HomeMy WebLinkAbout2005-P08556 - addn/remodel/repair CIT� OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Pogss6
Cry•stal Bay, Minnesota 55323 Pel"C711t Typ@: Addition/RemodeURepair
(952) 249-4600 Date Issued: a�6�2oos
SITE ADDRESS: 2345 Blaine Avenue(Well No. 3 Pumphous
Wayzata,MN 55391
P I D: 17-117-23-34-0011
DESCRIPTION:
Proposed Use: Other �
Pernut Class: Building Census Code � 437 ,
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: viner-<i.i)Exis�ing Aniennas w iii ise iceiocaiec'v'.ypproved isy iJreg v ror icecord
Keeping)
NOTICES/REMARKS:
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FEE SUMMARY: Perrnit Fee: $ 181.25 Valuation: $ 10,000.00
State Surcharge Fee: $ 5.50
TOTAL FEE: $ 186.75
APPLICANT: Design One OWNER: Verizon Wireless
9973 Valley View Rd 9955 59th Ave N
Eden Praire, MN 55344 Plymouth,MN 55442
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(�RDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS. ��"
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APPUCANT PERMITEE S[GNATURE � ISSUED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
� PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P08556
Crystal Bay, Minnesota 55323 P@CIl'llt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: ai6i2oos
SITE ADDRESS: 2345 Blaine Avenue(Well No. 3 Pumphous
Wayzata,MN 55391
PID: 17-117-23-34-0011
DESCRIPTION:
Proposed Use: Other
Permit Class: Building Census Code 328
Permit Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required: vmer-«�j Exisiing Antennas w iii ise iceiocateditipproved Fsy vreg�r ror icec;ord
Kceping)
NOTICES/REMARKS:
11.�_J'C.__`'_.. _CT__"_�""__ /�_11 C�:�_ //\ A._i__'..__ [S1_1/T_ A 1]_J T.
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FEE SUMMARY: PernutFee: $ 181.25 Valuation: $ 10,000.00
State Surcharge Fee: $ 5.50
TOTAL FEE: $ 186.75
APPLICANT: Design One OWNER: Verizon Wireless
9973 Valley View Rd 9955 59th Ave N
Eden Praire,MN 55344 Plymouth,MN 55442
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
MINNE LDING CODE REQUIREMENTS.
NT ITEE SIGNATU SUED BY SIGNATURE
i .
v �.
Copies: 1-File(Si�nitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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Total Fee: $ ��L � S Date Received: . � b
Entered By: �� ��� ��>f..�j �//5%L�, Permit#: �'�c_s`>`�[.�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforrriation)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR/AcicNi��T�
JOB SITE ADDRESS: 23y5 aLA�►�E AV ZIP: SS 3��
URo�� M
Will this be a P rade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �NO If yes, a special event permit is required with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
sufficient on-site parking is available. Non permitted events will not be al[owed.
ae��
NAME OF OWNER: 1/E(2,t2o�J 1,J�uE�Ess PHONE: (l�e) 612. 72 0• oDsz
C t�o� 2E►re r�� (work) 7�03. 595. sosz.
MAILING ADDRESS: 19 55 s9T" AvE I�le�-rtt CITY: �I �YM o,rN ZIP: SS''1 H Z
CONTRACTOR: �s��►-� 1 PHONE: �1�• 4°3• `IZ`l9
CONTACT PERSON: CHfZ�S '�av is MOBILE/PAGER: �I Z .�sl.8671
MAILING ADDRESS: q973 VAu.EY V�E� �o CITY: FocN �r ru+�RiE ZIP: nnnJ� �53y`I
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: ��si�a � . �Qg �t��s,n�a PHONE: 952, qo3.g25'�
MAILINGADDRESS: �q73 YA�.�.�Y v�sw ua� CITY• �p� �"��E ZIP• s�My
NAME: o� �,,� i S REGISTRATION: # I 2-�{L7
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration _ (
PROPOSED WORK(describe in detain: MCD�F,(�CQT►eN o� EX�ST�n�6 c.Ec� S�Tr- ,
�(o� ANTEn�NAS w�cc. � RDP�c7 Te� Ex�sT►rJ6 �/kT�2 '�'ewE.R. C.3�
�X�ST��►L ft�`Er+n11�S w t�.�- �i� R�.�acn�"��
STORIES: � �t SQ.FEET OF EACH FLOOR: nJ �l�
NO. OF BEDROOMS: N�A GARAGE STALLS: ATTACHED�,� DETACHED�/A
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��� OOO
1 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 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 accordance with the approved plan.
_---
APPLICANT'S SIGNATURE: DATE: 3 , 3D. o�
31
Sec13.04 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 conceming himself shall be
informed of. (a)the purpose and intended use ofthe 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 confidential 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 enforcement officer.
The commissioner of revenue ma�place the notice required under this subdivision in the individual income tax or property ta�c 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 further request,an individual who is the subject of
stored private or public data on individuals shall be shown thc data without any charge to him and,if he desires,shall be informed ofthe 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 thercafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. Thc
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 making certifying and compiling the copies.
The responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe 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 of public or private data
conceming himself To exercise this right,an individual shall notify in writing the responsible authority describing the nature 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 incomplcte data,including recipicnts named by the individual;or(b)notify the individual that he believes the data to bc correct. Data in
dispute shall be disclosed only ifthe individual's statement ofdisagreement is induded 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.
JorJa-�l�/�� � �PcRTI-1� (�
First Middle Last
`t473 J�LL�`� v ���.J �2r,��
Address
�tJE�J }�2R �RlE � /v�fJ 5S3y� �S2 ��3.`�2�2
City State Zip Phone
I unders n� rights stated above.
Signatu
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32
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CHECK OFF LIST FOR ISSUA1vCE D.F PER.11%tITS
FOR OFFICE USE ONL Y
ADDRESSORLEGAL: Z3y5 63��AiNE A�C.
PID:
DES CRIPTION OF Yf�ORK: � A^�t�-�i" �S A��e`�- � `a'a�"`'�ri�°�"'e�
- - - ----------
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ZONINGREVIEGVBY: G/!x6 6��/A �U . D.ATEAPPROVED: `/- Y-°� �
BliILDX1VGREVXEWBY, /���/� DATEAPPR06`ED:
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FEES TO BE CHARGED: hlisc. Fees Cafcccfated B}.�:
PERII�IIT Yes ✓ No
PL�4N REVIE6V Yes No � SEIVER GON�VECTIO�V
STATE SURCH.4RGE Yes � tVo YVATER COtWECTIOIV
I��IVESTIG,4TIO�V FEE Yes �Vo ✓ PARK FEE
SAC .Yes tVo .� SITE NSPECTION
Ncunber•of SAC U�tits OTHER (specify)
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ZONING CHECh'LIST Zar�in�District: �v o G/-��
Fire Depnrhrien/: Post Off ce: Sdxool District: __..
Lot,�(rea: Sq.f'�. flcres 6Vidtli Depth
S�c�-vey Subfriitted: Yes No Date of Su�vey:
Proposed Set6ndcs:
Frorit(Lal,e): Right Side:
Renr(Sh•eet): Left Side:
Adjncent Str•e�ctiu•es: Yf�edand:
Buildi�Tg H�ight: Def. Ngt. \ Peak Kgt.
� •
Lot Coverage: �
Grading: Staff.dpproval Date: By: Counci(rLpproval Date:
Septic: Staff,�Lpp�•ova!Date: BY�
Zonutg Fife: # Resolutia:: # Resoh�tiat Dnte:
Shoreland Dish•ict:
Avg.Setback: Bluff Setbnc/c: Lo[Coverage:
Esistirc,; Proposed
Hardcover: 0-T'
75-250'
?50-500' �
�
500-1000'
Harcicover Variatice Reqccired: Yes No Date of Coultcif Approval:
.RE1I�IARKS(ifi house):
PP2v�e� � 6�—� ��P -P`�, T it z,.o�
31
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BUILDItVG.REVIET�V CHECh'LIST
UBC: J'l///�– CON'STRUCTIO�Y TYPE: N/� _
Sq Foora�e .�Pe,•Sg Fc�
Bnsen�eitt r =
!st Flaor x =
?��d Floa• x =
Garc�e x =
x =
TOTr[L
�9V
Estirriated Coristricctio�i Vafue: S 1�.��� —
Inspectioits Required: 6F'ork Reqccu•iri�;Separate Pervrtits:
Site Pliuribir�g Fire
Kardcover Removnl Nlediani.ca[ GYnter Coiuiection
Footing Septic Sewer Connectial
F�'amutJ Firepface Law,�.lrrigacia,t
lnsulatioit (��lasonl}�) Other
LY"alf Boar•d (Nlfg.) FVell('St�te Per�nit)
_�Final Gi•ading/Fi!lin�; Elecn-ical(State Penriit)
Other '
R�E�YIARI'CS(.fN HO US,E): �
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RE f�l"E W B Y OTHERS: DATE:
.4ccess; Existin� Ne�v
;lccess�fpproval: Date By:
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REt'�I�tRh'S (TO BE tVOTED O[V PE12NI,CT):
32
DATE TIME "
CITY OF ORONO CALLED IN y"�0�'L��'
INSPECTION NO ICE SCHEDULED �/2��—�'�^ �%3l�
PERMIT NO. � '� 5 �' COMPLETED
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ADDRESS �-��� %� G'"t''�'c' �/Z-''.e I✓i`�'`'f� /7J"1,.%�l
OWNER CONTR.�/ S� %1 Jti- U��
TELEPHONE N0. C��� `'�"U�� S CP �
� DESCRIPTION �/,c�i�� Z��✓� C�r-��'--s
�
ly� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 5 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 EMO-SITE 27 SEPTIC MAINT. 21 COMPtAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ❑WORK SATISFACTORY:PROCEED OJECT COMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP OROER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-4600
OwnerlContractor on site:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice