HomeMy WebLinkAbout2004-P07421 - land alteration � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�42i
Crystal Bay, Minnesota 55323 Permit Type: user Defnea
(952) 249-4600 Date Issued: sisi2oo4
SITE ADDRESS: 785 Ferndale ud N
Wayzata,MN 55391
PID: 36-118-23-11-0012
DESCRI PTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(SOl+cu yd�
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/Self OWNER: Michelle&Thomas Cullum 7r
� 785 Ferndale Rd N
Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TFIE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STWCT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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ALICANT PERMTI EE SIGNATURL � � ISSUED BY SIGNATURH
Conies: 1-File(SiQnitures Repuirecl), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
' � ,¢0� City of Orono FOR CITY SE ONLY
P.O.Box 66 Date Received: -�p'� Permit#�}���Z�
��� � r�� 2750 Kelley Parkway r;-��ti r�
�;
� q1�3 ���, � Crystal Bay,MN 55323 �) �� Amount: $ � , .�"C.U.P Filed:
�' '1`�nii���` (952)249-4600 (.��� —�„—
�",r�,,�t�
��H� Approved By: Site Plan:
Recommends: A roval ❑ Denial ❑
CITY OF ORONO - USER DEFINED/GENERAL PERMIT
(All pennits must be approved by the Building Official and/or Zoning Department)
Job Site/Owrler Information:
Site Address: � � � � .• `��2 N�DP� , �
Owner: ��,n�A S � ��u,���t l,U.��u� Mailing Address:
City: [/U/�✓I Z.�.-r� Zip: S S � � �
Home Phone: �� 2 � � (0 1 �(� v Alternate Phone:
Contractor/ Applicant I�iformation: �
Contractor/App.: � �� Lkr�c�SC.a�n�� Contact Person: �-(.� �� ��
Address: 333 �- -r- ,�,lQ. �C State License #:
�—
City: S��li(,�� Zip: 5 S 3?�O Expiration Date:
Phone: 7(� 3 �� 1 �Z o 0 Alternate Phone:
TYPES OF USER DEFINED PERMITS
❑ Stairway to Lake ❑ Retaining Walls ❑ Temporarv Trailer
General-User Defined Surcharge General-User Defined Surcharge General-User Defined
*(Per UBC) * (Per UBC) * $30.00
*Estimated Cost: $ *Estimated Cost: $
❑ Docks-42"or Greater �Land Alteration ❑ Zonin�Review
General-User Defined Surcharge � ���General-User Defined General-User Defined
❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-7S Zone-$30.00
*Estimated Cost: $ �- $SQ.QQ rN�ice Ptan
General-User Defined � 501+CubiC Yards
❑ Residential- $30.00 �50.00 (Needs C.U.P.)
❑ Tree Removal
General-User Defined
*Within 0-75' -$30.00
I herby apply for a User Defined 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 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.
�� Z�o 'vL�
Applicant Date
(User De6ned Pem�it 3/18/44)
CHECK OFF LIST FOR ISSUANCE OF PER��lITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 7 S�S (Vo• F�2►.��A��
PID: '
DESCRIPTIONOFWORK We'rc�.�� ���,�-_—� o,.>
----------------------------------------�5�-----------------------•�----------------------------------------------
ZONING REVIEW BY: DATE APPROVED: �- 3 -�Y
BUILDING REVIEW BY.• N� � DATE APPROVED:
------------------------------------------------------------------------------------------------------------------------
FEES TO BE CHARGED: `°�"��-� ����`` � Fees Calculate�By:
isc.
PERMIT Yes ✓ No
PLANREVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
------------------------------------------------------------------------------------------------------------------------
ZONING CHECK LIST Zoning District: (Z R� � �
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width j3� Depth �l K7 � Y'
Survey Submitted: Yes_ � No Date of Survey: �2,-1�(-O 1
Proposed Setbacks:
Front (Lake): Right Side:
N . a4,
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
Grading: Staff Approval Date: ,S- 3 ��`T By: -��• Council Approval Date:
Septic: Staff Approval Date: N /13 By:
Zoning File: # �l-Z`1 b S Resolution: #t S!i � Resolution Date: Z-23 'a y
Shoreland District: N�
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval.•
REMARKS(in house):
32
BUILDING REVIEW CHECK LIST
UBC: — CONSTRUCTION TYPE: `�
Sq Footage $Per Sq Ftg
Basement x _
Ist Floor x _
2nd Floor z _
Garage X _
x =
TOTAL
Estimated Construction Value: $
Inspections Required: Work Requiring Separate Perntits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
In.rulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
_,�Final Grading/Filling Electrical (State Permit)
Other
------------------------------------------------------------------------
REMARKS(INHOUSE):
---------------------------------------------------------
REVIEW BY OTHERS: DATE: �
Access: Existing New
Access Approval: Date By.
--------------------------------------------------------------
REMARKS (TO BE NOTED ON PERMIT):
33
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUZLDING PERI�IIT APPLICATION
All information must be submitted in full before plan review n-ill be started.
(please print all ir:formation)
------------------------------ ------------ --------�-I--A------T------------ -------------------------
THE APPLICAIVT IS: (circle o�te) O«�E R COrTR�CTOR
� ;-� @ ,
JOB SITE ADDRESS: _���� � . �-�,(�/1G�1���E_ (�A �,'� �a�t`���t�� �`�ZIP: �����j`i l
`Vill 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 City
Council apprci�al 60 days prior to the event. Nor permitted events will not
be allowed.
_� �nI
NA��IE OF O`VNER: � �i�✓i,1n-� � U��� �,�c,�►n.� PgONE: (home) �l1 (n �l�(��
(work) �2 �(o�( �3 aS
MAILING ADDRESS: Jl S S �, �n� � 20� CITY: .nT,r�. ZIP: 5�3� I
CONTRACTOR: �-- � �- L�� sc/�(�rN(� ,S,,v� PHO�'E: 7G 3 ��7 �f?o 0
CONTACT PERSON: �(,� �L�� (�.i,Q,1�a 1�IOBILE/PAGER:
NIAILINGADDRESS: 33�, ��-r Q„�-c N� CITY: � ,/1/�wc�,,•L ZIP: s�3�(�
STATE LICENSE: #
ARCHITECT/ENGINEER: �N✓�2an �,—.�-L PHONE: °r 5 2 `-Lo t �?S�
�ZAILING ADDRESS: C,� W `0 6Lou Lq,v� CITY: S.[fo2�wov a ZIP: SS�3 1
NA1�IE: dl/�tl�..F (7e� re� REGISTRATIO\ r
TYPE OF�VORK: Ne�v Accessory Structure
Addidon l�Io��e
RemodeVAlteration Land Alteration �_
PROPOSED `'VORK (describe in detai�: _ p� p,-P��,�p �,N Cc-rz� � c/r�C e �
�7,eS� LvT��'L � S 1 I $— {��n►� 2�3���,sv�,
STORIES: 1'J/-�- SQ. FEET OF EACH FLOOR: /l��I-
NO. OF BEDROOMS: /J� GAR-�GE STALLS: ATT. � DET�
ESTI`IATED CONSTRUCTIO�' VALI;�TIO:V (excluding land): �_ 2,`j , p p O . p p
I hereby apply for a buildin�permit and I aclazo-::'.edQe that the information above is co~plete and accurate; that the
work will be in conformance �Lith the ordinance� and codes of the City and with the Sate Building Code; that I
understand this is not a pernut and work is not to�:art��ithout a pernut; and that the wors n-ill be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: DATE: �Z� �v
Sec.13.04 RIGHTS OF StiBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shail be as set forth in this section.
Subd.2. In[ormation required to be given individual. An indi�idual asked to supply private or confidentlal data concerning himtelf shall be
informed o[: (a)the purpose and intended use of the requested data within the collecting state agency,political sabdivision,or statewide s}-siem;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplyin;or refusing to supply
private or confldential data;and(d)the identity of other persons or entities authorized by state or federal law to recrir e the data. This requinment shall
not apply when an individuai is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a l�w enforcement officer.
The commissioner o[revenue mav lace the notice re uired under this subdivision in the individual income tax or ro ertv taz refund
instructions instead of on those forms.
Subd.3. Access to data by individual. lipon request to a respoosibie aut6ority,an individual shall be inlormed whether he is the sabject of
stored data on individuais,and whether it is classified as pubiic,pricate or confidendal. lipoo 6is further request an individual who it the svbject o[
stored private or public data on individuals shall be shown the data without any cha se to him and,if he desires,shall be informed of the content and
meaning of that data. After an individuai has been shown the private data and inCormed of its meaning,the dau oeed not be disclosed to him for six
months thereafter unless a dispute or action pursuant to this section is pending or addirional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or public data upon request b}-the individual subject of the data. T6e responsible authoriri-may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,itpossible,w ith any request made pursuant to this s�bdivision,or w ithin five da}�of the
date of the request,excluding Saturdays,Sundays and legal holidays,i[immediate compliance is not possible. If he annot rnmpl}�with the requeu within
that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,eacludin;Saturdays,Sundays
and legal holida}•s.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness o(public or prn-ate data
concerning himself. To exercise this right,an individual shall notify in writing the respoosible authorih�describin;t5e nature of the disagrtecnen4 The
responsible authority shall within 30 days either: (a)correct the data tou�d to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notlf��the individual that he beL'eves the data to be correct Dsta 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 of the administrati�e procedure act relaone to
contested cases.
DATA PRIVACY AD�TSORY
In accordance with 1�1.S.13.04,Subd.2,"Rights of subjects of data",�ve would 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
confidential information.
You are notified that:
1. The information you furnish will be used to determine}-our 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 federa!agencies to the estent necessar�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 1�I.S. 13.0�3(a��ailable upon request)to review private data on}-ourself.
6. Your full name is required to process this application or permit.
� � M/� !�t /(�f li1� �
First �Lddle Last �
6 S 1� . (-e�2N D.n-�..� t���
Address
�'`� n./ S �39 9S2 �f 7�
�,ty
State Zip Phone
I understand my rights as stated above. .
�
Signature
. �� � /� �:�c����..a ��� ����
- GRADIN� � L :������� � x..� : .
AN � ���
������ ����
� N
. -- ...,
��'`Loth on line ;-25' Minimum Buffer
� ' MCWD AND PUBLIC VALUE CREDIT
!'�� ��,Property Line AREA 3.39 AC
_ :;y� ��fl.=�k.�!c:;��::�::�:=:_:=::=_=::�::=:=-::�_=:::= ,��� �e{
1 :-:�:-:=llrre�`'•: •-:i�R�iQ.•�-���:� - 1C�---- 8t1
.....••••----._ .. . •-
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......•••••--•--. . .. -.
. ....................::..•: • -•-••._.. .._..•--- .• " \
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- --•........... .... ............. ........•----- ... ...
:_:-:::-=::=:��:::::=::::=:: ::�#:�:::._:::::.�::-�:- \ -.�-,��� � M���c��
--- -�---
. ri-:::::•::::::::::•::-:::�= j - - � ��6 5
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�rr.=::•:__':::':_.. � � � � �..
`u�" r � / �-�: \
''�'�_ •25, aLJ/... �� � — � �. -'�'. � �
:^;::.::= o� \t --- ..
`rt : ..�...-Lafh on line�e�� � .
�� - :-;� : •__......::::•::_�•
::�=� � �,ea � ::_.::::_=_:�::�-::-_:::=
ALLOW FOR == � �- - �� �� REFER TO KJOLHAUG i1�7LAND BUFFER s MiN. �cTM Posr
._ . . : :::.:... �-� -�
DRA/NAGE �NRU 15 �8��� � � �` PLAN FOR BUFFER TREATMENT � AT 4� AIAX• 3PAqNG
BERM. - -.-�- i:� - - � � / GEOTDCTILE FABRIC
'`,4:�� ,f'•� _"- ':.
_ f � • FABRIC ANCHORAGE TRENCH.
� � / ����.: / DIRECl10N OF i�' BACKFlLL IMTH TAMPm
;:::;:� + NATURAL SOIL
NOTE.� '-::.-v, . WETZAND y RUNo� �t.ow �
, � - IMPACT `�0 '. / .��A� B ;, .
CONSIRUCT BERM 15f W1DE, :: •-•::::-:
TOP ELEVA 170N = 99.0 (APPROX/MA TEL Y -- =- AREA ' � � �
0.5' ABOVF VYFTLAND ELEVA110N.) _ �=..�; I r / .r...,�.�.._.,.._�.._�__..,..�..,«�.-^,-�-,_,�.--.z:,__ �vg� MIN s.� �
� -:�:::_:'-
--_::�=:::: �, �•:�.:�--`� � ��'�,� ,- - G�TY ��� �����
;_,:.::::::
PROPOSED WETLAND IMPACT = 2,135 SF _.f _:,-'.. � ,/��� � �C �v`IT� Fi��I _,,�. Cii�F'.E_';i'�ix ?�PAIiJ 1 SILTFENCE DETAIL
. __-.l _�-':�-
TOrAL M171GA170N AREA=2,135 SF � � ��� �G,� ��,�����(j,!f�� S —SF—SF—�—DETIOiES StI.T fENC�
25' BUFFER AREA=5,157 SF :-::•.= : :fl� ../ � � �� � , ��• ` ,� , .�. ,„
1 � G U �Y a' � t. ;,'. :�"� :Y
16.5 BUfFER AREA=6,630 SF ��.::==:=-. --- • �- ._
'>'=�::=-�-. � , �� �E��.�, �--�.
TOTAL BUFFER AREA=11,787 SF ..... ::-:••-•- / � ��� ; �' ��� `'
:L:-:- _'-:�'-��. � � � �, .'
- • "�` �-€�_-'�i�t:"ine / �/ �� s ��,��----=�-�'n A~-�---�-�.�,..4.. ���, '•� .<:''s.... i ' E " � 1, `
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°� ` ` �
xrf, � � ��.1;:
` 1 P�operty Line�-•• - � ';f;
P�operty Desc�rption: _ _ l \ � � � �
\ �)
T�oct B, Registered Lond Survey �' � Note:
No. 1031, Hennepin Counfy, Minnesota, � 1. Wet/ands Delineoted by.
occording to fhe files of fhe Registrar of Trt/es_ Kjolhaug Environmenta! services.
Z The buildings, if any, were
nof /ocated os parf of this survey,
— — FIGUR� 3
R8qU2St8d By: I HEREBY CERTIFY THAT THIS PLAN
denotes iron monument found sPEaFicA�oN, OR REPORT ' Revised:
f �^y� WAS PREPARED BY ME OR UNDER Web Site: 11/Ol/02 KDK
Q denotes iron pipe S@t T�� CU�IU1 1 i MY DIRECT SUPERVISION WWw.offOaSSOCI�eS.Coti1
orra�aaa3 ANO THAT I AM A DULY LICENSED �
QI'1Cj marked as shown: ° PROFESSIONAL ENGINEER UNDER THE �
orro-�oosz o 9 West Dtvlslon S�. .
❑ denotes � wood loth Date: Drawn By: Scale: Checked By: Mo���P T�E�ST�ATE OF MfNNESOTA T Buffalo, MlV55393 Job No.
P Ph:(763)582-4727
� denotes soil boring ssoClATEs F�; ) � 639
08�14�02 KDK 1"=50� LICENSE # 19901 Engineers and Land Surveyors, Inc. (763 682-3522
O denotes ercolation test hole .