HomeMy WebLinkAbout2000-P02726 - addn/remodel/repair PERMIT �
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2�26
Crystal Bay, Minnesota 55323 P21'1711t Typ2: Addition/Remodel/Repair
(612) 249-4600 Date Issued: ��2s�2oo
SITE ADDRESS: ts6o FoX st
WAYZATA,MN 55391
PID: o2-1i�-2�-32-0006
DESCRIPTION: UBC occupancy ul
Construction Type VN
Proposed Use:
Census Code 438
Permit Class: Building
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Single Family
DETAILS:
Approved per resolution#:
Separate permits required: Eiecuicai(staie j
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 153.25 Valuation: $ 8,000.00
Plan Review Fee: $ 99.58
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 256.83
APPLICANT: 1'ERIGAN CONSTRUCTION OWNER: W MACMILLAN ET AL TRUSTEES
27741 UN[VERSITY AVE NE 1580 FOX ST
ISANTI, MN 55040 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.
, �� �
APPLICA R EE SI , TURE SLTED BY SIGNATURE
Copies: City,Applicant,Assessor, Finance Page 1
� Total Fee: $ �S-(o . �,3 Date Received: ��a'-'���
Entered By: _ Permit#: ,�_��`�4
CITY OF ORONO - BUILDING PERNIIT APPLICATION
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 CONTRACTO
JOB SITE ADDRESS: ��(,�G� �� �, U�,..�� �'�I�c.J ZIP: �S3`� �
NAME OF OWNER: I,c1,�,-r��� /�A�/��ic�,�,�, PHONE: (home) i�.�,3 --S£'��/
(work)
MAILING ADDRESS: 1��,,�-, ro X ��. CITY: [;e,c,"� ZIP: 5�3`j 1
C0�1'TRACTOR: y��ic.w �,�5:e vc%r c;•.., G� PHONE:�7r.,31 �-- S 3 :��
CONTACTPERSON:��.,�, ��J����.�.,, MO�ILE/PAGER: ���, aL.��2
MAILINGADDRESS: Z7'7�! (>�„��QS;-►-; �1.�� CITY: �,�,;i ZIP: �S�KG
STATE LICENSE: # a�q-,
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAIVIE; REGISTRATION#
TYPE OF WORK: New Addition�_ Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �,A-t� 2c�� �.'1o��t«ti T� Eu< S����
m�c.,rT���c�= c���t��
STORIES: _],_ SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ � ac.�,J
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 ce wi the �proved plan.
APPLICANT'S SIGNATURE. ,N �, DATE: `712�FI2c��
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non pernzitted events will not be allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DaT�
Subd. 1. Type of data. The righcs of individual on whom the data is stored or co be stored shall be as set forth in this secdon.
Subd..'.. Information reqirired to be given individual. P.n individuai asked to supply private or confidendal data conceming hicnself shall
be informed of: (a)the purpose and intended use of the requesied data withia the collecting'state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legaily required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the iden[ity of other perso�s or entities authorized by state or federal law to receive the data. This requiremeot shall
not apply when an individual is asked to supply invesdeaave dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the noace reauired under this subdivision in the individuai income tax or propercv tax refund
instruc[ions instead of on those forms.
Subd. 3. Access to data by indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject
of scored data on individuals, and whe[her it is classified as public, privace or confidencial. Upon his fur[her request, an individual who is[he subjecc
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[hat data. Aftzr an individuai has been shown the private data and informed of ics meaning, the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secrion is ptnding or addiaonal data on the individual has been collected or crea[ed.
The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual coscs of making, certifying; and compiling the copies.
The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of
the date of the request,exctuding Sa[urdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy with the request
within that time,he shall so inform[he individual,and may have an addiaonal five days within which to comply with the request,excluding Sarurdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individuat may contest the accuracy or completeness of public or pri��ate
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsibie authoriry describing[he nature of the disagreement.
The responsible authoriry shall within 30 days eithec (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipien[s named by the individual; or(b)notify the individual thac he believes the data to be correc[. Data
in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data.
The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act rela[ing to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Riabts 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 fumish 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 a�encies to the extent necessary to process
the pernut or license.
4. If your requested pemut or license requires Councii action to approve, some information may become
public.
j. 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.
�.�ti�n I.�i Ls U 120�.i�l V f�GC L.���C
First �Siddle Last
'��`��5 �,� � �. � �
Address
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.3�,i.�c-�t2'�Ctc[] ,
Ciry State Zip Phone
I understand my ri state above
,"�� _—���
Signature
CHECK OFF LIST FOR ISSUAi�TCE OF PERI�IITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: !S�� FO k 5 T
PID:
DESCRIPTION OF WORK: GA�,2AG c_ A 4D� n��
ZO�'G RE'V�W BY: DATE APPROVED: ? -Z y -o fl
BUILDING REVIEtiV BY: DATE APPROVED: �- �t -��
FEES TO BE CHA.RGED: Misc. Fees Calculated By:
PERNIIT Yes ✓ No .
PLAN REVIEW Yes v No SEWER CONNECTtON
STATE SURCHARGE Yes ✓ No WATER CONNEC'I ION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZO�r'G CHE.CK LIST Zoning Disuicc: N lL
Fire Department: Post Office: School District:
Lo[Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes�_ No Date of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side: � �
. �
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peal:Hgt.
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
� Septic: Staff Approval Date: By:
�'
Zoning File: # Resolution: # Resolution Date:
Shoreland District: Nv
Avg. Setback: Bluff Setback: I.ot Coven'e:
Eusting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No� Date of Council Approval:
REI�IARKS (in house):
7
BUII.DING REVIEW CHECK LIST
UBC: U - f CONSTRUCTION TYPE: ��
Sq Footage $ Per Sq Ftg
Basement x =
lst Floor z =
2nd Floor x _
Garage z =
z = =�
TOTAL
Estimated Construction Value: $ g U�v �-
—�
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Niechanical Water Connection
�Footing � Septic Sewer Connection _
Framing Fireplace Lawn Irrigation
Insulation (IVlasonry) Other
�Wall Board (Mpg.) Well (State Perm.it)
F�� Grading/Filling �Electrical (State Permit)
Other
REI�L�RKS (IN HOUSE): .
--- -----------------------------------------
REV�tiV BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date gy;
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REI�IARKS (TO BE NOTED ON PER1tiIIT�:
8
DATE TIME
CITY OF ORONO CALLED IN 7�7� o0
INSPECTION NOTICE SCHEDULED���O�' g'�
PERMIT NO. �-�� COMPLETED � '���
ADDRESS �S�U r�X S�'
OWNER CONTR. ��v'��✓�
TELEPHONE N0. 6/<= - .��E' `�/ /� �--
� DESCRIPTION
ly 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 G 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 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/REMOVA�
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� CO MENTS:
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W ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE
� �'f)CORRECT WORK&PROCEED '. ISSUE CERTIFICATE OF OCCUPANCY
W� ..
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
f] CORRECTUNSAFECONDITIONWITHIN HOURS. ;- pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
i-� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46�0
Owner/Contractor on site:
Inspector`/,�`c �al/)��
White Copyllnspector's File Canary CopylSite Notice
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