HomeMy WebLinkAbout2004-P07707 - addn/remodel/repair A �
` ` PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po��o�
Crystal 13ay, Minnesota 55323 P2CCTllt Typ@: Addition/RemodeURepair
(952) 249-4600 Date Issued: gi3i2oo4
SITE ADDRESS: 645 Ferndale Rd N
Wayzata,MN 55391
PID: 36-118-23-11-0010
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: �
Permit Class: Building Census Code 434
Permit Type: Addirion/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: ���m�ai�siaie�
NOTICES/REMARKS:
r.-� ----�n—�- r---- -,,,..- - -, -----
__. ..._
............,..✓._:»:,f.:�:.c:� ..::::.:.C:::::.:::::b......b..
FEE SUMMARY: Pernut Fee: $ 853.75 Vatuation: $ 80,000.00
Plan Review Fee: $ 555.03
State Surcharge Fee: $ 40.50
TOTAL FEE: $ 1,449.28
APPLICANT: Stonehouse Designs OWNER: Andrew&Sara Turner
420 East Rice 645 Ferndale Rd N
Wayzata,MN 55391 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.
��
` - .�_ ����----��J�-
APPL[CANT PERMIT . GNATURE SSUED BY SIGNA'CURE
Copies: 1-File(Sienitures Required), 1-Apvlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�at all iizforr�iatioiz)
THE APPLICANT IS: (circle o�ie) OWNER OR__ONTRACTOR �
JOB SITE ADDRESS: �o`f`S �-e���l�� �� � ZIP: S� ��`
Will this be a Parade of Homes, Remodelers Sliowcase Home or other Display Home?
❑ Yes �- No If yes, a special event perJnit is required with Police Departrnent and City
Cour�acil app��ova160 days pYior•to the event. Non permitted everats will not
be allowed.
NAME OF OWNER: �v���� c��r�'"C_- PHONE: (home)lvt�-�3�7�'�? 3�-�
/� � (work) �/'a2- 9'��{--(�,�21a
MAILING ADDRESS: � � 77 �(i�}ee� 1'�h�.� CITY: ' \S ZIP: S�'�S
-c;�,,"'��
CONTRACTOR ����� �S �j .�: PHONE: cI� ��� �'�I
CONTACT PERSON: g �v MOBILE/PAGER: ���-- 3�� -�3�3
MAILING ADDRESS: yd.G ��� (Z�c� ��. CITY: v�R�Ld�-`� ZIP: ,55 3�
� STATE LICENSE: # o?Ub� `t�S �3 �,
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition C Move
Remodel/Alteration Land Alteration
PROPOSED WORK(describe iiz detai�: _ �ei,� �(v�,.�Y �jc� � � �t� � t�1� .�'
STORIES: ( SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: v GARAGE STALLS: ATT. � DET.
ESTIMATED 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 will 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 permit; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATU DATE: ��'��
Sec.13.04 RIGHTS OF 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 shali be
inCormed 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 from his supplying 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 ot revenue mav nlace the notice required under this subdivision in the individual income taa or propertY 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 whether he is the subject of
stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of
stored private or public data on individuals shall be shown thc data without any chargc to him and,if he desires,shall be in[ormed of the content and
meaning of that data. After an individual has been shorvn the private data and informed of its meaning,the data need not be disclosed to him for six
months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected 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 making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possibte,with any request made pursuant to this subdivision,or within Gve days of the
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliancc is not possible.If he cannot comply with the request within
that time,he shall so inform the individunl,and may have an additional Gve 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 individuul may contest the accuracy or completeness o(public or private data
concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature atthe disagreement. The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to aotify past recipients ot
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 sta[ement of disagreement is included with the disclosed data.
The determination o!the responsible authority may bc appealed pursuant to the provisions oC 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 furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the pernut 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 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.
Signature
f , .
. •
CHECK OFF LIST FOR ISSUA��tCE OF PER11�iITS
FOR OFFICE USE ONLY
A.DDRESS OR LEGAL: (�,y 5 �=c-2N J,q t,� ��
PID:
DESCRIPTION OF WORK: �',4,�tq�P + Wt�v � (t.bvw� Y��D 0 t �►-"t,��
ZO.vI�Ii G REVIEW BY: DATE APPROVED: g • 2- o�-I
BUILDI�IG REV��V BY: DATE APPROVED; � •�m y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER1ti1IT Yes �/ No
PLA��I REVIEW Yes ✓ No SEWE.R CONNEC'I'ION
STATE SURCHARGE Yes �/ No WA'ITRC0�INECTION
INVESTIGATION FEE Yes I�`o PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZO�II�G CH�CK LIST zoning District:
Fire Departmen[: Post Office: Scbool District:
Lot Area: Sq.ft. Acres Wid[h Depch
Survey Submitted: Yes er No Date of Survey: S -��► �a`I
Proposed Setbacks: �
Froat (�ake}: �05 � Righ[Side: 5�0.� � N
Rear (StFeet): IOOp� 'f' Left Side: I I U�
Adjaceat Structures: — `Vetland: —'
Building Hei�ht: Def. Hgt. c> .K- Peal:Hgt.
Lot Coverage: /� �/�
Grading: Staff Approval Date: -- By: Council Approval Date:
Sep[ic: Staff Approval Date: — By:
Zoning File: # — Resolution: � Resolutioa Date:
Shoreland Dis[rict: ►'�I�
Avg. Se[back: Bluff Setback: Lot Coverage:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-5Q0'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REIVZARKS (in house):
7
. , �
r ,
BUILDING REV�W CHECK LIST
�C� �" 3 CONSTRUCTION TYPE: �/��1
_ Sq Footaje � Per Sq Ftg
B�sement x _
lst F1oor z _
2nd F1oor z =
Garage x =
z -
TOTAL
Estunated Construction Vaiue: $ �,(���v
Inspections Required: `Vork Requiring Separate Permits:
S ite Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�Footing ` Septic Sewer Connection
i� Framing Fireplace Lawn Irriga[ion
� Insulatioa (�fasonry) Other
��Vall Boazd (Mfg.) Well (State Perm.it)
_�Final Grading/Filling �_Electrical (State Permit)
Other
RENLARKS (Pi i HOUSE): .
----------------------------------------------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Ez.isting New
Access Approval: Date gy:
-------------------------------------------------------------------
REMA.RKS (TO BE NOT'ED ON PERivIIT�:
8
�-a �` �J
l�^ <i /'�A E TIME
CITY OF ORONO � CALLED IN T��I
INSPECTION NOTICE SCHEDULED �,�L—
PERMIT NO. f�C 7 70 7 COMPLETED
ADDRESS CL �f�� I`_ ---_���`�-� 1��
OWNER CONTR._����n�!�-
TELEPHONE NO. C'1 J� � �.� -- � ��-�
� DESCRIPTION �/!�� l ��f��i?�)
�
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL i 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU�YES_NO �
� COMMENTS: �
�
W
�
j
o i�� t° eS
a
�
� \ � C
w
�
Q
�
� �77D� rn;,
W
�
�
d /
W WORKSATISFACTORY:PROCEED J2IPROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED �❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WlLL RETURN
7 CITATION ISSUED
❑STOP ORDER POSTED.CA�L INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �952� 249-46QQ
OwnerlContra ite:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice