HomeMy WebLinkAbout2005-P08442 - add/remodel/repair � ' ' PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: pog442
Crystal Bay, Minnesota 55323 P21'llllt Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 2ii��2oos
SITE ADDRESS: 1200 Bracketts Point Rd
Wayzata,MN 55391
PID: ii-ii�-23-32-oo2i
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Pernut Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required: Yiumoing iviecnanicai Eieciricai�siatej
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 818•75 Valuation: $ 75,000.00
Plan Review Fee: $ 53228
State Surcharge Fee: $ 38.00
TOTAL FEE: $ 1,389.03
APPLICANT: Silver Bullet,Inc. OWNER: 7ohnNoble
2611 First Avenue S. 1200 Bracketts Point Rd
Minneapolis,MN 55408 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.
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APPLICANT PERMITEE SIGNATURE UED BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
r C u.e.Q.e.�Q �-I�-.oS/
Total Fee: $ /3g�', d.3 Date Received: �-� �'�S�
Entered By: �- Permit#: /� C� ��f a-
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it all infornzation)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTO�
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JOB SITE ADDRESS: �'� �'� �"' e��i?,� �K� i� � l�'� ,�� i '�I� . ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a special event permit is required with Police Department ancl City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: �.�'��iy�� U L,n.,,���� ���'..,-.'< L PHONE: (home) :�;_� -�/��' �� �-,,, �.
(work)
MAILING ADDRESS: �� ����� i"'������i�js /�D-ti�r /�n CITY: c=�_-�' �: ,v�-, ZIP:
CONTRACTOR: �%� ��2 i�� � � �r --��� = PHONE: �� � � ����y�- ��y��""
CONTACT PERSON: ��-i�%�y� G���.-%c,�:� MOBILE/PAGER: ��/1- - l�'7�-77,3�
MAILING ADDRESS: ?�;/l >�� /r �v� CITY: ��l,, ,:� ; r,��1-.�� ZIP: � �-a y����'
STATE LICENSE: # ��j' C - .� ,5�>I
� <�7`/�'c�C�-<<�'if[ /��e si���� ,G2[<
ARCHIT�CT/E�tGIIVE�ER• �T� � y C,� ���-� �'��� � PHONE: ��� �' �� ���" �' -,5-s' 6 r
MAILING ADDRESS: �!C,;��� :r. << < � �� �--��-. CITY: c"t/�-����t�� �rL ZIP: 5 S�l,�
NAME: 7-� o� C��c-��! . REGISTRATION# '�ti � y�y�y
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeUAlteration �;�� Land Alteration
PROPOSED WORK(describe in detai�: � i �` �i�,c,v ; L ,�� �z ��l' y -�? T-�
/'<�'���� c� �� �
STORIES: <�- SQ. FEET OF EACH FLOOR: i ��' �'
NO. OF BEDROOMS: _� GARAGE STALLS: ATT. !��: DET. �
�,. _
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��, � L' �'
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 with the State Building Code; that I
understand this is not a pernut and work is not to start without a permit;and that the work will be in accordance with
the approved plan. ,
, ,
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APPLICANT'S SIGNATURE: -'�� ��i (� ' --- DATE: .� / �'�
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type ot 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 individuai. An individual asked to supply private or confidential data conccrning 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 supplying or retusing to supply
private or conCdential 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 suppty investigative data,pursuant to section 13.82,subdivision 5,to a law entorcement ofGcer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or oropertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon reyuest to a responsible authority,an individual shall be intormed 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 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 thereaftcr 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 requcsting person to pay the actual costs of making,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 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 tive 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
concerning himself. To ezercise this right,an individual shall noti[y in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 30 days either: (a)wrrect 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 individuai that he belleves the data to be correcL Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with thc disciosed 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
con�dential 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.
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�' ignature
CHECK OFF LIST FOK ISSUAlYCE OF PER1tiIITS
FOR OFFICE USE ONL Y
ADDRESS ORLEGAL: 1200 �(ZACK�TS Poiu�t' 1?,carJ
PID:
DESCRIPTIOIV OF Yf�ORFC: ��s„(�Q,�� c�,� r�.0 � �iv-� ��='�'�°A�=z-
- ------------------------------------------------------------------
------------------------------- -
ZOtYItVGREVIEyVBY: � D.ATEAPPROVED: Z-i6-�S
BLiILDINGREVIEyi�BY. DATEAPPR06'ED: 2-�6 -oS
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FEES TO BE CHARGE.D: 1L'Iisc. Fees Calcccfccted By�:
PERNIIT Yes �/' No
PLA�V RE I�IE GV Yes �/ �Vo SE tiVER GON�VECTION
STATE SURCH.4RGE Yes __� �Vo YVATER CO�WECTIOIV
I�VVESTIG,4TIO�V FEE Yes �Vo PARK FEE
SAC Yes No SITE NSPECTIOtV
Num6er' of SAC U�zits OTHER (specify)
-------------------------------------------------------------------------------------- --
ZO�VIIVG CHECIi LIST Zorcirt,�Dist��ict: No C/-/ANGe
Fi�•e Deparhnerrt: Post Office: Sclr.00l Distr•ict: __..
Lor.=irea: Sq.f't. Acres 6�idtlt Deprh
Scutiey Subniitted: Yes No ate af Su�vey:
Proposect Setbadcs:
Fror�t(Lal.e): Right Side:
Renr(Str•eet): Geft 5ide:
Adjace�zt Str��ctcu•es: Wet rtd:
BuildirTg Height: Def. Hgt. eak Kgt.
Lot Coverage: �
Gracfing: Staff,4pproval Date: By: Council rLppi�oval Date:
Septic: Stnff,�lppf•o1�al Dc�te: BY�
Zonirtg File: # Resofutia : # Resolutiat Dnte;
Slaoreland Dish•ict:
Avg. Setbnck: Blu 5etback: Lot Coverage:
Elistt a P�•oposecf
HRrdcover: 0-7Y
75-2.i0'
250-500'
500-1000'
Harc{cover Variartce Reqcei�•ecf: Yes No Date of Coc�ncil Approval:
REi12ARKS`(irt liouse):
31 ' �
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.
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B UILDI�VG.R.�T�XET t�CHECIi LIST
UBC: (Z• 3 COr\'STRUCI70�YTYPE: `L�'V
Sq Foota,�e .�Pe�•Sg FcQ
Bc�ser�ie�ct � _
!st Floor .r =
?iid Ffoor x =
Gar•r;e 1 =
s =
TOT�{L
u
Estimated Consd�uctio�c Valcce: ,S �j��c7(7
Lispectiorts Required: 6j�'ork Requiriit�Separate Perruits:
St�e �_Pl�unbing Fire
Hardcover R�moval _g Nlechanical GYater Corulectiori
�-{�attfrg Septic Setiver Connectial
�c Framiu,� Firepface Latiwt lrriga[io�t
_,![/nsulatia�� ('��lasonrz:) Oiher•
�FY"afl Boar•d (A�Ifg.) G�e!!(St�te Per��tit)
Final G,•acfi,tg/Filling _�Elech-ical(State Permit)
Other•
PEttiIAR.I�S(fN HO USE):
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RE f�ZE tV B Y OTHERS: DATE:
Access: Existi�i,� rVe�v
,�{ccess�fppravnl: Date B��:
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RE�'�I�R.h'S (TO BE NOTED OtV PERttitIT):
32
� � � DATE TIME �
CITY OF ORONO CALLED IN ���g
INSPECTION TI SCHEDULED -��- ��
PERMIT NO. �� � COMPLETED ,�- /
ADDRESS �aOO D�� F�
OWNER CONTR. c�G�'�`JLC�:�PiZ��
TELEPHONENO. ��� /� / � �� �
� DESCRIPTION ����
L� 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 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINA� 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED Cl PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED 'l, ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑Ct�RRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR '-� CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the n xt inspection 24 hours in advance. (J52� 249-4600
Owner/Contra site:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice