HomeMy WebLinkAbout2002-P05156 - addn/remodel/repair � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Posisb
Crystal Bay, Minnesota 55323 PeC'CTllt Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: si22i2oo2
SITE ADDRESS: ls2o Fox st
Wayzata,MN 55391
PID: o2-1i�-23-32-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required: Eiec;iricai�s[aiej
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 643.75 Valuation: $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.50
TOTAL FEE: $ 1,087.78
APPLICANT: Anderson Woodcraft Inc. OWNER: Kingsley Mutphy
1438 85th St NW 1520 Fox St
Buffalo,MN 55313 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND GRE O DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MI A BUI ING CODE REQUIREMENTS.
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` PLICAN"I' G GNA E ISSUED F3Y SIGNATURE
Copies: 1-File(Si�nitures Required). 1-Applicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
.
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Total Fee: $ ��,�h'%� �% ���� Date Received: �'� ��� - � - '
Entered By: t"�� Permit#: %,i.-�
� �,,,., CITY OF ORONO - BUILDING PERMIT APPLICATION
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{✓;`�' All information must be submitted in full before plan review will be started.
�; (please print all information)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTOR�
JOB SITE ADDRESS: �,�C% �� ZIP:
NAME OF OWNER: �`� PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:—t1t�
CONTRACTOR: (� PHONE:
CONTACT PERSON: BI��PAGER I'Z_ " �,; Z.�
MAILING ADDRESS:� �>�# �j, 1'v,�. TY. ��''�}-� ZIP: , , l�
STATE LICENSE: # r1�r7.2��q�,
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PR POSED WORK(describe in detai�: � �U�
i '� �- � � �.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
, C�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $�t���"�—
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 unde s 's is not a permit and work is not to start without a
permit; and that the work will be i corda e i the approved plan.
APPLICANT'S SIGNAT / DATE: �j
NOTE! Parade of Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
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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 indiridual. An individual asked to supply private or confidentiai data concerning himself
shall 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 supp(ying or
refusing to supply private or confidential data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data.
This requiremen[ shall no[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�lace the notice reQuired under this subdivision in the individual income tax or oropertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidentiaL Upon his further request, an individual who
is the subject of stored priva[e 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. After an individual has been shown 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 authoriry 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 possible,with any request 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, he shall so inform the individual, and may have an additional five 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
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authority shali within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipienu of 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 statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 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. Yo ame is required to process this application or permit.
First Middle Last
Address
Ciry State Zip Phone
I underst y rights a state ab
Signature
6
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CHECK OFF LIST'"FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /5 Z� �=D x �'i�ZC� 7`
PID: .
DESCRIPTION OF WORK: S�-�!(� v� /�po,��,�
---------------------------------------- -------------------------------------------------------------------------------
ZONING REVIEW BY: DATE APPROVED: S-- �y�v2
BUILDING REVIEW BY: � DATE APPROVED: � - ,�, -o-z
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes �/ No
PLAN REVIEW Yes �' No SEWER CONNECTION
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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ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes � No Date of Survey: O� �=�c.�.s
Proposed Setbacks:
Front (Lake): I)� � � Right Side: � Zc�
Rear (Street): �0� Left Side: Z 3�
Adjacent Structures: �}i 7�-c.(,�� Wetland: /U/�
Building Height: Def. Hgt. tJ . �� Peak Hgt. —'
Lot Coverage: — ���
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # '— Resolution: # Resolution Date:
Shoreland District: /�
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):
7
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BUILDING REVIEW CHECK LIST �
UBC: IZ- 3 CONSTRUCTION TYPE: �//�
Sq Footage $ Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ St�, OoJ `�
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)
_�Final Grading/Filling _pSElectrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMIT):
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N T�C� SCHEDULED
PERMIT N0. �� 5� COMPLETED �- •—��— n " 3 c�
ADDRESS �� �'I -
OWNER CONTR.f�i�1� �'
TELEPHONE NO.
� D TION
OTING 11 MECHANICAL RI 18 EXCA�//GRADING/FILLING
� 02 G 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 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
� OWNERICONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
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ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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Q ❑CORRECT WORK,CALL FOR AEINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-Q6�0
OwnerlContract r�pn site:
Inspector.�.���'✓�c.. � /
White Copyllnspector's Fiie Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOj,�C SCHEDULED � �_
PERMIT NO. �`J COMPLETED
ADDRESS �o�D
OWNER CONTR.��S'�h ��'��-
TELEPHONE N0.�n �� �.5�� ��U2-- --����
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCA�//GRADING/FILLING
Q FR,4MIN 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSU N 24/25 WOOD BURNERIFIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOILOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
` J 10 PLUMBING FINAL 36 FOUNDATIpN/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENT�:
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� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT YJORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-46�0
OwnerlC ctor on si :
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Inspector.
hite Copyllnspector's File Canary py/S1te NoUce