HomeMy WebLinkAbout2004-P07539 - addn/remodel/repair t PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelle y Parkwa y- PO Box 66 P07539
Crystal Bay, Minnesota 55323 PefClllt Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 6�gi2oo4
SITE ADDRESS: 2555 Fox St
Wayzata,MN 55391
P I D: 04-117-2 3-44-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Porch-Residential
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 321.25 Valuation: $ 20,000.00
Plan Review Fee: $ 208.78
State Surcharge Fee: $ 10.50
TOTAL FEE: $ 540.53
APPLICANT: Structures Unlimited, Inc. OWNER: Mr. &Mrs. Eckerline
5425 Clayton Drive 2555 Fox St
Maple Plain,MN 55359 Wayzata MN 55391
THE UNDE IGN D HEREBY QUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AG ES T DO ALL W IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNES TA ILDING E REQUIREMENTS.
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APPLICAN E SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(Si�nitures Required), 1-Applicant 1-Monthlv Reports, 1-AssessinQ, 1-Finance Page 1
. � 6��/D�
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Total Fee: $ 5�f0. 53 Date Received: ,�-����
Entered By: ��S Permit#: ��� 753 9
CITY OF ORONO - BUILDING PERIVIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it all infoYfnation)
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THE APPLICANT IS: (circle o�ze) OWNER OR N�'-�A�TOR _
�__._ �_
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JOB SITE ADDRESS: �� �� � ����C �\\I��:'C'`� ZIP: '��+�j'/
Will this be a Par e of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes No If yes, a special event permit is reqatiired with Police Department and City
° � Council approval 60 days prior to tlae event. Non permitted events will i�ot
be allowed.
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NAME OF OWNER: '��� �ri �- '�.�1��'v�a� `,_-y��','°�� PHONE: (home) �i �,� G�'c��/�
(work) ��L-�,, •� ���i Z
MAILING ADDRESS: �%�-v.-�- <A� ��_��y:� CITY: (��--P�r���`� ZIP: 5���/
CONTRACTOR: �fln�. ��S I��n��-ec� _ PHONE: ��/Z `� 3.�-/���3
CONTACT PERSON: ��g �r ���-,c,�,.e�� > MOBILE/PAGER: ���►r---�.
MAILING ADDRESS: �ZS '' �4.�.� C1rl�� CITY: :��p�� Pfc<yr� ZIP: . J`` 35`'l
STATE LICENSE: # '�j 7 �_�(„
ARCHITECT/ENGINEER: �(�/`1�i��_ PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition iVlove
RemodeVAlteration � Land Alteration
PROPOSED WORK(describe in detai : �,��-�� � ��' �� — ��
�-i�� � � �
t(/�-j'•J �3G 1�-L'�ti-� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��',�' ,C�
I hereby apply far a building pemut a I aclrno edge that e i�formation above is complete and accurate; that the
work will be in conformance with e ordin ces and co es f the City and with the State Building Code; that I
understand this is not a pernut and work � ot to start wit t a pernut; and that the work will be in accordance with
the approved plan. ,
1
�PLICANT'S SIGNATURE: � __ DATE: �`i����c
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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 shali be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to suppiy private or confidential 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 retuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity o(other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply i�vestigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or uropertv tax refund
instructions instead of ort those forms.
Subd.3. Access to data by individual. lipon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classified as public,private or conCdential. Upon his further request,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
mea�ing 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 authority 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,iCimmediate 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[ive days within which to comply with the request,excluding Saturdays,Sundays
and legal holidays.
Subd.4. Procedurc rvhen 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 noti[y in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients 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 appcaled pursuant to the provisions ot the administrative procedure act relating to
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 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 noti�ed 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.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature
,
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: ZS s S �'=�X
PID:
DESCRIPTION OF WORK: Scu�av a osJ ���snv�, 0�Zlc
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ZONING REVIEW BY: DATE APPROVED: ,g -7 - �y
BUILDINC REVIEW BY: DATE APPROVED: � - �- �y
FEES TO BE CHARGED: tblisc. Fees Calculated By:
PERMIT Yes �� No
PLAN REVIEW Yes � No SEWER CONNECT[ON
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sy.ft. Acres Width Depth
Survey Submitted: Yes_ L No Date of Survey: oN �(-■��
Proposed Setbaci<s:
Front (Lalce): Right Side:
Rear (Street): Left Side: �U C�
Adjacent Structures: �Vetland: Z� �
Building Heibht: Def. Hgt. c� �+� Peak Hb.
Lot Coverage: I Z."�
Grading: Staff Approval Date: — By: Counci( Approval Date: _______
Septic: Staff Approval Date: � By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District: �C�
Avg. Setback: BluFf Setbadc L o t C o v e r a g e :
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
.
BUILDING REVIEW CHECK LIST
UBC: �"j CONSTRUCTION TYPE: V�
Sq Footage $ Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ �,o°Om�
Inspections Required: Work Requiring Separate Permits:
Site Plumbittg Fire
Hardcover Removal Mechanical �Uater Connection
�C Footing Septic Sewer Connection
� Framing Fireplace Lawn Irrigation
�lnsu(ation (Masonry) Other
Walf Board (Mfg.) Well (State Pern�it)
o� Final Grading/Filling Electrical (State Permit)
Other
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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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�AT�� TIME
CITY OF ORONO CALLED IN �
INSPECTION NOTICE SCHEDULED �� �-30
PERMIT NO. tP�7S3�1 COMPLETED
ADDRESS_ 0�5�5 � ��
OWNER CONTR.��J�.IwtICS GUI�l���
TELEPHONE NO. ���-- �O T �(P�oe�
� DESCRIPTION ��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 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
J 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:_YES_NO
� COMMENTS:
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� ❑ CORRECT WORK&PROCEED C: ISSUE CERTIFICATE OF OCCUPANCY
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O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTIONREQUIRED.C�LLTOARRANGEACCESS.
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Call forthe next�nspection 2a hours in advance. (952� 249-46��
OwnerlCo or on it :
Inspector. '
White Copyllnspector's File Canary CopylSite Notice
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�, DAT,�.��0 TIME
CITY OF ORONO CALLED IN � �
INSPECTION NOT�,���� SCHEDULED /07-�lld
PERMIT NO. COMPLETED
ADDRESS ���� ��� S� �
OWN ER CONTR.
TELEPHONENO. � ��� �g� - ��D(j� � /l�'G��
� DESCRIPTION ����—��S_ I�-�(j�..
� 01 FOOTING 11 MEC ANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPEC710N
Q OS 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 FINA� � � 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:�YES_NO /
� COMMENTS:�,�c 1 S ��� ��L `� �-/�Z�- '
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� ❑CORRECT WORK&PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
G INSPECTION REQUIRE .CALL TO ARRANGE ACCESS.
Call for the n t inspection 24 hours in advance. (952� 249-4600
OwnerlCon r ite:
Inspector.
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