HomeMy WebLinkAbout2005-P09206 - Extension for FP PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09206
Crystal Bay, Minnesota 55323 Permlt Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
. l0/7/2005
�ITE ADDRESS: 3490 Birch La Unit#
WAYZATA,MN 55391
PID: 08-117-23-43-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit T e: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair
Yp
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Extension for FP
FEE SUMMARY: Perniit Fee: $ 251.25 Valuation: $ 15,000.00
Plan Review Fee: $ 163.31
State Surcharge Fee: $ 7.50
TOTAL FEE: $ 422.06
APPLICANT: George Stickney&Joan Oliverius OWNER: E LILJEQUIST&S LILJEQUIST
2590 Counh-yside Dr 3490 BIRCH LA
Long Lake,MN 55356 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.
l �
APPLICANT PER ITEE SIGNATURE UED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3'-1°i� (� r�c,r..F c,�NL
' PID:
DESCRIPTION OF WORK: , , � , r
Z0.�1Ivi G RE'VIEW BY: DATE APPROVED: /v• � -6 S
BUII,D�G REVIEW B : DAT'E APPROVED: i � � � -0 5
FEES TO BE CHA.RGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes �/ No SEWER CONNECITON
STATE SURCHARGE Yes �/ No WATER CONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------------------------------------------------------------------------------------------
Z0��1G CH�CK LIST Zoning District:
Fire Department: Post O�ce: School District:
Lot Area: Sc.ft. Acres Width Dep[h
Survey Submitted: Yes_ c�_ I�10 Date of Survey: O�v f–r �F
Proposed Se[backs: �
Front (Lake): Right Side: (�
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Heiaht: Def. Hgt. Peal:Hgt.
���� Lot Covera;e:
P '
N' Grading: Staff Approval Date: — By: Council Approval Da[e:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: v.2S
Av�. Setback: ��_� Bluff Setback: /�1 (�"r L.otCoverage: �,�L
Ezistin� Proposed
Hardcover: 0-75'
7�-250' 2 S
2�0-500'
500-1000'
Hardcover Variance Required: Yes No a Date of Council Approval:
REI�IARKS (in house):
�
BUILDING REVIE`V CHECK LIST �
�C� �' 3 CONSTRUCTION TYPE: V�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor z _
Garage x =
R -
TOTAL
Estimated Construction Value: $ /S, o�� �v
Inspections Required: Work Requiring Separate Pecmits:
Site Plumbing Fire
Hardcover Removal oc Mechanical Water Connection
Foo[ing � Septic Sewer Connection
_�Framing Fireplace Lawn Inigation
o� Insulation (Masonry) Other
Wall Board _�(.(Mfg,) Well (State Permit)
F�� Grading/Filling _�Electrical (State Permi[)
Other
RENIARKS (IN HOUSE):
--------------------------------------------------------------------------------------------------------------------
REVIE`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By;
-----------------------------------------------------------------------------------------------------------------
REI�IA_RKS (TO BE NOTED ON PER1vfI1�:
8
' Total Fee: $ Date Received: /-�i'--5�
Entered By: ,t� ti,� , Permit#: � ' � , �
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pf�i�zt all inforntation)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: ��(9 � (��r��, ��, Cl�,;n,/;� r�N- ZIP: S�3
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ YeS �NO If yes, n special event per•mzt is r•eqirir�ed i�vith Police Departn�ient and City Council approval
60 dnys pr�ior to the event. Sht�ttle bus service tivill be reguir•ed zrnless appllcant demonst��ates
sct�cient on-site parkir7g is available. Non-pern�itted events wi11 not be allorved,
NAME OF OWNER: Crf'c�r�-� ��, �c ,.i�� PHONE: (home)�i j� y7.S�Z7SJ
(work)'�a��- 7 ,— �,��c�
MAILING ADDRESS: Z,�'�o C����r';J'.��� D�,. CITY:C/���� ZIP: .�S.jS
CONTRACTOR: �,n UZ� �� PHONE: �
CONTACT PERSON: �n, U�, � MOBILE/PAGER: ��.'r c<,` � �- ,��j�f 3
MAILINGADDRESS: CITY:.J;��c����_�:
STATE LICENSE: # EXPIRATION DATE:
AR��ITE,�`Pt�N�INE�R����� C�� PHONE: �7s- �(l�t
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition � Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(descl•ibe in rletcrin: �� X �a,.,d,��,e�P�' a� �'rv2,
%? n �^I i lt t'Zi r n, � ('e �i . '/�1-. J /'U�.c-,�o.?,u�J ,
�.,�;NS iy' ��� Z' ��'�
STORI�S: ( �/z � S�.FEE'�i'O�'EACI�FI,OOR: �o v�� �u,," /os C� %��l,`�`Uf�rc�w(1'pa<�)
NO. OF BEDROOMS: S GARAGE STALLS: ATTACHED DETACHED �- � J
ESTIMA�'�D CONSTRi1CTION VAL�TA�'ION(excluding land): � �-��d o �
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate;
that the work will be in conformance with the ordinances and codes of tlle City and with the State Buildin�
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 accordance with the approved plan.
APPLICANT'S SIGNATURE: � C� DATE: �/Zl e�s
31
Scc13.04 RIGHTS OF SUBJECTS OF Dr�TA �
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. Information required to be given individuaL An individual asked to supply private or contidential data concerning himself shal I 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 supplying or refusing to supply
private or confiden[ial data;and(d)the identity of other persons or entities authorized by state or federal law to receive die data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuan[to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue ma�place the notice required under this subdivision in the individual income tas or propertv ta�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 classitied 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 witliout 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 infonned 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 authoriry 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 making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,�aith any request made pursuant to this subdivision,orwithin tive days of
the date of the reques[,excluding Saturdays.Sundays and legal holidays,if immediate compl iance is not possible. If he cannot comply with the request
within that time,he shall so infonn the individual,and may have an additional five days�vithin�vhich to comply with the request,excluding Saturdays,
Sui�days and legal holidays.
Subd.�i. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himsel£ To exercise this right,an individual shall notity in writing the respoi�sible authority describing the natu�e ofthe 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 rec ipients 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 stafement 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
con[ested 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 perniit 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:
l. The infonnation you furnish will be used to detennine 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 rec�uested pennit 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 yourseif.
6. Your fu(l name is required to process this application or permit.
First Nfiddle Lust
Address
Cih� Statc Zip Phone
I understand my rights as stated above.
Signaturc
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GEORGE W. STICKNEY � ` �� � ���C� l D -' � �r� � ld
Ovcr$400,OOQ000 Sold l
952-476-3694 Direct
_ � � �_ 4 952-475-9293 Fax •
gstickney@cbburnet.com
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Wayzata Of[ice �� ���'�C f'��Q
'ti�""�-�, 201 East Lake Street � �
�� �'1 Wayzata,MN 55391
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�5� _^,t_ •�I LEGAL DESGRIPTION OF PREMISIS SURVEYED
F' - -. - � Lot 2 , Block 1 , BALDUR PARK
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S I �l:'.�' � . �•�\� .
j•��;•��:` � o : denotes i ron marker
t i ;�'"�. _,..-��-�
'"�`��'�'-� ; ` �" (93�.$): denotes existing spot elevation , mean
C9n.e��. -- � ,�o, �' sea 1 eve 1 datum
� eQ/ Bearings shown are based upon an assum�ed
q�G datum .
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This survey intends to show the boundaries
' �pQ � of the above described property , and the
� � Q�.� location of an existing house and garage , and
� a proposed house. thereon . It does not purport
to show an,y other improvements or enccroachments
�
� �
1 hereby certify that thir sun-cy �vis prepar�d by mr or under my direct suPer- oATE 3-25-94
�' � , � � � � vision, and that 1 am a dulv registered Civil Engineer and Land Surveyor under
the laws of the State of Minnesota. SCn�E I'�= �O�
` � , �
�'���-�
Mark S. Gronberg Minnesota License Number 12755 ��___ ^ __ _ �Oe�'o. 9�-55
� 4
O� � / AT TIME V
CITY OF ORONO CALLED IN `���� —�-�,�
INSPECTION TI SCHEDULED �
PERMIT NO. �c�UCo COMPIETED
ADDRESS 3 O �
OWNER CONTR. ��
TELEPHONE NO. �lZ !a �O lO�a .3 4J��'''�
� DESCRIPTION �/'�C171'V( K Q
��OTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 F AMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 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� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CAILINSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Ca11 for the ext inspection 24 hours in advance. (952� 249-4600
Owner/Contr�ctq� site:
.;{
Inspector_ `.�
White Copyllnspector's File Canary Copy/Site Notice