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Home My WebLink About2003-P06816 - addn/remodel/repair � -� PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P06816 Crystal Bay, Minnesota 55323 P@rCTllt Typ@: Addition/RemodeURepair (952) 249-4600 Date Issued: loi�i2oo3 SITE ADDRESS: 1280 Bracketts Pt Rd Wayzata,MI�I 55391 P I D: 11-117-23-32-0019 DESCRIPTION: UBCOccupancy R3 Construction Type VN Proposed Use: Residential Pernut Class: Building Census Code 434 Pernut Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: Separate pernuts required: riwnning Eiecmcai�siaiej NOTICES/REMARKS: TJ_a_l____ T_".__�_1 FEE SUMMARY: Pernut Fee: $ 1,049.75 Valuation: $ 110,000.00 Plan Review Fee: $ 682.43 State Surcharge Fee: $ 55.50 TOTAL FEE: $ 1,787.68 APPLICANT: Tom Potter Construction Inc. OWNER: T ''"p'"°'""" J�'�"`� �� 6531 Devonshire Dr. 1280 Bracketts Pt Rd Chanhassen,MN 55317 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. � , ' " �, �'��.,.,,_ c� G' \ ��- �.�''// G �`��J�� APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Apnlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 � � ��'a �01'� . ... Total Fee: $ /787�8 Date Received: g-23-03 Entered By: �,S Pernut#: �DloB/l,� 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 O� C N C O� JOB SIT'E ADDRESS: /,�,�L- �,�'y�,�::�ry_� r"l - =l� ZIP: :.S'��`�%/ ��1��►'� � NAI�iE OF OWNER: i�A�'1.C-5 >��Lf- PHONE: (home) ��,.5 L- 2�(�_br�,�`l' : (work) MAILING ADDRESS:��1� �5��°�C KE TT�' %�T�- CITY: �i,Y��.ti�� ZIP: ��5��j �' COV"TRACTOR:� (�1` ��_' C��iJ��: ��i11C" PHONE: �'�� -�,)� - / ) �� COI�TACT PERSON: "�U,� �►�-7'G-/�'�.. NIOBILE/PAGER: L;!�- � �? - 7 y.3 f� NLAII.,ING ADDRESS:�>53! j�`i��%'S��°'c /��'. CITY: (�fl%tti��s.S E;�� ZIP: S��.�/ ST�T'E LICENSE: #��(3��>/y� ARCHIT'ECTlENGINEER:�k'�(c:� 5��,;t� . - 55��c�� PH0�1E: J�� - =�7�; ._ �v ZZ L NI_�II,ING ADDRESS:<�a �,',7�;;� f��c,S CITY: ��,�-��4-� 'z.� t Z�: �S�3%� NA:�IE: ��o�L �-,�.-�-fc:;cs REGISTRAT ON# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration i✓ Land Alteration PROPOSED WORK (describe in detai�: C`;�� j�E�- /�r T� tf�.�` � �� t'-:�.�U� 1 � �,-�3 , -�->r��c� ��t- c ,� ��:��is STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOviS: � GARAGE STALLS: ATT. DET. EST�IATED CONSTRUCTION VALUATION (excluding land): $ �1��' t'��' �'� I hereby apply for a building perm.it 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 wilI be in acco dance with e approved plan. � F ' - APPLTCANT'S SIGNATURE:� _ � ��'1��a..-r�,,,;�� %� DATE: c.�� "- �� NOTE! Parade of Homes events require separate permit approval by Police Department anrl City Council 60 days prior to the event. Non permitted events will not be allowed. 5 ' � :.. . Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. i. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subci.2. InformaHon required to be given individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and intended use of the requesced data within the collecting state agency,polidcal subdivision,or statewide rystem;(b)whether he may refuse or is legally required to supply the requested dara;(c}any lmown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persons or entiaes authorized by sate or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav lace the norice re uired under this subdivision in the individual income taz or ro em tax refund instrucrions 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 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 hun and, if he desires, shall be informed of the content and meanin�of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or action pursuant to this secaon is pending or addidonal data on the individuai has been collected or crea�ed. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesrin�person to pay the actuai cosu of making,certifyin„and compiling the copies. T�e responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of che request,excluding Saturdays,Sundays and legal ho(idays,if immediate compliance is not possible. If he cannot comply wich the request within that time, he shall so inform the individual,and may have an addirionai 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 dara conceming himself. To exer�ise this right,an individual shali nocify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and attempt to noafy past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)notify the individual that he believes the dara to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administraove procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance �vith 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 pemut or license requires Council action to approve, some information may become public. �. 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 Middlt Last Address C�ry State Zip Phone I understand my rights as stated above. Signature , 6 � ` ' CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: �Z �3 p ��,�� ,�- PID: �- DESCRIPTIO�'OF WORK: /j,�c��D� ZO.�tI�ti G REV�W BY: �tJ/i4 DATE APPROVED: BUILDING REVIE`V BY: DATE APPROVED; /o -�• �3 FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes �/ No PLAi�1 REVIE�V Yes c/ No SEWER CONNECTTON STATE SURCHARGE Yes _� I�To WATERCONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTTON Number of SAC�Units OTHER (specify) ZONING CH�CK LIST Zoning District: iva G(-��"�2 Fire Department: Post OfFice: School District: � Lot Area: Sq.fr. Acres �,'idth Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front (Lzke): Right Side: Rear (Sueet): Left Side: Adjacent Strucnues: � etland: Building Hei�ht: Def. Hgt. al:Hgt. Lot Coverage: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: � Resolution: # Resolution Date: Shoreland District: Avg. Setback: Bluff Setba k: Lot Coverage: Existino Proposed Hardco��er: 0-75' 75-250' 250-500' 500-1000' Hardco�•er Variance Required: Yes No Date of Council Approval: REMARKS ('Ln house): 7 BUII.DIl\'G REV�W CHECK LIST �C: 2� 3 CONSTRUCTTON TYPE: \//l! _ Sq Footage $ Per Sq Ftg Basemeat x _ lst�loor x _ 2nd F1oor x _ Garage x _ z = TOTAL Estimated Construction Value: $_�+y� �`� Inspections Required: `Vork Requiring Separate Permits: Site yC Plumbing Fire Hardcover Removal Mechanical Water Connection FO°��b ~ Se tic _�Framing p Sewer Connection Fireplace Lawn Irrigation _�Insulation (Masonry) Other �R'all Board (Mpg,) Well (State Permit) F�� Grading/Filling �Elecuical (State Permit) Other RENIARKS(ni 1 HOUSE): -------------------------------------------------- REVIE�V BY OTHERS: DATE: ~� Access: Ezisting New Access Approval: Date By: — ---------------------------------------------------------- REI�ZARKS (TO BE NOTED ON PERiviIT�; 8 ' V �4 "V DATE TIME CITY OF ORONO CALLED IN 1� �'` INSPECTION NO CE SCHEDULED "�'� �N PERMIT N0. �1 COMP�ETED ADDRESS t'��(..�' �✓i�C ICC�� . ��Q• OWNER CONTR. �>r�t �i-�r �--rT�-�'f- TELEPHONE NO. /�a �:l� ��d v� — ��v�/� � DESCRIPTION �r�� _ ��-�='V""�U' • � Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION OS FINAL 14 SEWER HOOK-UP O6 PROGRESS � 0 O-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC F NAL 35 HARO COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU: YES_NO � COMMENTS: � W C o �'�utu vK< <s ��G '' PD �860 FP ✓ � � P� �� c� /�1evi � W � Q � z W � W � � � O � WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALLTOARRANGEACCESS. Call forthe next inspection 24 hours in advance. �95Z� 249-46QQ OwnerlContr��e)or on site: Inspector. � White Copyllnspector's File Canary Copy/Site Notice ✓ DATE � TIME CITY OF ORONO CALLED IN I l'�%'D� INSPECTION NO ICE SCHEDULED %/-/�-O� C, � PERMIT NO. �S COMPLETED ADDRESS /a��'CJ �rZ c (� e f f S f T /2c�( OWNER CONTR. �� /'�a �� itirs�". TELEPHONEN0. ��S � y�C� / �,�� DESCRIPTION l� 01 FO 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � F� 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS Q Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL B0. 12 WATER HOOK-UP 17 SITE INSPECTION Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: W � a j 0 a � 0 � W � Q � z W � W � � a W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W`vCl CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALI INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (95Z� Z49-46�� OwnerlContr c ite: Inspector. White Copyllnspector's ile Canary Copy/Site Notice