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Home My WebLink About2003-P07070 - addn/remodel/repair `� e PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 Po�o�o Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair (952) 249-4600 Date Issued: i2isi2oo3 SITE ADDRESS: 3550 Ivy Pl Wayzata,MN 55391 PID: 20-117-23-42-0016 DESCRIPTION: UBc occupancy R3 Construction Type VN Proposed Use: Residential Permit Class: Building Census Code 434 Permit Type: Addirion/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair DEfAILS: Approved per resolution#: Separate permits required: . — NOTICES/REMARKS: FEE SUMMARY: Pemrit Fee: $ 23.50 Valuation: $ 400.00 Plan Review Fee: $ 15.28 State Surcharge Fee: $ 1.00 TOTAL FEE: $ 39.78 APPLICANT: Owner/Self OWNER: �'�'illiam Dampier MN 3550 Ivy Pl Wayzata MN 55391 THE UND ED H BY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGRE T L WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF MINNE A BUI CODE UIREMENTS. � � � APPLIC I S ATCIRE ISSUED BY SIGNATURE Couies: 1-File( Qnitures quired). 1-Atmlicant, 1-Monthlv Renorts, 1-Assessine. 1-Finance Page 1 _ � � Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION f111 information must be submitted in full before plan review will be started. (please print a11 information) THE APPLICANT IS: (circle one) OWNER R CONTRACTOR JOB SITE ADDRESS: �SSc� T ily P�,AC_� ZIP: _�5�3� r 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 approva160 days prior to the event. Non permitted events will not be allowed. NAME OF O�VNER: , PHONE: (home) �7'�Z -�/'l�2�3 (work) ) �r r�y3» MAILING ADDRESS: �Sb ,� �f �t4c� CITY: �7A-,� ZIP: �S'�� CONTRACTOR � L /`— PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration�_ Land Alteration PROPOSED �VORK(describe in detai�: �' p L�}� Sc�t3 5-7�}n,2p�p ��,2. STORIES: �i" SQ. FEET OF EACH FLOOR �2o SQ��, 1 ST �02 �(�,SQ�� NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION(excluding land): $�� I hereby apply for a building pernut and I aclrnowledge that the information above is complete and accurate;that the work will be in conformance �i-ith the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work i not to st wi out a permit;and that the work will be in accordance with the approved plan. r �� APPLICANT'S SIGNATURE: DATE: � � � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The rights of ind'n•idual on w6om the data is stored or to be stored shall be as set fort6 in t6is sectioa Subd.2. Information required to be givca individual. An indi�idual asked w supply private or rnntidentlal data concerning himtelf shall be informed of: (a)the purpose and intended use o[the requested data within the colieciing state agency,political subdivis(on,or statewide rystem;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from 6is supplying or refusing to supply pr�vate or rnnfidential data;and(d)the Identity of other persoos or entities authorized by state or federal law to receive the data Thls requirement shall not apply when an Individual is asked to supply in�•estigative data,pursuant to seccion 13.82,subdlvlsion 5,to a law en[orcement officer. The commissioner of revenue ma lace the notice r uired under this subdlvision in the individual income tax or ro e tax refund instrurtions instead of on those forms. Subd.3. Access to data by Indivldual. i pon request to a responsible authority,an individual shall be informed whether 6e Ls the subject of stored data on individuals,and whether it is classiBed as public,private or coniidential. Upon his further request,an Individual who ts the subJect of stored private or pubi(c data on individuals s6a11 be shown the data without any cha se to him and,if he desires,s6ai1 be informed of t6e content and mean(ng o[that data After an indlvidual has beea s6own the private data and informed of Its meaning,t6e data need aot be disciosed to 6im for sIx mooths thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the(ndividual has been rnllected or created. The responsible suthority shail provide copies of t6e prn ate or publlc data upon request b�the Individual subject of the data.Tde responsible autLority may requlre the requesting person to pay the actual com of making,certifyiog,and compiliag the copies. The responsible authority shall compiy immed7ately,if possible,w(th any request made pursuant to t6is subdivision,or within frve days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance(s not possible.If he cannot comply wich t6e request within that time,he shall so inform the indlvidual,and ma�Lave an addltional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accunte or complete. An individua!may contest the accuracy or completeoess of public or private data rnncerning himself. To exercise this right,an Indlvidaal shaU nodfy in writing the respooslble authority describ(ng the nature of the disagreemenG The responsible authority shail within 30 days elther: (a)correM the data found to be inaccurate or incomplete and attempt to notify past recipieats of tnaccurate or Incomplete data,including reclpients named by the indivldual;or(b)notify the fndiv(dual that he believes the data to be correct. Data in dispute shail be disclosed only if the(ndividual's statement of disagreement is iacluded with the disclosed data. The determination of the responsible suthority may be appealed pursuant to the provisions of the administrative procedure act relating to rnntested cases. DATA PRIVACY AD�ZSORY In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that�-our 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 notified that: 1. The information you furnish will be used to determine cour 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 eztent 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 NI.S.13.04(a�•ailable upon request)to review private data on�ourself. 6. Your full name is required to process this application or permit. First �Iiddle Last Address - City State Zip Phone I understand my rights as stated above. Sigoature � � � CHECK OFF LIST FOR ISSUANCE OF PERILIITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: ?S� �v y ��,,� PID: � DESCRIPTION OF WORK CZ,c—�vw,�Z ZONING REVIEW BY.• DATE APPROVED: /� - 4� -n � B UILDII�'G REVIEW BY: DATE APPROVED: �2- $ - n 3 FEES TO BE CHARGED: lliisc. Fees Calculated By: PERMIT Yes � ��'o PLANREVIEW Yes �/ ' SEWER CONNEC770N STATE SURCHARGE Yes �Zo WATER CONNEC770N INVESTIG.-�TION FEE Yes :\'o PARK FEE SAC Yes 1�"o SITE I1�SPECTION Number of SAC Units OTHER (specify) ZO�VING CHECK LIST Zoning District: �'�Jc) G C-�� Fire Department: Post Office: School District: Lot Area: Sq ft. Acres Width Depth Survey Submitted: Yes No Date of Survey: Proposed Se�backs: Front (Lake): Right Side: Rear (Street): Left Side: Adjacent Structures: ji'erland: Building Height: Def. Hgt. Pealc Hgt. Lot Coverage: Grading: Sta�fApproval Date: Bti�: Coa�ncil Approval Date: Septic: StaffAppro�•al Date: B�•: Zoning File: = Resolution: !# Resolution Date: Shoreland District: Avg.Setback: Bluff Setbcck: Lot Coverage: Existing Proposed Hardcover: 0-75' 75-250' 250-500' 500-1000' Har�cover Variance Required: Yes �o Date of Cour.;-il Approval: REMARKS(in house): 32 I► ""'' , BUILDING REVIEW CHECK LIST UBC.• l� ` � CONSTRUCTION TYPE; �l�1 Sq Footage $Per Sq Ftg Basement x Ist Floor z 2nd Floor x = Garage x = x TOTAL Estimated Construction Value: $ �{Q p°`—' Inspections Required: Work Requiring Separate Permits: Site _�_� Fire Hardcover Removal Mechanical Footin Water Connection g Septic Sewer Connection o�Framing Fireplace �Insulation ry� ��Irrigation (Mason _� Wall Board (Mfg.) Well (State Permit) _�Final Grading/Filling Electrical (State Permit) Other ------------------------_---- ----------- ----_� REMARKS(INHOUSE): �-� "- ----------------------------- ------------------------------------------- REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date By. ----------------------------------------------------------- REMARKS (TO BE NOTED ON PERMIT): � � 33 -- ------Q�-�-�------ -��-------- ---- C� CITY OF QR�N�'j ----- ------- -- _� •.•� '�n ��'� , �.1�'�"W_— , ,. . ;, . _ ' -, }_ -�""'---- �� C i� � - _ -;- -- - ,�- ., , . _I __.� .... ,_ � I' ``-� - r i'. . , . � .,�`�� ._i . :�,.-. ;b;:tl .. . . . .� , .,��. ,��.','OiF •ric'� Jh C�'�� Fti � . � - � aa;in•� cude. _ , ,�,-. -��- �::�7 �� ; S�cT c?N :tlTt AT AL�.;`!'IMES I . I; �;; --- ,� , �; �� I ��5 _ >, :-- � ��C`-`"v'`"` i � � �� I' -- ----- --�-� �_ ;,�V EO - - � � ��:� i�, --- ------ ---- -�--- , , �;. TA�2S _ � � ; - -- ; �� -�- ----, -� � � _-- � � U , -- i ; : � i ' ` � � �;: � � -- - \ / --------- '' l� ; L� i � '' � � ;� i;i � ,` � - �{ '{ , , � j�! , 1 � � a I � i l� r ,� r _ i -. � ? �7� •C-• (t� S��4�u ,, _ �Q� ;; — 1 ';. , , ; , _ ,, . . >; i ! � , _ '_�---- i , i __ —�---;-- ;� , ; � _ � —t�—. ; il - —;–� i i; � �� ` ',� . --- ; ��` � - - -� - - --- - - ; ��, — r; r ; — -- � .; , -- — j� �� :' � __ � e �- �`� / . ------------- - � � o c ----- ----- �r---7- — � � -� ''`� - Si��,,�,� � i - � - ---- �---!--- — i i -------- --- ---__ _ __._ ___. __ ---------__ __-- -- - — -�,__ . _ _----- � I ( '. { .."__- _ --�-- _ .-_"_______'_.__-'.-_____-__'_____'�___ _ __. .........'"_'._'_ . �� I'