HomeMy WebLinkAbout2003-P06302 - attached deck ' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po63o2
Crystal Bay, Minnesota 55323 P@I'llllt Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: sizii2oo3
SITE ADDRESS: 1680 Concordia St
Wayzata,NII�155391
P I D: 17-117-23-22-003 2
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 57.05 Valuation: $ 1,600.00
Plan Review Fee: $ 37.06
State Surcharge Fee: $ 1.30
TOTAL FEE: $ 95.41
APPLICANT: Owner/Self OWNER: Brian H Williams
M� Judy A. Fesenmaier
1680 Concordia St
Wayzata,MN 55391
THE LINDERSIGNED 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.
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APPLICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
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( l� �� f�
Total Fee: $ � 7 Date Received: = /2 -U
" Permit#: OCQ �
Entered By: �t�/►,!� �i�� �—
��,,�v�i `-��Z�
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER R CONTRACTOR
JOB SITE ADDRESS: /(o �TU �cah/L'o�,�/ S"i��l ZIP: �5 3l�
_ �
NAME OF OWNER: ` �.�r.Q,�✓ � ��.c:��,y,�r s PHONE: (home) ��"' 47/`3.�1r`�
. (work) �S�,G�Zt
MAILING ADDRESS: f��� ��1�'6i�i� S"i CITY: p�,urd ZIP: J�"1���"/
CO\�'R.ACTOR: 5�4•`tL PHONE:_
COr�TACT PERSON: NIOBII..E/PAGER:
M,AII.,I�i 1G ADDRESS: CITY: ZIP:
ST?iT'E LICENSE: #
ARCHTTECT/ENGINEER: J'�,K� PHONE:
MAII..I�i iG ADDRESS: CITY: ZIP:
N���; REGISTRATION#
TYPE OF WORK: New Addition � Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: ����{ ��j�,;�a,�/
STORIES: SQ. FEET OF EACH FLOOR: jjQ�, _
NO. OF BEDROOviS: � � GARAGE STALLS: ATT. DET.
EST�IATED CONSTRUCTION VALUATI0�1 (excluding land): $ %(��
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 the 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.
APPLICAIVT'S SIGNATURE: _������f 1�,��« DATE: l' �3
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGHTS OF SUB,TECTS 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 ro supply private or confidential data concerning himself
shali be informed of: (a)the purpose and intended use of the requested dara wi�hin the collecting state agency,polidcai subdivision,or statewide
rystem;(b)whe[her he may refuse or is legally required to supply the requested data; (c)any]mown consequence arising from his supplying or
refusing to supply private or confidential daa;and(d)the idenury of other persons or enades authorized by sate or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigadve data, pursuant to secdon 13.82, subdivision S, to a law
enforcement officer.
'Ih�commissioner of revenue mav lace the notice re uired under this subdivision in the individual income taz or ro e tax refund
instruccions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be informed whether he is the
subject of stored data on individuals,and whecher it is classified as public,private or confidenrial. 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 meanin�of that dara. Aher an individual has been shown the private data and informed of iu meaning, the data need not be
disclosed to him for six months thereafrer unless a dispute or action pursuant to this secoon is pending or addirional 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 au[horiry may require the requesring person to pay the acruai cosrs of making,certifying,and compiling the copies.
The respoasible authoriry shall comply immediately,if possible,wich any request made pursuant to this subdivision,or within five days
of the 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 whea data is not accurate or complete. An individual may contes[the accuracy or compleceness of public or
private dara conceming himself. To exercise this right,an individual shall nocify in writing the responsible authoriry describing the nature of the
disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy
past recipienc�of inaccurate or incomplete data,including recipients named by the individual;or(b)noafy the individual thac he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's sratement of disagreement is included with the disclosed data.
The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the adminis�arive procedure act relaang
to contested cases.
DATA PRIVACY ADVISORY
In accordance with NS.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 �ity 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 pernut 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.
_�
.��U'/�.✓ �/Gw�'( z, G'G�t�C,��/u�
F�rst Middle Last
_-� �(J�/_�G;��//� 5/%G�LT��
Address
/��1� /��'/� ��,���� ��Z�-¢•7� -3.���
C��' State Zip Phor.e
I understand my rights as stated above.
. ��� �'L'i2��GsY��
Signamre
6
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CHECK OFF LIST FOR ISSUANCE OF PERiV1ITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: l�g o c.b,�c��,✓a sr
PID:
DESCRIPTION OF WORK: Q�.�k
Z0�1ING REVIEW BY: DATE APPROVED: s- z� -o�
BUILDING REVIEW BY: DATE APPROVED: �--�-a 3
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓' No
pLAN REVIEW Yes �' No SEWER CONNEC"TION
STATE SURCHARGE Yes �� No WATERCONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONIlVG CHECK LIST zoning Districr.
Fire Department: Post Office: School District:
Lo[Area: Sq.ft. �Io,5��6 Acres •�3 Width Depth
Survey Submitted: Yes_� No Date of Survey: o•.� r�c.c� 9�-�-gg!
Proposed Setbacks: �
Front (L-Riccj: �`�5 � Right Side: i"1'
Rear (&�eet): � 5 Z Left Side: 7�'
Adjacent Structures: ,4-rT�uf Wetland: N/�
Buildin�Hei�ht: Def. Hgt. — Peal:Hgt. —
Lot Covera?e: �•t�
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date: .
Shoreland District: v-e 5
Av�. Setback: �r�� Bluff Setback: �✓l!a- LotCoverage: —
Existin� Proposed
b
Hardcover: 0-75' 'A
7�-2�0' 8' V�
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
gEMA12KS (in house):
7
" � s � rt .
BUILDIi�'G REVIEW CHECK LIST
usc: R- � coxsTxuc�ox�E: v�
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor R =
Garage R =
�'� Ib� x IC1.Ov =
TOTAL
Estimated Construction Value: $ 1 f 600 `�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�C Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
C F�� Grading/Filling Electrical (State Permit)
Other
REI�IARKS(ni T HOUSE): '-----Y-
--------------------------------------------------------------------------------------�----------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
-------------------------------------------------------------------------------------------------------------------
REMARKS (TO BE NOTED ON PERMI�:
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F#:; ,�r����,^u}i�,,.�,��; ,,!?<:-n:;no;s:;�a'ic_I�y noted in this-eview.
Y.��:r�T��iS Pi.AN 3ET ON 8{TE AT ALL TIMES
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CERTIFICATEOF SURVEY
�--_--- for Dayna Qelawski �� �
� in Lot 29 , Coffee ' s Addition to Shad wood �
C��� �� �����Q y ...r- . �r .
.,� ¢ Hennepin County , Minnesota ..,.- j�,
� • , � llll-� �,L+���Y lAfli''�L17�\./ I Lllii �' 2�6 �t,��2 �.;�;y•a�
� � . �l'?�"f���4���� '✓L.�K Rt7 3 ���R�r. �. �� � � Rs.: �
, " •£�..f'a�'�.i k'.:�
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� ____`�•9--=:=��� �� � �„�G _ g�, 03�, sg. �+. + � � I hereby certify that this is a true and
� o �; correct representation , of a survey of the
z � � boundaries of the North half of Lot 29 ,
o ` a
v � ',�a and the South half of Lot 29 , Coffee ' s
�: Addition to Shadywood , and all ekisting
r � o , . . . . . ��-;s thereon , and a proposed house
' � �:�.::���:�+ . It does not purport to show any
;, , �' T : other improvements or encroachments .
, ,
5���� ��Y.�8 - t oo.ti a '
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vos �8 �,�as�.�� " COFFIN & GRONBERG , INC .
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