HomeMy WebLinkAbout2005-P08942 - addn/remodel/repair PERMIT
C�TY.�OF ORONO Permit Number:
2750 Keliey Parkway- PO Box 66 P08942
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 7/18/2005
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SITE ADDRESS: 245 Ferndale Rd N Unit#
Wayzata,MN 55391
PID: 36-118-23-41-0004
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 434
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 23.50 Valuation: $ 300.00
Plan Review Fee: $ 15.28
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 39.28
APPLICANT: Owner/Self OWNER: Darrell&Kenwyn Beckstrom
� 245 Ferndale Rd N
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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PPLI T PERMITEE SIG TURE SUED BY S[GNA7URE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ �•� Date Received:
Entered By: Permit#: � •;/� � � c��;—"
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all infornzation)
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THE APPLICANT IS: (ci�•cle o►te) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��-.5 c�Qrnc����,o� �l�' Oror�o N1N zlP: 55 3�)
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ NO If ves, �special event permit is requif•ed with Police Depardnent a�lcl Citv Counci!approvc�l
60 clnys prior-to the event. Slriittle bi�s service titi�ill be required unless npplicarzt rlenionstrates
strffieie�zt o�i-site parking is av�ailcable. Non per�mrtted events will not be�illorvec�.
NAME OF OWNER: � � a ' P ONE: (home)952-�-76-1.�5
(work)
MAILINGADDRESS: z�5 �PYnr�r��� �a, ��CITY: ZIP: 5�35'7
�SAME AS AE30yE�
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
�'YPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration _�
PROPOSED WORK(descf�ibe in detai�: � C
NOT EtJ LDS�
STORiES: S�.�EE'I'OF EACI-�FI,00�2:
NO. OF BEDROOMS: GARAGE STALLS: A'�"TACHED DETACHED
ESTIMATED CONST'I2UC�'ION VALiJATION(excluding land): $ 30(� ,�0
I hereby apply for a buildin�permit and I acknowledge that the inforniation above is complete and accurate;
that the wark will be in conforniance with the ordinances and codes of the City and with the State Building
Code; that I understand this is not a pernlit and work is not to start without a perniit; and that the work will be
in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: 77 D..�
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. L Type of data. The rights of individual on whom the da[a is stored or to be stored shall be as set forth in this section.
Subd.2. Infonnation required to be given individual. An individual asked to supply p�ivate or confidential data concerning himself shall be
infonned of: (a)the pu�pose 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[he requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by s[ate 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 place the notice required under this subdivision in the individua) income tax or prooerty tax refund
instructions instead of on those fonns.
Subd.3. Access to data by individual. Upon reques[to a responsible authority,an individual shall be infonned whether he is the subject of
stored data on individuais,and whethe��it is classitied 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 infonned of the content and
meaning of that data. After an individual has been shown the private da[a and infonned of its meanin�,the data need not be disclosed to him Yor six
months thereafter unless a dispute or action pursuant to this section is pending or additional data on[he 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,ceitifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pmsuant to this subdivision,or within five days of the
date of the i•equest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. lf he cannot coinply wi[h the request
wi[hin that time,he shall so infonn 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 piivate data
conceming himselE To exercise this right,an individual shall notify in writing the responsible autlioiity describing the nature of the disag��eement. The
responsible au[hority shal]within 30 days either. (a)correct 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 individual that he believes the data to be con�ect. Data in
dispute shall be disclosed only iY the individual's statement of disag��eement is included with the disclosed data.
The detennination of the responsibie authority may be appealed pursuant to the provisions of the adminisUative procedure act relating to
contested cases.
DATA PRNACY 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 pennit 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:
l. The information you fumish 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 Ciry 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 infonnation 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.
, � � -�
irst Middle Last
z�5 C�erno�a� � �1�.
Address
�i��a�.�� MN 55391
City Statc Zip Phone
I un m rights as state ve.
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ig� ture
� CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS ORLEGAL: zti� �-��►��4�-G 20� N
PID:
DESCRIPTION OF WORK: TR.y (�,o��= _
ZO�'G REVIE�V BY: DATE APPROVED: � -� 3� b s
BLTII.DING REVIE`V BY: �_ DAT'E APPROVED: —�-��- o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes _� No
PLAN REVIEW Yes ,/' No SE`VER CO�TNECITON
STATE SURCHARGE Yes ✓ No WAT`F,RCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZO�tI�iG CH�CK LIST Zoning District:
Fire Departmear. Post Office: School District:
Lo[Area: Sq.ft. Acres Width Depch
Survey Submitted: Yes �_ No Date of Survey: o� �_� �-
Proposed Setbacks:
Front (Lake): 13�j� '' Ri;ht Side: �Q"1
Rear (Stree[): 1��� � Left Side: I o 5
Adjacent Structures: �r�c�c-tt:-� �Vetland: N\A
Building Hei�ht: Def. Hgt, p , � Peak Hgt. —'
Lot Covera�e: 0•I�
Grading: Staff Approval Date: /U 1 J� By: Council Approval Date:
Septic: Scaff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: /V (�
Av;. Setback: Bluff Setback: L.otCovera�e:
Existina Proposed
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Hardcover: 0-7�'
7�-2�0'
2�0-�CO'
500-1000'
Hardcover Variance Required: Yes No Da�e oF Council Approval:
ItE�iARKS (in house):
BUILDING REVIEW CHECK LIST
�C� n ' CONSTRUCTTON TYPE: �//`J
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z _
2nd Floor x =
Garage z _
x =
TOTAL
Estimated Construction Value: $�Uc) �=
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
� Foating ` Septic Sewer Connection
o� Framing Fireplace Lawn Irrigation
Insulation (Masonry) Ocher
Wall Board (Mfg.) Well (State Permit)
o F�� Grading/Filling Electrical (State Permit)
Ocher
REI�IARKS(IN HOUSE): � �
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REV�`V BY OTHERS: DAT`E:
Access: Existing New
Access Approval: Date gy:
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REI�IARKS (TO BE NOTED ON PERi�IIT�:
8
✓
DATE TIME
CITY OF ORONO CALLED IN -��5
INSPECTION NO IC SCHEDULED
PERMIT NO. ��� COMPLETED
ADDRESS � 7 '`] /�-�= �
OWNER �°ll.tl�l Qil
TELEPHONE NO. �� Z" �?Co'/� D�
� DESCRIPTION �v�/
� 01 FOOTING 11 MECHANICA 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 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
Q
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENT :
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W WORKSATISFACTORY:PROCEED CI PROJECTCOMPLETE
� ❑ CORRECT WORK&PROCEED 1- ISSUE CERTIFICATE OF OCCUPANCY
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O ❑ CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
r7 CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n t inspection 24 hours in advance. (J52� 249-46�0
Owner/Contr r o 'te:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice