HomeMy WebLinkAbout2000-P02394 - pool � �
PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: po23aa
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(612) 249-4600 Date Issued: si9ioo
SITE ADDRESS: 1540 Fox St
WAYZATA,MN 55391
PID: 02-117-23-32-0003
DESCRIPTION:
Construction Type VN
Proposed Use:
Census Code 329
Permit Class: Building
Permit T e: Accesso Structures Permit Sub-type(s): Building-Pool
YP rY Accessory Structure
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SU1111MARY: Permit Fee: $ 209.25 Valuation: $ 12,000.00
��.,���,-� R-e���.,� i�s.`(�
State Surcharge Fee: $ 6.00
TOTAL FEE: $ 351.23
APPLICANT: Pooi,& sPa corrcEPTs OW NER: J A NOLarr&J a rroLarr
6415 WAYZATA BLVD 1540 FOX ST
ST. LOUIS PARK,MN 55426 WAYZATA MN 55391
THE LJNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPEC[FIED
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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APPLI ANT PERMITEE 1 NATURE ISSUED BY SIGNATURE ��;j�/
L..��'�)
Copies: City,Applicant,Assessor,Finance Page 1
� `
Total Fee: $ _ _`S/ 3 Date Received: '�����O�
Entered By: ��y; Permit#: �}p�^3 G
CITY OF ORONO - BUII.,DPtG PERNIIT 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 CONTRACTOR
JOB SITE ADDRESS: J� `�� �'G� .�/����J ZIP: 5 S.3L%f
NA1�fE OF OtiVNER: .�Gl�l�l� JGff'�I( �GLfj"!� PHOi�tE: (home) `f 7 3 -G.3 7�
(work)
MAII..�1G ADDRESS: 1 S �v �c x S T���T CITY: c%�c�sl� zIP: � '3�'
CONTRACTOR: �'��GL �SG'� GGl�IGE-�� PHONE: �76 l/S�
COi�1TACTPERSON: �?cSS �'c-��.5�'��MOBILE/PAGER: ��fS --i�'/ Z .
M�iILI11G ADDRESS: 64�l5� w�t�l�t��l4C.�l� CITY: S i����^�ZIP: SS���' .
STAT'E LICEl�SE: # ��/� ��.Z�3
ARCHTTECT/ENGINEER: PHONE:
1�iAILII�'G ADDRESS: CITY: ZIP:
N�,�: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: �-��7�' �Gc� �
STORIES: SQ.�'EET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTII�IATED CONSTRUCTION VALUAT'ION (excluding land): $�?;GGc; � �' _
I hereby apply for a building permit and I acknowled�e 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 SIGNATLTRE: l`� -� � DATE: zE' �G
NOTE! p�rade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Szc.13.0�i RIGHTS OF SUBJECTS OF DaTa
Subd. 1. Tvpe of data. The righcs of individual on w�.�che daci is s.ored or co be smred shall be as sec fonh in this secrion.
Subd.'_. Information reqirired to be�ven individual. ?.r individ.:al asked to supply privace or confidendal dam conceming himself shal!
be informed of: (a)the purpose and incended use of che czques�i�a Wi�hin'''--colleccing'snrr agency,potidcal subdivision,or sratewide rystem:
(b)whether he may refuse or is legally requiced[o supply the reques.�:aci:(c)��+ciown coasequence arising from his supplying or refusing to supply
priva�e or conndenrial data;and(d)the idznrity of ocher persoas or e-�es au[he��by ssate or federal law to receive che dara. 'Ihis requiremeoc s6a11
not apply whzn an individual is asl:ed to supply in�•esrigadve daei.,�'suanc to s.-=�on 13.82, subdivision 5, co a law enforcemenc ofFicer.
The commissioner of re�e�u mav pla-�the nodc� r�-�-� und�-��s subdivision in the individual income tax or propem taz refur.d
instrucdons instead of on �hose forms.
Subd. 3. Aecess to data b�individuaI. tipon requesc�i r:sponsib?e aurhoriry,an individual shall be informed whether he is the subjecc
of stnred dara on individuais,and whe:her it is class�ed as pubiic. :-va�e or cen:.dendal. lipon 6is further request, an individual who is the subjecc
of stord privace or public dara on indir•iduals shall be shown[he c3 wichout aay caarge tD him and, if he desires, shall be informed of the concent
and meaning of chat data. After an individual has bezn shown rhe:-•ra�.dat�a=d iniormed of its meaning, [he data need not be disclosed ro hun for
six monchs rhereafter unless a dispute or acrion pursuanc to �his scr��is per.c�:.3 or addidooal dara on the individual has beea collected or creaced.
The responsibte authoriry shall provide copies of che priva�e or pubi:='_:ca upor..�,sest by the individual subject of che dara. Tne responsible au�horiry
may require the requesring penon to pay [he acalal cos�s of maki:.=.:errifYin�.3"-d compiling che copies.
The responsiblz auchoriry shall compiy unmedia[ely, if=:�:ble, w:,_^.3^.y requesc made pursuant to this subdivision,or wichin five days of
the dar`of cha request,excluding Saturdays,Sundays and legsl holi.'s;s,if is.r-.�3m compliance is not possible. If he cannot compty with the requesc
wi[hin cha�cime,he shall so inform che individuai,snd may have a:.-�:�irional fi��e days wi[hin which to compiy wi�h the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure whea data is not accurate or com_iete. An ir�':v:dual may contest[he accuracy or compleceness of pubiic or pri�•ate '
data concorning himself. To exercise�his righ[,an individual shall=_c:'y in wr.==��:e responsible auchoriry dzscribing[he nacu:e of the disagreemeac. .
The responsibla authoriry shall within 30 days ei�`:er. (a)correct-�'_ira four_3�be inaccurare or incomplece and aaempc[o nodfy past recipients of
inaccura�e or incomplete dac�, inctuding recipiena named by [he i�:_•ridual; or(b)eodfy el:e individual chat he believes che dara to be correct. Data
in dispu�e shall be disc'.osed only if che individual's statement of c_�_reemenc is i.cluded wich the disclosed data.
The de�erminadon of the responsible au[horiry may be �_ealed pu:ss3:.c to the provisions of the adminisaarive procedure act relacing to
contested cases.
DAT� PRl�'ACY �,DVISORY
In accordance wich M.S. 13.04, Subd.2, "Riah��:subjer's ot data", we would like to inform you that your reauest
for a permit or license from che Ciry of Orono or �.� oi its de�z-tments may require you to fumish certain private or
confiden[ial information.
You are no[ified that:
1. The information you furnish wiil be use�:o decer—�....:=e your qualification for the perm.it or license requested.
2 You may refuse to supply da�a, but re:.:�al may :�quire that the Ciry deny the permit or license.
;. The information may be shared with ot.==Iocal, stac�or federal a�encies to the extent necessary to process
the pemut or license.
.}. If your requested permit or license re.^_:res Co�.cil action to approve, some information may become
public.
j. You have certain ri�hts under N1.S. 1:.�� (ava�?able upon request) to review private data on yourself.
6. Your full name is required ro process :� appl:�on or permic.
First �tiddla Lasc
?�ddress
Ciry S`�.s Zip Phone
I understand my ri�hts as stated above.
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c�9�O _
Signacure
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: /S yc� F-�� snu.�7'
PID:
DESCRIPTION OF WORK: v v � — �pulc,� cx �snn� c�
ZO�iI�i'G REV�W BY: DATE APPROVED: S-3 -o0
BUILDTi�1G REVIE`V BY: DATE APPROVED: .5 - 3-v�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes =� No SEWER CONNECTION
STATE SURCHARGE Yes / No WATERCONNECTTON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZOt�tI��1G CH�CK LIST Zoning District: GZ/Z. • I�
Fire Department: (.� Post Office: (�ca� School District: (�2e�N�
Lot Area: Sq.ft. ��1��� Acres Width Depth
Survey Submitted: Yes ..c No Date of Survey: vN �< <-�-�
Proposed Se[backs:
Front(Lake): ZZ� � Right Side: Z'3 � t
Rear (Street): I t�5� � Left Side: Z L v` t
Adjacent Structures: 1 O S' � Wetland: N�l�
Building Height: Def. Hgt. — Peal:Hgt.
Lot Coverage: —
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
N � . Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RENLARKS (in house):
7
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BUII.DING REVIEW CHECK LIST
�C� � ���'' C ONSTRUCTION TYPE: ���
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z =
2nd Floor x =
Gazage x =
x =
TOTAL
Estimated Construction Value: $ / 2, v c�u `�
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
x Footing ` Septic Sewer Connection -
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
� F�� Grading/Filling Electrical (State Permit)
Other
REi�1ARKS(IN HOUSE): .
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By:
REVIARKS (TO BE NOTED ON PERitiII'1�:
8
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