HomeMy WebLinkAbout2002-P05172 - pool �ITY OF ORONO PERMIT
275Q Kelley Parkway - PO Box 66 Permit Number: Posi�2
Crystal Bay, Minnesota 55323 Permit Type: A��essory stru�tures
(952) 249-4600 Date Issued: sii�izoo2
SITE ADDRESS: 165 Crystal Creek Rd
I.ong Lake,MN 55356
P I D: 33-118-23-33-0005
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Buildin Census Code 329
Permit Class: g
Permit Type: Accessory Structures Permit Sub-type(s): Pool-Outdoors-In Ground
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 321.25 Valuation: $ 20,000.00
Plan Review Fee: $ 208.78
State Surcharge Fee: $ 10.50
TOTAL FEE: $ 540.53
APPLICANT: P�ol&Spa Concepts OWNER: Bob Heleited
6415 Wayzata Blvd 165 Crystal Creek Rd
St. Louis Pk,MN 55426 Long Lake, MN 55356
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 - ISSUED Y S(GNATURE
Copies: 1-File(Si�nitures Renuired). 1-Apolicant, 1-Monthlv Reports. 1-Assessine. 1-Finance Page 1
� � � 1
/_\� Total '.Fee: $ � ��� � � Date Received: <,(U � `��-
�i� .
�� Entezed By: Permit#: �'/ic/c��
�� CITY OF ORONO - BUII.,DING PERMIT APPLICATIOIet
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANr IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��,5 � I� Y S �lZ �'�'��- z�:
NAME OF OWNER: (,�Fj J7�Z�/J`�^� �J� PHONE: (home)
(work)
MAILING ADDRESS: CITY: !'s��%�� ZIP:
C����
(��� V CONTRACTOR: PG�[� �S�i�- G��G�'� PHONE: �SL i ��3 -- �2 2.d
�J�" '� CONT'ACT PERSON:_�j GS� MOBILE/PAGER: 6'j 2„-3��- �?/ 7
��, MAILING ADDRESS: G'�1 S ��YZ�7a4l3G i%�CITY: Si. ���-r-{-� ZIP: �S, �?�'
/ STATE LICENSE: # �"t��l�
ARCHITECT/ENGINEER: PHO�TE:
MAILING ADDRESS: CITY: ZIP:
NAl�1E: REGISTRATION#
TYPE OF WORK: New _� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
i
PROPOSED WORK(describe in detai�: �G��"i� �-��\�=�`�l�`�� � ! ��`�'�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTTVi IATED CONSTRUCTION VALUATION (excluding land): $ 2�,���
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 Ciry 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: � � --�"�TE: 5 �j' �r �_
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
_ �,
Sec.13.04 RIGHTS OF SLJB.TECTS OF D�TA .
Subd. 1. Type of data. The righrs of individual on whom[he data is stored or to be stored shall be as set fonh in this secaon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data concerning himself shail
be informed of: (a)the purpose and intended use of the requested data within the collecang"state agency, poliacal subdivision,or sratewide system;
(b)whe[her he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising from his suppiying or refusing to supply
private or confidendal data;and(d)the identiry of other persons or enddes authorized by stace or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesaeadve dam,punvant to secdon 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or oropertv tax refund
instructions ins[ead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whecher he is the subject
of stored data on individuals,and wherher ic is classified as public, private or confidendal. Upon his further request, an individual who is the subject
of stored private or public dara on individuals shall be shown[he data wi�hout any charge to him and, if he desires, shall be informed of the contenc
and meaning of that data. Aher an individual has been shown�he private dara and informed of ics meaning, the dara need not be disclosed to him for
six monrhs thereafrer unless a dispute or acaon pursuant to this secdon is oending or addidonal data on the individual 6as been collected or created.
The responsibie au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesdng person to pay the actual costs of making, cerufying, and compiling the copies.
The responsible 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 Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within rhat time,he shall so inform the individual,and may have an addirional Five days within which to compiy with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accutacy or completeness of public or private
data concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing[he nature of the disagreemeot.
The responsible auchoriry shall wichin 30 days eicher: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipients of
inaccucate or incomplete data, including recipients named by che individual;,or(b)notify the individual that he believes the data to be correct. Data
in dispute shali be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
Tlie de[erminarion of the rzspensible authoriry may be appealed pursuant to the provisions of the adaunistrarive procedure act relacing 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 pemut 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 deternune your qualification for the pemut 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 a�encies 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 ri�hts under N1.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 Vtiddle Last
Address
Ciry State Zip Phone
I understand my rights as stated above.
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
� ADDRESS OR LEGAL: l �,S C�2 y 5��- �,�
' PID:
DESCRIP'TION OF WORK: �v o �
ZO�tING REVIEW BY: DATE APPROVED: ,S_ �� .oZ
BUII.D�G REVIEW BY: DAT'E APPROVED: S-_��• oz
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERi1�1IT Yes �/ No
PLAN REVIEW Yes �' No SEWER CONNECITON
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning Districr.
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes X No Date of Survey: phr G'�t�
Proposed Setbacks:
Front (Lake): I`{0� � Right Side: (�O 5
Rear(Street): � ��� � Left Side: S� �
Adjacent Structures: �' Wetland: �v/�a
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
� Zoning File: # Resolution: # Resolution Date:
N�
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Ezistin; Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
7
v
BUILDING REVIEW CHECK LIST •
�C� — CONSTRUCTION TYPE: �
Sq Footage $Per Sq Ftg
Basement x =
lst Floor z =
2nd Floor x =
Garage z =
R -
TOTAL
Fstimated Construction Value: $ "Z•�, �v o `'=
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�Footing � Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd (Mfg.) Well (State Permit)
_�Final Grading/Filling Electrical (State Permit)
Other
REMARKS(1�1 HOUSE):
------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
----------------------
REMARKS (TO BE NOTED ON PERNIIT�:
8
� `�� � 3 `��
✓ � DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N T/lIC� SCHEDULED � �
PERMIT N0. V ��� �� COMPLETED
ADDRESS � � �- -f C_- C'-L-
OWNER CONTR. ��C�% I
TELEPHONE NO. �� ' . �- ' ��C�
.
� DESCRIPTION �L�-'�� N�� — T .
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETIANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 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 INSTAIL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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� ,l�WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W �O CORRECT WORK&PROCEED ❑ ISSUE CEATIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �952� 249-4600
OwnedContractor o�site;
inspector. ��...�t
�
White Copyllnspector's File Canary Copy/Site Notice
HENNCPIN COUNTY, P�1INNCSOTA �
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� PREM I SES : ��•�������"""��
�TAL CREEK
irker "'"
g spot e I evat i on , mean sea I eve I datum �'!T� �� ���f���
d spo t e I eva t i on , mean sea I eve I da t um °� ����;��A"� I Gi�l�G(NG PLlt�i
���P, �-,U v�..17 NCw 2�1�,
g con tou r I i ne , mean sea i eve I c��t um � APP�OU�� 'JVIl�i7 C�EVISIONS
„ „ [� CI�APPf;OvED PROPOSED ELEVAT I ONS : "
ased upon an assumed datum. fjY --� —
C�/�iE _ � - t e-d Z– 1 ) G a r a g e = iais.�
������ ������Top of foundation = /ai�. 3
i ��: �P.! ��� � .