HomeMy WebLinkAbout2005-P08741 - pool PERMIT
CITY �F ORONO
275�U Kelley Parkway - PO Box 66 Permit Number: p08741
Crystal Bay, Minnesota 55323 Permit Type:
Accessory Structures
(952) 249-4600 Date Issued:
6/20/2005
SITE ADDRESS: 855 Forest Arms La Unit#
Mound, MN 55364
PID: 07-117-23-12-0013
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: Residential Census Code 329
Permit Class: Building
Permit T e: Accessory Structures Permit Sub-type(s): Pool-Outdoors-In Ground
YP
D ETAI LS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Pool contractor will be obtaining permit far deck and taking responsiblity for
FEE SUMMARY: Pernut Fee: $ 349.25 valuation: $ 22,000.00
Plan Review Fee: $ 227.01
State Surcharge Fee: $ 11.00
TOTAL FEE: $ 587.26
APPLICANT: Aqua Pool and Spa OWNER: Alan&Barbara Golz
Site Works Design Inc. 855 Forest Arms La
1225 Hwy. 169N Mound, MN 55364
Plymouth, MN 55441
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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C ICANT PERMITEE S[GNATURE �ED BY SIGNATURE
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Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ ��7 ' Date Received: �����y�
Entered By: �� ��-�'� Permit#: �r � �C_�- � G�
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CITY OF ORONO - $UILDII4TG PERNIIT APPLICATION
All information must be submitted in full before plan review wzll be started.
(please pf�int all infof��natian)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle o�ie) O�VIVER OR CO'rTTR.A.CTOR
JOB SITE ADDItESS: ��� ��ps� ��� �- ZLP: --
`Vill this be a Parade of Homes, RemodQlers Showcase Home or other Display Home?
❑ Yes �No If yes, a special eve�zt permit is reqa�ired with Police Departmer7t and City Council approval
� � 60 days prior to lhe e✓ent. Shtrttle bzrs service will be required unless a�plicant demanstrates
sz�cient on-site par�inu is available. Nar Permitted events will not be allowed.
NAME OF OWNER: �L C� D L/ � PIIONE: (home) �2-'y72 �S�Y�,�
�� (work)
MAIg..ING ADDRESS: �.SS' �e�'e S�/�`M CITY: d�'�✓�r' ZIP:
CONTR.A.CTOR: �I��7� f uv�S PHONE: 7�.? '
CONTACT PERSON: K�e�„� MOBYLE/PAGER: (,/2 �Y.��2/�S'
MAILING ADDR.ESS: /2 2s - h%,. �6 9' n� CITY: �C y�- ZL�P: ss-fi1
STATE LICENSE: # �c Z a�2 5r�?7 EXPIRATION DATE: 3-�/ 2��t
ARCHITECT/ENGINEER: PHaNE:
NiATLI�IG AD�I2ESS: CI`i Y: ZIP:
NA�iE: REGISTRATIOI�T: #
T'i'PE OF W0�2.K: New Addition Accessory Structure
Move Home Remodel/Alteration
PROPOSED��IOJEL�(rlescl•ibe in detai�: �o�� .qi,� ,Le �QQ cG,¢e��
�c.�e c�— �ai��- — f�.v-� t�.�s .s1J�=s �.� ri S'rn-iP i..a—
S'�'OI�.i�S: SQ.FE�'�'O�'��C��'LO�IC�:
1�0. OF �ED1ROOidIS: G�fl2AGE S'I'�LLS: A�'I'A��I�I3 D�TACHE�
�S'I'I17AT'E� CO?VSTRUCB'IOl�i VAL,�T��'iai�(eYcluding lancl): 2 Q �
I hereb}�apply for a bui?din�pernu:and I acknowled�e that the;nformation above is complete and accurate;
chat the work wi11 be in conforman�e �vith the ordinances and codes of the City and with the State Buildine
Code;that I understand this is not a permit and work is not to start w�ithout a oern�it; and that the work will be
in accordance with the approved plan.
APPLICA,�T'S SIGNATURE: �� .Vti1L.
� �ECi/G ��s /�D/�Q C� J-� /��U�fMy i/"/� /�.4n Ny�.r P00� �Ant M.�.C:7��. GPi"9-S o Q!'79�.�.�iv S ./).p.,�..i,`�
� �Gk- �'`� ��GiNy �^�'S�b/N p`� • �'� �� �,'7� J `- `
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
5ubd. 1. Type of data. The rights of individual on whom che data is stored or[o be s[ored shall be as set fortlt in this section.
5ubd.2. Information required to be given individual.An individual asked to supply private or confiden[ial data conceming hin�self shall be
informed of: (a)the purpose and intended use of the requested data within the collectine state agency,political subdivision,or statewide system;(b)
�vhether he may refuse or is 1egally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential daca;and(d)[he identity of other persons or entities authorized by stafe or federal law to receive the data. This requiremen[shall
no:apply when an individuat is asked to supply investigative da[a,pursuant to section 13.32,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav ntice the notice required under this subdivision in the individual income ta�or propertv ta�refund
instruc[ions ins[ead of on those ferms.
Subd.3. Access to data by individual. Upon request[o a responsible authoriry,an individual shall be informed�vhether he is the subject of
stored data on individuals,.and whether it is classified as public,priva[e o;confidential. Upon his fui-ther request,an individual who is the suoject oi
stored pnvate or public data on individuals shail be shown the data�vithout any charge to him and,if hz desires,shall be informed of ihe contenc and
meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for si�
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 reques�by the individual subject of the data. The responsible authonty
may require the requesting person to pay the acC�al cos[s ofmaking,ceRifying,and compiling the copies.
Thc responsible authority shail comply immediately,ifpossible,wich any requesc made pursuant to this subdivision,or�vithin five;lays o[
the date of the reques[,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp!y�vith the request
within that[ime,he shall so iniorm the individual,and may have an additional five days«�idtin which to complywith the request,excluding SaturdaYs,
Sundays and legal holidays.
Subd.4. Procedure wheo daca is not accurate or complete. An individual may contest the accuracy or comple[eness ofpublic or private data
concerning himsel£ To exercise[his right,an individual sha!1 notify in wiiting[he responsiblz authonty descnbing the nature of[he disagreement.The
responsible authoriry shall wi:hin 30 days either: (a)con'ect the data found ro be inaccura[e or incomple�z and at[empt to notify pasc recipients o`
inaccurate or incomplete data,including recipients named by[he individual;or(b)notify the individual!hat he betieves the data to be cocrect. Data in
dispute shall be disclosed only if the individual's statement of disa�ceement is includzd with thz disclosed data.
The determinadon of[he responsible zuthority may be appealed pursuan�to[hz provisions of the administra�ive procedure act rela[ing to
contested cases.
DATA PRIVACY AD`'ISORY
In accordance�vith M.S. 13.04,Subd.2;"Rights of sub}ects oi data",we would like to infom you that your request
for a permit or license from the City of Orono or any oi its departments may require you to fumish certain pnvate or
confidential information.
You are notified that:
1. The information you furnish will be used to deterrnine your qualifcation for the pernzit or licease
requested.
2. You may refuse to supply data,but refusal may require that the City den_y the pe:mit or Iicense.
ti. The infor.mation may be sha-ed with other local, state or federal a�encies to the extent necessary to
process the perniit or license.
4. If vour;•equested permit or license requires Council actior.to approve, some infomlation rnay become
nublic.
�. You have certain rignts under M.S. 13.04(zvailable upon request) to revie�v private data on yourset.`.
6. Your full nam�is required to process this appiication or permit.
'First ltiliddle Last
Address
C�h, State Zip Phone
i understand m�� rights as stated above.
Signature
32
' Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom thc data is storcd or to bc storcd shall be as set forth in this section.
Subd.2. Information rcquircd to be given individual.An individual askcd to supply privatc or wnfidential data wnccming himsclf shall bc
informed of: (a)the purpose a�d inte�ded use of the requested data within the collecting state agcncy,political subdivisio�,or statewide system;(b)
whether he may refusc or is legally rcquired to supply the requcsted data;(c)any known consequcnce 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 rcceive 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 rcvenue may place the noticc required under this subdivision in the individual income tax or propertv tax refund
instructions instead of on thosc forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infortncd whethen c�is the subject of
stored data on individuals,and whether it is classified as public,privatc or confidential. Upon his further requcst,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 informed of the content and
meaning of that data. Aftcr an individual has bcen shown the private data and informed of its mcaning,the data nced 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 bcen collected or created. The
responsible authority shall provide copies of the private or public data upon requcst by the individual subject of the data. The responsible authority
may rcquire thc rcquesting person to pay the actua]costs of making,certifying,a�d compiling the copies.
Thc responsible authority shall comply immediatcly,if possible,with any requcst made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,hc shall so inform the individual,and may have an additional five days within which to comply with thc request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completencss of public or privatc data
conceming himsclf. To exercise this right,an individual shall notify in writing thc responsiblc authority describing the nature of the disageement.The
responsible authority shall within 30 days cither. (a)correct the data found to bc inaccurate or incomplete and attempt to notify past recipients of
inaceurate or incomplete data,including recipients named by thc individual;or(b)notify the individual that he bclicves the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The detertnination of thc responsible authority may be appcaled pursuant to the provisions of the administrative procedwe act relating to
con[ested 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 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 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.
, r
�.\
��,C' i ��.� I�C.', r '� 1 C'� (: ��c,, �.-�i 'ti ��x-��;}
First Middle Last
� �r<; �. �.�:..lc;�.�� I���� ��_ �t.
Address
1'��-��� e� �'i�-� ��, - --�--i��� ��1 ��? -- �, .���. ����,; -�,, ���
City State Zip Phone
I understand my rights as stated above.
�'� ,�'�
s�g �
�._ >
32
"�6� - SY� � $�`7-Ei
t ' CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �SS �=o c�r �4-/Lc� S L�-�
PID:
DESCRIPTION OF WORK: N G W Qn�� ,/�.� ,�r-r�-vc � r� �J c-c-��
ZOr1�i G REV�`V BY: DAT'E APPROVED: 6-/S •oS
BUII.DING REV�`V BY: DATE APPROVED: 6-�5 -o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes � No SEWER CONNECI'ION
STATE SURCHARGE Yes � No WATERCONNECTION
INVESTIGATION FEE Yes No ,/ PARK FEE
SAC Yes No �� SITEINSPECTION
Number of SAC Units OTHER (specify)
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ZO�G CH�CK LIST Zoning Districr.
Fire Department: Post Office: Schooi District:
Lot Area: Sq.ft. Acres �Vid[h Depth
Survey Submitted: Yes �l No Date of Survey: oN t=�c�"c
Proposed Setbacks: Po.l O�c.� (�••< <Oc�vc
Front (Lake): 2�r y'_' z�3 � Right Side: ,5 Si � ''-
Rear (Street): `Go' # 63 1 Lef[Side: 7u ' l3� y
Ad;acent Structures: (U' Wetland: µ/ /,�Q
Buildin; Height: Def. Hgt. N /� Peak Hgt.
Lot Covera�e: /V�� c r�r�w.,�,R
Grading: Staff Approval Date: — By: '-' Council Approval Date:
Septic: Staff Approval Date: — By:
Zon.in, F:le: # — Resolution: # Resolution Date:
Shoreland District: ��5 ,
Avg. Setback: c�•�� Bluff Setback: /v�� L.ot Covera;e:
Eusting Proposed
Hardcover: 0-7�'
7�-250' p,�
25a-500' 30"��
50a-1000'
Hardcover Variance Required: Yes No >C Date of Council Approval:
RE�iAR�iS (in house):
�
�
BUILDING REVIE`V CHECK LIST
UBC: _ �• 3 CONSTRUCTION TYPE: VN
Sq Footage $ Per Sq F[g
Basement x _
lst Floor x _
2nd Floor R =
Garage z =
R -
TOTAL
Estimated Construction Value: $�o 00�
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�( Footing � Septic Sewer Connection
_�( Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
__�FLIl� Grading/FIlling � Electrical (State Permit)
Other
REMA.RKS(IN HOUSE): - - -�-----
-------------------------------------------------------------------------------------------------------------------
REV�`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
-------------------------------------------------------------------------------------------------------------------
REI�IARKS (TO BE NOTED ON PERitiIIT�:
8
Total Fee: $ Date Received: �:',`� %��, C�
Entered By: Permit#: � r� �7� �
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR�ONTRACTQ$.�
JOB siTE annREss: ���:>�=� �� i ��_,� ►��r��ti--,� (�-� zir: ���G�-�1
Will 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 approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
suff cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: ��'� C'""C` �Z� PHONE: (home) ��`�-Z-�LI� �-5�-� ��
(work)
MAILING ADDRESS: �h-�'S �-t,;'r;} 1��rw,-� _�,�CITY: � ,'�r-�L. ZIP:5"S"�6'�-I
� � F�X ?�3�c� -gvyb
CONTRACTOR: �'�-,��Y.,,, �{t c�.��� �U��._ PHONE:��L- �--'S LI�-I' ? �E`I
CONTACTPERSON: O MOBILE/PAGER: ��'j�" Z. 3�{ -G`� �
MAILING ADDRESS: 1),�. . 't lu,, �; `��-�;'�_; CITY: t �I ,;� �, _ 14� ZIP:`��� ,- ��
STATE LICENSE: # t'�,(;?.C,,<' l�r�{ <��� r" EXPIRATION DATE: - i � � r � `;' �
ARCHITECT/ENGINEER: � � PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New �� Addition Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(describe in detai�: __t r'1 `�j��..r 1C1 i>C:L � �G '���
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �U, �n�
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 without a permit;and that the work will be
in accordance with the approved plan.
APPLICANT'S 5IGNATURE: ' i/ �! . DATE: �-"��-I C -�'r�
` �_.
31
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�5p Katherine Taylor 's Homes 763-473-3414 p. 4
1`tL (a0��' �t SJ K�vuc �
4-/7-02 FoR�st /�Q,N! '
HARDCOVER CALCULATIUN �VOI�KSHEE'T �
SETBACK ZOIVE: (CIRCLE ONE) Q-75' 75-Z�U' 0-500' S00-1000' ' �
EXISTING HARDCOVER IN ZONE � ,
A, House �; _ � �
2044 S.F. ,
Lcngth �Vidth
� - 7 S.F.-ViwQiovS coNc
... x -_Z� S.F. -Id4R��S �Y;
4-F�+57 , x I 04-wrsr a 108 S.F.-BOutAF,l� i
�
B. Garuge x _ � �
S.F. � �
._. �
C. Drire�vay x = 1520 S.F. �6lAUtTOP i
_ � = 539 S.F. -caNc,�t&`T�
D. Sidewalk x = S,F.— BQIGI� WA�
� = S.F, . �
E. Patio/Deck x = I S.FrEAST �
...... . . . c - s.F:=�/EST i
F. L dsc e x _ }�toER i
Un r uin � —. S.F.� NE CAR �
.... x S.F.
By astic x = S.F. �
Or a ric �
i
G. Other _ ��`� W�p t
x - �: ��` s:F,-w►HoowEL►.S �
TOTAL HARDCOVER IN ZONE . � ;
�$92 S.F. A ;
- • TOTAL PROPERTY A-REA IN ZONE • J 4,� S.F. B' t
... A �' B x 100 = 32.qb % E
.
PROPOSED HARDCOVER IN ZONE' � �
' . A. Housc _ ___- .. ,
� x - �(� �l N S.F. . ,
_.. . I,enB� Width .._ I
(� � x ��• _ /b R S.F./4-�c��ri��, �
�..— x 1$ -�- �X3 = f�S,F. PbRC«/sr'E�5 i
� , x = S7�F-� S.F. �Q.rrousP�c4� ;
k-�Asr �ou-w�sr /v$ sF ►3ouL/Jc2s
B, Garuge x � S.7F.
i
C, Dr'veway x = � S,�D S.F.��-/3-Ck1?9(� ,
,
.__. . . . . x = . . . S.F:�' (
;
D. Sidewulk x = 9(>r S.F.►.r�JwS/�06ru�lct (
--- � � S.P.
E, Patio/Deck x = f�� S.F.�/¢-�-T '
�
X = S.F. r
F. Landscape x - /�S,g,�cc�CS S dg orti�P !
Underlain � _ �F �Rr✓s.��,
- By Plus�ic x = S.F. . '
Or Fabric
G. Other , x = S,F.�ue n W ut�(,��u, �
� 5
.. TOTAL EIARllCOVER IT'ZONE - _�(�� S.F: •-�►
TOTAL PROPERTY AREA IN ZGNE � S,F. � '
A + $ x 100 = alq �'c ' -
R..,��,..os--.t..��: _......__. � � ,
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`\' -�'� �� �, wEw 5r i,: ' �IJVDUAL �/�
�,. �__ ,�`T.��-�':,• 'R�KS ORONO
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< ,;.,,; r,`w,�-5,°"""".:�'� �. S1TE P'LAN GRADING PUN
Fr�,�r
�� �� J�.� ��' `�\ .�oP.r�lp �r
Q � u�A�PFRO�YED �.-�-.r' o * Ao��
��� CONCRE:TE �,� 4s.e ❑ RPP�OVED W1TH REV! ONS CO CRET'
� D � E�I S T I�� 'Q•4 OVERHANG / LJ IJI�r1�r" OV 80 OER
CONC. �
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250' SETBACK LINE•.•••''. �\ `��"'°"` °��.�E�t
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BOULDERS � � �� � `�
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CONCRETE 80RDER 0��EPPING i n �
S70NES V
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/�/ �^ �"`� DA��� � TIME �
CITY OF ORONO CALLED IN � � /�-�
INSPECTION N TIC / SCHEDULED ��aSL/QSr�
PERMIT NO. r, � COMPLETED
ADDRESS ��
OWNER CONTR.�«_.�l?r ��;J
TELEPHONE N0. �� ���� �-' �� �s
� DESCRIPTION � ��G�
� 01 FOOTING 11 MECHANICAL RI 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 O6 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 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:1�YES_NO
! �
� COMMENTS:
� -��,� i� l f�.�� `���
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0
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W ORK SATISFACTORY:PROCEED C PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED - ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR RE�NSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. jJ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR n CITATION ISSUED
❑ INSPECTfON REQUIRED.CAL�TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContractor on site:
Inspector. ��� � 6 's�i�-�
White Copyllnspector's File Canary CopylSite Notice
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EXISTING �.� , �:� �-�oQ ,�2 :�
HoIJSE . � �G °26
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� \ '�, • � resn.,.�- •,. `'R�KS
DECK� � � ' � � ` .' - �s''�<�•�+�•�'� 5�� THIS CORNER FALLS
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^ Ur �\\ _poa.r��'� li�� L •�"TN ARBORVITAE BU�H
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�t,�� CONCRETE
�.1� CONCRE�TE °s/6 �
� D � E�I S�I�� '0.4 OVERHANG i BORDER :•
CONC.
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250 SETBACK LINE••''� � " --- � a
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BOULDERS �
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CONCRETE BORDER ��0�EPPING
STONES
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