HomeMy WebLinkAbout2003-P07026 - attached deck S ` PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po�o26
Crystal Bay, Minnesota 55323 Pet'1711t Typ2: Addition/RemodeURepair
(952) 249-4600 Date Issued: i2�ii�2oo3
SITE ADDRESS: 1926 Fagerness Pt Rd
Wayzata,MN 55391
PID: 1�-i 1�-23-23-0016
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Sub-type(s): Deck-Attached
Permit Type: Addition/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: PernutFee: $ g3•25 Valuation: $ 2,500.00
Plan Review Fee: $ 54.08
State Surcharge Fee: $ 1.75
Misc.Fee: $ 83.25
TOTAL FEE: $ 222.33
APPLICANT: Fred 7ohnson OWNER: Randy&Michelle Chwialkowski
3535 Cty. Road 44 1926 Fagerness Pt Rd
Minnetrista,MN 55364 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 ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
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Total Fee: $ ZZZ• 33 Date Received: 11 l�1-v3
Entered By: (�S Permit#: �s;�} �0� !o
e� CITY OF ORONO - BUILDING PERMIT
�z(�p 3 APPLICATION
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All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTOR�
-.� __,
JOB SITE ADDRESS: _1� .�- b l►���� PT: ►2cl , 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 and Ciry
Council approva160 days prior to the event. Non permitted events will not
be allowed.
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NA1��E OF OWNER: r�, �;: � ��`'ll,V ICI.�����'�PHONE: (home) �( Z -'�1�.,�"`_�l l�l�
-r-� -
(work)_ -
MAILING ADDRESS: ` _ � ; _, __ � CITY: _ZIP: : �
CONTRACTOR: �Ye(� T��'l�`�S(7'l, PHONE: I�,,I ,� -`�lv I-����-� -
CONTACT PERSON: ��f� ����1'1SCl'�1 NIOBILE/PAGER:
MAILING ADDRESS: �`��� C�y (Z�1 �.�� CITY: l�1 w (lrl�'�,'4 S�G��ZIP: �'�,���
STATE LICENSE: # � (�'Q � ��� �
ARCHITECT/ENGINEER: �Y�� ,TL`�1f�C-�`LS' PHONE:
MAILING ADDRESS: SL e. �`-lt�i.� p, CITY: ZIP:
NAI�IE: REGISTRATION #
TYPE OF WORK: New Accessory Structure t.�
Addition Move
RemodeVAlteration Land Alteration
PROPOSED WORK(describe in detai�: ���j-�-E"�' ��� �y��1L`�}'" �;',��1��11 �"" �L�7?_ Z�`� J 1���
I�C.l�.�.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIti�ATED CONSTRUCTION VALUATION (excluding land): $ :��C(..�.�C�
,
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate;that the
work �vill 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 pernut; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: �`-" DATE:
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Sec.13.04 RIGHTS OE 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 concerning 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 Iegally required to supply the requested data;(c)any known consequence arising trom his suppl}ine 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 mav olace the notice reauired under this subdivision in the individual income tac or oroaertv tax 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 w hether he is the subject of
stored data on individuals,and whether it is classitied as public,private or confidential. tipon his further request,an indi�idual who is the subject o[
stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed o[the content and
meaning of that data. Atter an individual has been shown the private data and informed of its meaning,the data need not be disclosed to 6im for six
months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been crollected 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 requesting person to pay the actual costs of mal:ing,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within fi�e days ofthe
date of the request,escluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot compt�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,excludins Saturdays,Sundays
and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or private data
concerning himself. To exercise this right,an individual shali notify in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notiCy past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions o[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�vould like to inform}�ou that��our request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidentia(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 appro��e, some information may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to review private data on�•ourself.
6. Your full name is required to process this application or permit.
�Y�'� (�!'1� J��hnS���v
First M1liddle Last
3�3� C`�Zu��-�I I�Zc� �-�
Address
���������fv�is t� t���� ��3��4 6i� -���ol -5��y
C�n' State Zip Phone
I understand y r as st d above.
Signature
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CHECK OFF LIST FOR ISSUANCE OF PERIVIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: t G zc� 1=r��t=2NC-5 S Pc��N� 1Zo�
PID:
DESCRIPTION OF WORK: ,q r�7z -rt-�-� F=ft c r ✓J�Uc
ZO�tPi i G REVIEW BY: DATE APPROVED: /z-� -0 3
BUII�DING REV�`V BY: DATE APPROVED; r Z- r• 03
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERI�IIT Yes �/ No
PLA��t REVIEW Yes � No SEWER CONNECITON
STATE SURCHARGE Yes ✓/ No WATERCONNECTTON
,�INVESTIGATION FEE�3�isYes ✓ No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONII�IG CH�CK LIST Zoning District:
Fire Department: Post Office: School District: �
Lot Area: Sq.ft. Acres Width Dep[h
Survey Submitted: Yes o�- No Date of Survey: ON i=<<.�,
Proposed Setbacks:
Front(Lake): Right Side:
Rear (Street): Left Side: zrrc� ��- ���� �S
�U� ��� ��'71tsL J.����
Adjacent Structures: �Vetland: 5
�/�J �-T—1�c �S' i4�r�D S-Q �I'1{l�.S
Building Hei;h[: Def. Hgt. Pealc Hgt.
Lot Coverage:
Grading: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # � Resolution: # Resolution Date:
Shoreland District: u��
Avg. Setbac��— Bluff Setback: L.ot Coverage:
Eusting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval: '
RENIARKS (in house): � �-F�'t � �c� /��'�f� .�1�"n'�'�^ � T
� S S/6nrcaP ,?
a
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BUII,DING REVIE`y CI�CK LIST
�C' �Z � 3 CONSTRUCTION TYPE: �/�
_ Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z _
2nd F1oor x _
Garage x _ .
z =
TOTAL
Fstunated Construction Value• $ Z, S o � °=
Inspections Requiret}: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ' Septic Sewer Connection
Insul�at�ion Fireplace Lawn Irrigation
Wall Board ��0�'� Other
(I�Sfg.) Well (State Permit)
F�� Grading/Filling Electrical (State Permit)
Other
�'�'�,S(�'HOUS�;�:—/U U �,�l/,5� �y r/'/��� � GC..c�S�e �2 (.�� �Tf�
�T �SSv,��
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REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By:
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RE�IARKS (TO BE NOTED ON PER�tiIIT�:
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