HomeMy WebLinkAbout2004-P07112 - addn/remodel/repair ' � PERMIT
CITY OF ORONO Permit Number:
2750 K�Iley Parkway - PO Box 66 Po�ii2
Crystal Bay, Minnesota 55323 P@I'CTllt Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: li6izooa
SITE ADDRESS: 3555 Frederick St
WAYZATA,MN 55391
PID: 2o-ii�-23-i2-ooi�
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Sub-type(s): Addn/Remodel/Repair
Perniit Type: Addition/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required: i'iumoing Eiec�ricai�siaiej
NOTICES/REMARKS:
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: Rehab, Inc. OWNER: J M INGALLS&S v INGALLS
17158 Round Lake Rd 3555 FREDERICK ST
Eden Prairie, MN 55346 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVENfENTS 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�PLICANT PERM�1.� NATUR ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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Total Tec: $�S`�D. 5.3 Date Received: /L����C j�
Cnterecl C,y: �_ Pern�it #: _�_ /.} c� �//2.
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in fuli before plan review will be started.
(p/��asc print all iu���rin�liva)
THE APPLICANT iS: (�ircle one) (�WNER OR ��)NTRACT�
JOB SITE ADDRESS: 3`�5`� �Z�Qc�+�� 5� ZIP: SS'3� 1
NAME OF OWNER: ���*�- '1o,.,AT..�,' i,�+,,,_,-� pHONE: (home)
(w�►-k)
MAILING AUDRESS: CITY: ZIP:
�'iS�. 9ctQ����
CONTRACTOR: �� . ►N�- PHONE: (.QiZ �fri 2o7c�
CONTACT PERSON: Q�i3 5�.�:Ya��nS,a_ MOBILE/PAGER:
MAILING ADDRESS: ��t�s�3 i2c�,�� ►.w,�.� �ZA CITY: �c�;-�,.� �r^-h��� ZIP: s�.3=4�
STATE LICENSE: # �.a3�z-Y,r6`�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION # �
TYPE OF WORK: New Adclition Accessory Structure
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Move Re�nodel/tllteratiou�_ Laud Alteraiioil __
PROPOSED WORK (describe in detai�j: ��mo�.-� C er��t,�e ,,�.�1 ;� �.��,;� 2��:,r � �'�.,cr�n.�
��Cli-�-� LC7.1/Ji�vZ�`�� , C�O�.u� ���fS� tC�-mCv"C �'OD�1 �t�7'+tK'Lt LY..►�r�.LS.
STORIES: ! SQ. FEET OF EACH FLOOR: r 3�
NO. OF BEDROOMS: � GARAGE STALLS: aTT. Z DCT.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ Z.�,o00
I hei•eby apply for a buildin� permit and I acknowledgc that the information above is complete and
accurate; that the work will be i❑ confortnance wit}� tl�e orciinances and coc�es of the City and witl� the
State Building Code; that 1 understand this is not a permit and work is not to start without a permit;
ancl tl�at t1�e work will be in acc�rdar�with tl, pproved plan.
APPLICANT'S SIGNATURE: C UATE: _J Z -!l��v-�
NOTE.� Parade of Homes e vents require separate permit appro va/by Police Department arrd City
Council 60 days prior to the e vent. Non�er�nitfed e vents wi//not be allo►vev
CHECK OFF LIST FOR ISSUA��'CE OF PERMITS
FOR OFFICE USE ONLY
ADDRESSORLEGAL: 35ss ,�rr.c,n2,�i� sr
PID:
DESCRIPTION OF WORK: 2��,,,.��.—�
ZOYPi 1G REV�`V BY: DATE APPROVED: �//A
BUILDI�i tG REV�`� BY: DATE APPROVED: �z- �,e -og
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER1vSIT Yes ✓ No
PLAN REVIEW Yes v� No SEWER CO�ECTIO�T
STATE SURCHARGE Yes � I�'o WATER CONNECITO�
INVESTIGATION FEE Yes I�'o f PARK FEE
SAC Yes No � STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�TING CH�CK LIST Zoning District: rv e c. �
Fire Department: Post Office: School District:
I.ot Area: Sq.ft. Acres Wi th Depth
Survey Submitted: Yes No te of Survey:
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: �Ve�land:
Building Hei�ht: Def. Hgt. Pei�H t.
Lot Covera?e:
Grading: Staff Approval Date: B�: Council Approval Da[e:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setba�s: I.ot Coverage:
EustinQ Proposed
0
Hardcover: 0-75'
75-250'
250-500' .
500-1000'
Hardcover Variance Required: Yes tio Date of Council Appror•`:
RENIARKS (in house):
�
7
. �
BUILDING REVIEW CHECK LIST
�C' 2� 3 CONSTRUCTION TYPE: �lN
_ Sq Footage $Per Sq Ftg
Basement x _
lst Floor x _
2nd Floor x _
Garage x _
x =
TOTAL
Estimated Construction Value: $_ >b,00 v ��
Inspections Required: �Vork Requiring Separate Permits:
Site _�Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�Footing ' Se tic
jC Framin P Sewer Connection
�Insulation Fueplace Lawn Irriga[ion
_ �t Wall Board ��0�'� Other
(Mfg•) Well (State Permit)
—�F�� Grading/Filling _�Electrical (State Permit)
Other
REl�IARKS (L�t HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Ezisting New
—_
Access Approval: Date
By:
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REI�IARKS (TO BE NOTED ON PERivIIT�•
8
Sec13.04 R[GHTS OF SU[i�ECTS OF DATA
Subd. I. Type oF data. �l�hc rir�hls of individual on wliom the data is stored or to be stored shall be as srt forth in�his section.
Suhd. 2. [niormaHon required to be ,n�i��en indi��idval. .An individical asked to supplv private or c�nfiAenlial data concernin��himseli shal]he
informed of: (a) the purpose and intended use oC the rcyuested data within Ihe colleclin� state agency, political subdRision, or statewide systenr, (b)
whe9}ier lie �tiay refuse or is Ic�;ally required to supply the requested data; (c) any w�ow�� consequence �risin� Crom his supplying or refusin� to supply
pri�;ite or ca�l�idential daL, :md (d) ll�c idci�lit�° o(othcr persun� ur entitics :wtl�orized b�� slate or (eder.il l;i��� lu rccri��r Llie data. Tl�i� rcyuirement s1�a11
not apply when an indii•idual is asl<ed to supply investigative data,pursuant to section t"3.2i2,subdi�•ision 5,to a Inw en(orcemeni of[icer.
The cunmii�simrer ol revenue ma1' ulace Ute no�irc rcuuiiz� u>>�er tiva aubdi��isiou i�i Uie indi��iduxl uicm�ie taa or prouertY tax relund
insvuctions instead o1 on those fonns.
Subd. 3. Access to data by individual. llpon reyuest to a responsihle authority,an individual shall be infomied whelher he is the subject o1
stored data on indrciduals,and whether it is classified as public,private or confidential. Upon his furiher request, an indieidual who is the subject of storcd
private or public data on indrviduals shall be shown the data wiihout ;u�y charKe to him and, if he �lesires, shall tx in[ornied of the content and nieaninR
of that data. After an indi��idu�l has been shown the prn•ate data and intomied of its meanin�, the data need not be disclosed to him for sis ntonihs
thereaher unless a dispute or action pursuant to lhis section is pendin�or additional data on the individual has been collected or created. The responsible
authoriq�shall pro�•ide copics of the private or public data upon reyuesl by the indn•idual subjeci o(the data. The responsible authority may require the
requesting person to pay the actual wsts ot makin�,certilyin�,and compilink the copies.
The responsible authority sh�ll comply immediately, iC possihle, with any requesl rtiade pursuant to this subdirision, or within iive days of the
date of the request, excludin� 5aturdays, Sundays and le�al holidays, if i�Timediate complituice is not possible. [f he cannot comply with the request within
that time, he shall so inform the indi�idual, and may have an additional tive days within which to comply H7th the requesl, excludin#; Saturdays, Sundays
and lenal holidays.
Subd. 4. Procedure when datx is not accurate or complete. An individual may wntest the accuracy or completeness o[public or pri��ale
data concen�in� hi�t�selC. To exercise this ri�ht, an indi�•idual sh:ill notify in writin� the responsible authority describin� �}ie nalure of the disa�recment.
The responsiMe atithority sh�l] within 3(1 ��ys eithec (a) rnrre�t �he data found to he inaccurate nr incomplete and atlemPt i� notify past recipienfs oi
inaccurate or incomplete data, includinK recipients named by the individual; or (b) noiffy the indrcidua] that he belieces the data to be correct. Data in
dispute shall be disclosed only ii ihe indicidu:il's statement oi disa�;reement is included with the disclosed data.
Tf�c determinntioi� of tltc responsiblc autl�oriiy i�ciy h�� appealed pursu:u�t to the pro��isioi�s of tl�� :�diuii�istratit•e procedure act rclatin�ti to
contested cases.
UATA PRIVACY AUVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request
for �i ��ermit �r licens�� frrnn the City of Or�m� r�r an�� nt its de�artments may require }�ou to hirnish cerl.iin �ri��ate �r
conFidential information.
You are notiFied that:
1. The information you furnish will be ❑sed to determine your qualiFication for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Cily deny the permit or licensc.
3. The information may be sharcd with other local, state or federal ag�encies to the eatent necessary to process
the permit or license.
�. If your requesied permit ur license requires Council action to approve, sonie infonnation may bccome public.
5. You have certain ri;hts under M.S. 13.U4 (available u�on request) to review private data on yourseli.
6. Y�ur full name iti rer�uired tn�,r�cess this�����lication or�ermit.
�vb err �,e.�r�-*���� ��h, ��.c,L
Pirst ddlr Last
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Addres �
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Cit�� — ---- -- �tdc Zip P}�one
I ncla�stai m r'g s as stated above.
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Si�,*�ta�urc
� DAT TIME
CITY OF ORONO CALLED IN 3�L
INSPECTION N TICE SCHEDULED -z -O �.:o v
PERMITNO. ��� �� COMPLETED` �
ADDRESS �SSS c
OWNER CONTR.�I11� U ���
TELEPHONENO. �5Z g3� Z��pQ
� DESCRIPTION �� '� �c
� Ot 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 B0. 12 WATER HOOK-UP 17 SITE INSPECTION
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
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED FiOJECT COMPLETE �
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALI INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (95Z� Z49-4600
OwnerlCon o site:
Inspector.
White Copyllnspector's F e Canary CopylSite Notice
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3��T TIME
CITY OF ORONO CALLED IN
INSPECTION N TICE SCHEDULED -z -D �;o v
PERMIT NO. 4�// ?�' COMPLETED` /
ADDRESS �555 �
OWNER CONTR.�(1�� ���
TELEPHONE NO. �5Z �3� Z�/pQ D _
� DESCRIPTION �� —� �c
� 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 06 PROGRESS
� 07 OEMO-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
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW WORKSATISFACTORY:PROCEED ROJECTCOMPLEfE �
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-46��
OwnedCon o site:
Inspector.
White Copyllnspector's F e Ca�ary Copy/Site Notice
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� , � .1 ;; � �_ .� + i Project Address 3555 Frederick Wayzate;Minnesota ' - � :e
��_-:i �.�-i �,J I ��� � � � �`; ��� � Owners Suzanne andJonathoningalls ,,,_.,�yy�
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17T58 Round i ake Rnad Cden Prairie,A4innesota 553d6 Contaci: Bob Swearengin 612.849.2070 .
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