Ve[land: N/R
Building Hei�ht: Def. Hgt. N C1� Pea�:Hgt. —
Lot Coverage: �V -C -
Grading: Staff Approval Date: �v r . � By: Council Approval Date:
Septic: Staff Approval Date: — BY�
Zoning File: # —' Resolution: � Resolution Date:
Shoreland Distric[:
Avg. Setback: �,�� Bluff Setback: �1(/� Loc Coverage: n!•C--
Ezistin� Proposed
b
Hazdcover: 0-75'
75-250' �v t� G f�. __ d
250-SQO'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
BUILDING REV�W CHECK LIST
�C� — � ' 3 CONSTRUCTION TYPE: ��J
_ Sq Footaje $ Per Sq Ftg
Basement x =
lst Floor X _
2nd F1oor z _
Garage x =
z —
TOTAL
Fstimated Construction Value: $ Z�,�pp ``�
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removai Mechanical Water Connection
_�C Footing � Septic Sewer Connection
_IS Framing Fireplace Lawn Irrigation
_�Insulatioa (Masonry) O[her
�Vall Boazd
—�Final �fg'� Well (Scate Permit)
Grading/Filling oC. Electrical (State Permit)
Ocher
RElYL4RKS (I�i I J.-IOUSE): .
---------------------------------------------------------------
REV�W BY OTHERS: DAT'E:
Access: Existing New
Access Approval: Date gy;
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RENIARKS (TO BE NOTED ON PERNIIT�:
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Certificate oi' Survey
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for R. 'rlilliain 'I'ouard , '"� � . .,
in Lot 1�, "Lydiard' � Park" Laka N�innitonka ` '� °� ' � '' ' �' ',. � �,y��
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,., �" ,a �q
i;ennepin County, rlicinesota / � � � '° ��„�,H;
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104 .' , t:t;� i i �EGlC ,� � ti�+ 4 � 3 N
+ tz.:ilt '�� ,� ^`ir` r� '.1 -'�'^�.�'= _ 31• w�
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r� � r-' rj�.- - � rc x i5 f%/!9 6'8 ,y� 1p.2 � -�
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_ Q �� o- d 6'� ` ,.t • -�
f 1"-�� 1 �r `I� '%// /�1. D.[S,` .
I hereby certiiy tnat this is -^; �.:� ' s'`Pf " �� � ll, _-y;
lTi./er.../4 /
a true and correct representa- � ���p��.k{� ,.;-;, ,��� . .
tion oi' a survey of the boundarizs �, �:.� • ,��: ' ;-� .�
of' al�. tnat part of Lot 19, a� q, `� � � � � ,
"Lydiard�s Park" Laka Minne tonke, ,:? 1-� ����'� ; ,_ qq.q6 '
lyin� Norttierly oi' the NorthF,rl;� line �or ��`� '?� P�E' �.
of birch L�ne in��Baldur Park" i1' said � a��s.-..« � ' � �
Nor t her ly line were ex ten de d in a A- ,� ��. �
straight line �:cr�ss said Lot 1�, and �' :- g� �
the location of all existin� buildings o.�3 �� -;-�
thereon, It dxs not purport to shou � � �5"
other itnprovements or encroachments. No�
For purposes of tr,is pl�+t, �irch Lana �„
ha� been a4sumed to have teen openad � �'_,� G-6r ,, e = �/°�� =�.f+.
across saici Lot 19 (as sYioun on the "�-;,, ��'K 4�S ' ��-�`'��_= f 33 �� •
Iiennepin Count.y Surveyor's half- •- 14R "•� - -4-��A �`�o � '
- .
sect.ion sheet) . ' -�X��•����� _ �� ' "
GOIZDON R. CJF'FIN CJ. , INC . N�� ��� '� ��
Pc.� gc:r �
� �,y��r /3'�r��, [�
Scale : 1" - l�'�' °Gor on �Cof�in kec�, �Ro. �6�
Date ; 4-18-�3 Mdric S. Gronberg R�g. No.12755 �
• . Irun r�arker found LHnd Surveyors and Ylannors
o . Iron marker set Lon; Lake, Minnesota