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Home My WebLink About2003-P06369 - addn/remodel/repair CITY C)F ORONO PERMIT 2750'Kelley Parkway- PO Box 66 Permit Number: Po6369 Crystal Bay, Minnesota 55323 PeCCTIIt Type: Addition/RemodeURepair (952) 249-4600 Date Issued: siz9i2oo3 SITE ADDRESS: 1937 Fagerness Pt Rd Wayzata,MN 55391 PID: 17-117-23-23-0012 DESCRIPTION: Proposed Use: Residential Pernut Class: Building Census Code 434 Pernut Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: �--�--- --- ---„ --:.,- ------�- �-�--�- ..�r:.::,�b.:..:b� ..�.. .:.�...,.,...,.�.�.,..,�.� .... . ..... . . ...... _ FEE SUMMARY: PermitFee: $ 181.25 Valuation: $ 9,500.00 Plan Review Fee: State Surcharge Fee: $ 5.25 TOTAL FEE: $ 186.50 APPLICANT: Creative Services OWNER: RichardRoberts New Germany,MN 55368 1937 Fagerness Pt Rd Wayzata MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � , , �,�� v;� APPLICANT PERM[TEE S[GNATURE ISS D BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Apvlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERNIIT APPLICATIOle1 All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: j�� J� � � �to��r�; tlF'°�.� ��c'�U`� �' � � ZIP: r � �IL c� u � PHONE: home `�`��%�l� NAME OF OWNER: ��`.� `' �� '`_, ��_ ( ) ` , . (work) MAILING ADDRESS: %�'��l f�- �;; -�`��c_� r' CITY: ZIP: CONTRACTOR: ` - ` ; , PHOl��: `C 5.� �� -� l�'`1 ��_t� .� �� .. � � f.� CONTACTPERSON:Gti�� (c ( �� -'E%� �� MOBILE/PAGER � ' MAILING ADDRESS: �Ll�� C��'��,._, CITY: 2'�I��, c,�� ZIP: �. : . �`,; STATE LICENSE: # ARCHITECT/ENGINEER: PHO�tE: MAILPIG ADDRESS: CITY: ZIP: NAME; REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: ��,��c��- G�c�rr<<r �-� _ °� i l � • � fi � �`�-z �t�� '��` 1 � 1�• STORIES: I SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. G;- ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �5l l I hereby apply for a building pernut 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: / ��"��t�f z�°'s�� DATE: �(�c�, 1 % l 5 NOTE! Pclrade of Homes events require separate permit approval by Police Department anci City Council 60 days prior to the event. Non permitted events will not be allowed. Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. I. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to suppfy private or confidential dara concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecdng"statc agency,polidcal subdivision,or sratewide system; (b)whether he may refuse o'r is legally required ro supply the requested data;(c)any Imown coasequence arising from tus supplying or refusing to supply private or confidenrial data;and(d)the identiry of other persons or entides authorized by state or federal law to receive the data. This requirement s6a11 not apply when an individual is asked to supply invesdeadve dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�•enue mav place the noace reauired under this subdivision in the individual income tax or orooertv tax refund instructions instzad of on those forms. Subd. 3. Access to data b�individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to hirn and, if he desires, shall be informed of the content and meaning of rhat data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for six months thereafter unless a dispute or action pursuant to [his secdon is pending or additionai data on the individual has been collected or crea[ed. 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 making, certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or wichin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the request wi[hin that time,he shail so inform the individual,and may have an addiaonal five days within wtuch 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 conceming himself. To exercise this rieht,an individual shall norify in wricing the responsible authority describing[he narure of the disagreement. The responsible auchoriry shail within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempe to norify past recipienu of inaccurate or incomplete data, including recipiencs named by the individual;or(b)nocify the individual that he believes the data to be correct. Data in dispuce shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The de[ermina[ion of the rzsponsible authoriry 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 fumish 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 pemut 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. First Middle Last Address City State Zip Phone I understand my rights as stated above. / l��/S�y/'/.. F Z �� l �� Signature • CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: 1�`c�► Fi4Ge�'Lti-ess Pe�N'� �/+O PID: DESCRIl''I'ION OF WORK: (�� ,,.�ro�n.��, '�/�� 2 —____ ---__------------------------- • ZO.YI�i 1G REVIEW BY: /U �/� DATE APPROVED• BUILD�IG REV�W BY: DATE APPROVED; s-Z5-0 3 FEES TO BE CHARGED: Misc. Fees Calculated By: PER�1i1IT Yes f No PLAN REVIE`'V Yes No � SEWFIZ CONNEC7TON STATE SURCHARGE Yes � No WATER CONNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No STTEINSPECTTON Number of SAC�Units OTHER (specify) ZONING CI3�CK LIST Zoning District: N a cc�� . Fire Department: Post Office: School District: � L,ot Area: Sq.ft. Acres � Width Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Fron[ (Lake): Right Side: Rear (Street): Left Side: Adjacent Structures: �Vetl d: Building Heigh[: Def. Hgt. Pe Hgt. L.ot Coverage: Grading: Staff Approval Date: B : Council Approval Date: Septic: Staff Approval Date: B : Zoning File: # Resolution: # Resolution Date: Shoreland District: � Avg. Setback: Bluff Setbac� L.ot Coverage: Existing Proposed Hardcover: 0-75' � 75-250' 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: RENIARKS (in house): 7 BUII,DING REVIEW CH�CK LIST ��' �' � CONSTRUCTTON TYpE: �/� _ Sq Footage $Per Sq Ftg Basement x lst Floor x — 2nd Floor x _ Garage x — x TOTAL Estimated Construction Value: $ Inspections Required: `Vork Requiring Separate Permits: Site PIumbing Fire Hazdcover Removal Mechanical Water Connection �. —�FO°��g ` Septic Sewer Connection � Framing Fire lace Insulation P ��igation WaII Board ��0�'� Other � �Mfg•) Well (State Permit) °� F�� Grading/Filling Electrical (Sta[e Permit) Other REI�IA RKS(ni 1 HOUSE): ------------- - --------------------------------------------------- REV�W BY OTHERS: DATE: �~ Access: Ezisting New Access Approval: Date BY: ��_______--- ----------------------------------------------- REn'TARKS ('TO BE NOTED ON PERiI�IIT�: ------�----- 8 DATE TIME CITY OF ORONO CALLED IN �°�/� O-03 INSPECTION NOT E SCHEDULED _1�� _� ' 'G �� PERMIT NO. COMPLETED ADDRESS_ �� C��('�il�SS f /_' /�c9. OWNER CONTR. __�rP c�..-�fi��,�� S�-�'-� , � TELEPHONE NO. �S � �/� �/r� `� � DESCRIPTION r/��.�' ��aC �� 1��5-- �-,��•3'� � 01 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 Z04 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 `� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL v 1 BING FINAL 36 FOUNDATION/REMOVAL Q W ONTRACTOR TO MEET YOU: YES_NO � COMMENTS: � W a � � O � � O � W � Q � 2 w � W � � 0 W� , ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the n xt inspection 24 hours in advance. (952� 249-4600 Owner/Contract � ite: Inspector. White Copyllnspector's Ff Canary Copy/Site Notice