HomeMy WebLinkAbout2005-P09156 (entrance monuments) PERMIT
CITY �F ORONO
275�Z Kelley Parkway- PO Box 66 Permit Number: Po9156
Crystal Bay, Minnesota 55323 Permit Type:
Accessory Structures
(952) 249-4600 Date Issued:
9/20/2005
SITE ADDRESS: 1070 Ferndale Rd W Unit#
Wayzata,MN 55391
P��� 02-117-23-43-0002
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Accessor Structures Permit Sub-type(s): Entrance Monuments
Permit Type: y
DETAILS:
Approved per resolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ g3.25 va�uation: $ 3,000.00
Plan Review Fee: $ 54.11
State Surcharge Fee: $ 1.50
TOTAL FEE: $ 138.86
APPLICANT: Jyland Distinctive Homes OWNER: Timothy&Rosie P Owens
401 E. Lake St 1070 Ferndale Rd W
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.
,-1.
� �.� ,� � G� � /? ����
f P LICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE
Copies: l-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, l-Septic) Page 1
, � `��' �iZ�
Total Fee: $ j � > n � DateReceived: �����J-�`5
Entered By: ,;,��� (; ��� Permit#: _�����( Q��
�.._
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before Plan review will be started.
(please pi•iizt all information)
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-- �—�
THE APPLICANT IS: (circle one) OWNER CONTRACTOR��
_--
JOB SITE ADDRESS: �b�0 ��e��deLCi� t� V�}. ZIP: �39' I
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Homc?
❑ Yes �NO L/'yes, cr specin!event permit is reqirirerl with Police Deparlment and City Co�i�rTcil approvn[
�� 60 clnys prior to/he event. Sh:dtle fius service wi!/be reqtiired unless upplicant denaonstrntes
sufficient arsite pcu�king is available. Non-perrniited even/s wil!not be nllowed.
NAME OF OWNER: �Vv�� 'Q�SI�_ �w Fi�� PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: �.�� �o�� ��ti�n�#vv-� ��o�__, PHONE: �iS��I�`�-�`� C`��
CONTACTP�RSON: `�� �p,,`�go�--, MOBILE/PAGER: lQ�d �-$�� N'�1
MAILINGADDRESS: c�b� � , 1.�� S`f-, CITY: ���� ZIP: SS�qI
STATE LIC�NSE: # �3ry(Q�Z5 EXPIRATION DA I'E:
ARCHITFCT/F,NGINEER: -�OY��� N�tl„�;�c� PHONE: �Q�2'3�l �{l�{Z�
MAILINGADDRESS: 'LZ5" �'ra.-�1c.�-4- St�-., �,�,,,,,",� �{'�{'"1 CITY: �`�;�,�hy�ar�p�`i1 ZIP: �S�tD�
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure �
Move Home Remodel/Alteration
PROPOSED WORK(describe in cletai�: ���n��y��-j �, ,��-� G�
S'I'ORIES: SQ.F�C'I'O�'�ACI�FLOOR:
NO. OF BEDROOMS: GARAG� STALLS: ATTACHED DETACHEll
ESTIMAT�D CONS'I'RUC�'ION YALUATION(excluding land): � j��o�`�
I hereby apply for a building 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��vithout a permit;and that the work will be
in accordance with the approved plan.
AYPLICANT'S SIGNATUR . ' DATE: 1 D�
31 '
�
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. '1'ype of data. "fhe rights of individual on whom the data is stored or to be stored shall be ai set forth in this section.
Subd.2. Infonnation required to be given individuaL An individual asked to supply private or contidential dataconcerning himselfshall 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 legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or conYidential data;and(d)the identity of other persons or entities authorized by state or federal Iaw to receive the data. This requirement shall
not apply�vhen an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enCorcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propertv ta�refimd
instructions instead of on those fonns.
Subd.3. Access to data by individual. Upon reyuest to a responsible authority,an individual shall be infonned whether he is the subject of
stored data on individuals,and whether it is classitied as public,private or contidential. Upon his further request,an individual who is thc subject of
stored private or publ ic data on individuals shal I be shown the data without any charge ro him and,if he desires,shall be informed of dic content and
meaning of that data. After an individual has been sho�vn the privale data and infonned of its meaning,the data need not be disclosed to him for six
months thercafter unless a dispute or action pursuant to this section is pending or add itional data on the individual has been col Iected or created. The
responsible authority shall provide copies of the private or public data upon requesl by die individual subject of the data. The responsible authority
may require the reyuesting person to pay the actual costs of making certifying and compiling the copies.
The responsible authority shall comply immedialely,if possiblc,with any request made pursuant to this subdivision,or widiin tive days of
the date oY the request,e�:cluding Saturdays,Sundays and legal hol idays,if immediate compl iance is not possible. If he ca�mot comply with the request
�vidiin that timc,he shall so inform the individual,and may have an additional tive days�vithin which to comply�vith dic rcquest,excluding Saturdays,
Sundays and Icgal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest lhe accuracy or completeness of public or private data
concerning himself. To exercise this right,an individuai shall notily in writing the responsible authority describing the nawre ot�the disagreement.The
responsible autliority shall within 30 days either. (a)correct the data found lo bc inaccurate or incomplete and attempl to notify past recipients of
inaccurate or incomptete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be cocrect. Data in
dispute shall be disclosed only if the individual's statement of disagrcement is included with the disclosed data.
"The determination of the responsible authority may be appealed pursuant fo the provisions of the administrative procedure act relating[o
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 pei7nit or license from the City of Orono or any of its departments may rec�uire you to furnish certain private or
confidential inforniation.
You are notified that:
l. The infonnation you furnish will be used to detennine 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 agencics to the extent necessary to
process the permit or license.
4. If your requested permit or license requires Cowicil 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 111iddlc Last
Address
Cit,y St:�tc 7.ip Phone
I understand my rights as stated above.
Signature
32
� CHECK OFF LIST FOR ISSUA.��TCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: I��o Fcr�lp�Av� �`���
PID:
DESCRIPTION OF WORK: EtiT/li4-s�� /vL���•�-�S t� r�r-i �•4%Z:
Z0�1I�tG REVIE�V BY: DATE APPROVED: � •�b� o �
BUII,DI�'G REVIEW BY: _ DAT'E APPROVED: � - i 6 - o s
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes �/ No SEWF�C0�INECTION
STATE SURCHARGE Yes � No WATERCONNECTTON
INVESTIGATION FEE Yes No �/ PARK FEE
SAC Yes No �/ SITEINSPECTION
Number of SAC Units OTHER (specify)
-----------------------------------____-----------------------------------------------------------------------------
ZONI�IG CH�CK LIST Zoning Districc:
Fire Department: Post Office: School Dis[rict:
Lo[Area: Sc.ft. Acres Width Depth
Survey Submitted: Yes_� No Date of Survey: o n< <=�v� I- Z S ' 0 5
Proposed Setbacks: ,
Front (Lake): Z� ' Right Side: �d i'
Rear (Street): yoo� i Left Side: �"fJ� �
Adjacent Structures: Z.y 0 � Wetland: '�J � 'ti
Building Hei�ht: Def. Hgt. � 1 Peal:Hgt.
Lo[Covera�e: � (l�
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: �"r By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: -�
Av�. Setback: Bluff Setback: L.ot Coverage:
Existin� Proposed
Hardcover: 0-7�'
7�-250'
2�0-500'
�00-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RE�iARKS (in house):
BUILDING REV�W CHECK LIST
�C� " CONSTRUCTTON TYPE: —
Sq Footage $ Per Sq Ftg
Basement x _
lst Floor x _
2nd F1oor R _
Garage x _
x =
TOTAL
Estimated Construction Value: $ 3,Onb `'�'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
or Foo[ing ` Septic Sewer Connection
Framing Fireplace Lawn Irrigatioa
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
� F�� Grading/Filling �_Electrical (State Permit)
Other
REMARKS (ni t HOUSE): � �
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REVIE`V BY OTIiERS: DATE:
Access: Existing New
Access Approval: Date gy.
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REVIARKS (TO BE NOTED ON PER1VfI1�:
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