HomeMy WebLinkAbout2004-P07949 - addn/remodel/repair , PERMIT
CI�'Y` �F ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: po�949
Crystal Bay, Minnesota 55323 PeCt711t TypE: Addition/RemodeURepair
(952) 249-460U Date Issued: 9�23i2ooa
SITE ADDRESS: 1510 Green Trees Rd
Wayzata,MN 55391
PID: 11-117-23-23-0015
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Buildin Census Code 434
Pernut Class: g
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate pemuts required: riumoing iviecnanicai Eiecmcai�siaiej
NOTICES/REMARKS:
T:___,l_ 1_.___ 1__�l_"___.__ "._._ �___ _.___11_".l__.1_ ____"._
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FEE SUMMARY: Permit Fee: $ 391.25 Vatuation: $ 25,000.00
Plan Review Fee: $ 254.28
State Surcharge Fee: $ 13.00
TOTAL FEE: $ 658.53
APPLICANT: �Building OWNER: George&Nancy Danko
801 Second Ave No 1510 Green Trees Rd
Minneapolis,MN 55405 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.
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/ -
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APPLICANT PERMITEE SIGNATURE UED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reoorts, 1-Assessing, 1-Finance Page 1
C�-�-�
R- u`0�
Total Fee: $ (�J�B. 53 Date Received: �I-1�(-�'� /
Entered By:c�'Y21 Permit#: (j��j��� '
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)
-- ---�
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR �'
JOB SITE ADDRESS: /�f/G l�-r.�sr 1�n.v�s ��-=tO ZIP:
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ Yes � NO If yes, a special event permit is required with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonsh-ates
suff cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: —�nic�� ��y.4�, a �,�� PHONE: (home) 7S�- y�Y- /�s'
(work) `ls>- /7y-Sr:�,��'
MAILING ADDREss: /,�i� �✓�wti r%��rl�,��/ cITY: f';-�z�,�. zIP:
CONTRACTOR: k/y /�.�,%�,�,� �c��• . PHONE: v�d- 9)�-y'c�C,cz
CONTACT PERSON: ����-�.s�.y MOBILE/PAGER: G�/J- 7.�.�-��.�o �
MAILING ADDRESS: P�'i ,lr�.u:�' /clue �i,.,.�'i' CITY: /"l�f_i �'i ZIP: , s o -
STATE LICENSE: # �I t' - 2c�i�/of/YL EXPIRATION DATE:��/�,/n_�_
ARCffiTECT/ENGINEER: iy�r,� PHONE:
MAId�ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home RemodeUAlteration �_
PROPOSED WORK(describe in detai�: � �,;�,/� /,r,� � ./�.a�����.4
�`,�..✓r� �v ;!hu����- /�� v.�:,�s
STORIES: Z.- SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE 5TALLS: ATTACHED DETACHED_
ESTIMATED CON5TRUCTION VALUATION(excluding land): $ �5 ���c� '
I hereby apply for a building pemut 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 pernut;and that the work will be
in accordance with the approved plan.
APPLICANT'S SIGNATURE• DATE: � ,
31
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 individual.An individual asked to supply private or confidential data conceming himself shall be
informed oE (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 supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shal)
not apply when an individual is asked to supply investigative da[a,pursuant to sec[ion 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propertv ta�c refund
instructions instead of on[hose fortns.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whethec it is classified as public,private or confidential. 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 flte content and
meaning of that data. After an individual has been shown the private da[a 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 authoriry
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,ifpossible,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
witlun that time,he shall so inforra the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal hoJidays.
Subd.4. Procedure when data is not accucate or complete. An individual may contest the accuracy or completeness ofpublic or private data
concerning himself.To exercise this righy an individual shall notify in wridng the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either. (a)correct the data found to be inacwrate 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 t6e 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 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 depariments may require you to furnish certain private or
confidenrial informarion.
You are notified that:
1. The information you furnish will be used to determine your qualification for the pernut or license
requested.
2. You may refuse to supply data,but refusal may require that the City deny the pernut 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 acrion to approve, some informarion 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 applicarion or permit.
First Middle Last
.�/'7 �.i.�Bfj F,r e C-cll�afJ�II/y
Address
,�'J/ f.�c.�� �a �`i7G, l/y�� �f/�' �� .S"S��,S
City State Zip Phone
I understand my rights as stated above.
Signature
32
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: i S� o C��z�v 'I-R.E�S I���
PID:
DESCRIPTION OF WORK: �3�-r�� ij�ww✓.��:Z
ZO�tG REVIE`V BY: -- DATE APPROVED:
BUIIIDIPIG REVIE`V BY: DATE A]'PROVED; S - z� -6 y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER��IIT Yes � No
PLAl�i REVIEW Yes l/ No SEWER CONNECTION
STATE SURCHARGE Yes �/ No WATERCONNECI'ION
TNVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONI��1G CHE.CK LIST Zoning Districr. �o GH��
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depch
Survey Submitted: Yes No Da[e of Survey:
Proposed Setbacks:
Front(Lake): Right Si e:
Rear (Street): Left Side.
Adjaceat Structures: ` tiand:
Building Height: Def. Hgt. Pe -Hgt.
Loc Coveraoe:
Grading: Staff Approval Date: B Council Approval Date:
Septic: S[aff Approval Date: BY
Zoning File: # Resolution: # Resolution Date:
Shoreland Dis[rict:
Avg. Setback: Bluff Setback: L,ocCovera�e:
EzistinQ Proposed
0
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Da[e of Council Approval:
REMARKS (in house):
7
� " !
BUII.DING REVTEW CHECK LIST
�C� R ' 3 CONSTRUCTION TYPE: �1/`�
_ Sq Foota�e $ Per Sq Ftg
Basement x =
lsc Floor x =
2nd Floor x =
Garage x =
z —
TOTAL
Estimated Construction Value: $_Z 5��j p p«'
Inspections Required: `Vork Requiring Separate Permits:
Site _�_Plumbing Fire
Hardcover Removai _Lc Mechaaical Water Connection
Footing ` Septic Sewer Connectioa
_�Framing Fireplace Lawn Irrigation
_�c Insulation (I�Iasonry) O[her
�_`Vall Board (Mfg.) Well (State Permit)
,� Final Grading/Filling _�c Electrical (State Permit)
Other
REI�LA.RKS(I�'HOUSE): .
--------------------------------------------------------
REV7EW BY OTHERS: DATE:
Access: Ezisting I.,*e�,
Access Approvai: Date gy;
---------------------------------------------------------------
RENL4RKS (TO BE NOTED ON PER1tiII1�:
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�� ,c f�TG�iI�°urr�ior y�ur rer a'�on ��i l•n�C S�'.I�u,:({�f18 /t//J ? f �,�
In ��I' c r�r,i� 11cC ly;�.h all ,I��r= ;e F ! � J V C�!!'-��il! l.�i`'�i! ��'o•`"��
�,�F . ,.,.c.�� ar.d zcn�ng code.
Fc.c;;,�;,�� :��;�nc:ucf�ng ite^-,,�;;;s;,vc�,�ca!1yr�oied in this revieae
KEcr'THIS f'LAN SET ON 3CfE AT ALL TIMES �j�,�,�,,� �i�_
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.
RICH KIEMEN
Senior Project Manager
DIRECT: 612.746.0706
F: 612.977.9060 C: 612.723.6107
F: 612 977,�061 E: rkiemenQkmbldg.com
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