HomeMy WebLinkAbout2005-P08662 -addn/remodel/repair ' �, PERMIT
C`iTY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p08662
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued:
7/13/2005
SITE ADDRESS: 3550 Iry Pl Unit#
Wayzata,MN 55391
P��: 20-117-23-42-0016
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Pernrit T e: Addirion/RemodeURepair Pernut Sub-type(s): Addn/RemodeURepair
YP
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Electrical(state)
NOTICES/REMARKS:
No Expansion Over Deck Allowed
FEE SUMMARY: Permit Fee: $ 167.25 valuation: $ 8,800.00
Plan Review Fee: $ 108.71
State Surcharge Fee: $ 4.40
TOTAL FEE: $ 280.36
APPLICANT: Owner/Self OWNER: William Dampier
MN 3550 Ivy Pl
Wayzata MN 55391
THE UNDERSI ED REBY UESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGRE O DO O IN S T COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNES BUILDIN ODE QUI MENTS.
� •
APPLICANT PE EE S ISSUED BY SIGNATURE
Copies: 1-File(Signatures Require , 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
• ✓ ! �
Total Fee: $ Date Received: —2�-'��
Entered By: Permit#: O G7/
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNE OR CONTRACTOR
JOB SITE ADDRESS: 3SSv �v y �c.a'� (.�A�YZ�Y'A MaJ ZIP: SS_��,/
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 demonstrates
sufficient on-site parking is availa6le. Non permitted events will not be allowed.
NAME OF OWNER: t2�H y ����r)i�� PHONE: (home) �SZ �/�/aS�
(work) ��2zZ/ oS��D
MAILING ADDRESS: �S�p T US/ ►-�G��'� CIT'Y: C�,eo,�,�n ZIP: 53-��
CONTRACTOR: S��i� PHONE: 6/���l -b y3o
CONTACT PERSON: ��'�� MOBILE/PAGER: ��-n��
MAILINGADDRESS: �rn� CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: ��'�; PHONE:
MAILING ADDRESS: S��r= CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration _ �
PROPOSED WORK(describe in detai�:�f,,,o�ti � �-�;��� �-;c u ��M� �F�4f,�
STORIES:� SQ.FEET OF EACH FLOOR: ��D
NO. OF BEDROOMS:� GARAGE STALLS: ATTACHED DETACHED_
' n�
ESTIMATED CONSTRUCTION VALUATI N(ex luding land): $ 3� �(Q�
I hereby apply for a building pernut an I ac�cu wledg�e tha information above is complete and accurate;
that the work will be in conformance ith tlhe rdina�ces an codes of the City and with the State Building
Code;that I understand this is not a pe a�nd rk is�ot to s w�out a permit;and that the work will be
in accordance with the approved plan.; . , 1 � �', �
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APPLICANT'S SIGNATURE: �t .' �' ' �-- ' � DATE: l, Q05
i i
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31
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.I. 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 o£ (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 entides suthorized by state or federal law to receive the data.This requirement shail
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mayplace the notice req,uired under this subdivision in the individual income tax or pro�rtktax refiand
instructions instead of on those forms.
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 whether it is classified as public,private or confidential. Upon his fwther 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
meaning 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 bee�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 requesdng person to pay the actual costs of making,ceRifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pucsuant 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
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4.Procedure when data is not accurate or complete.An individual may contest the accuracy or completeness of public or private data
conceming himself.To exercise this right,an individual shall notify 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 shail 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 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 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 futl name is required to process this application or permit.
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 35so �v PcAc�
PID:
DESCRIPT'ION OF WORK: �Z�C'�i�.� P�tirr••v ��= ►1,ous1+ a.,-e. �x�sr�n•5 (�--���v/�a;��.-�
ZO.�i TG REVIEW BY: DATE APPROVED: �-� t -os"
BUILDING REVIEW BY: DAT'E APPROVED: �_,Z -o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes 1� No
PLAN REVIEW Yes �' No SEWER CONNECTION
STATE SURCHARGE Yes ,� No WATER CONNECTION
INVESTIGATION FEE Yes No c� PARK FEE
SAC Yes No v SITEINSPECTION
Number of SAC Units OTHER (specify)
----------------------------------------------------------------------------------------------------------------------
ZONI�IG CH�CK LIST Zonin; District:
Fire Departmen[: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes_� No Date of Survey: oN E=t�
Proposed Setbacks:
Front (Lake): Right Side:
Rear (Street): Left Side:
Adjacent Structures: Wetland:
Building Hei�ht: Def. Hgt. Peal:Hgt.
Lot Covera�e:
� CTrading: Staff Approval Date: By: Council Approval Date:
� Septic: Staff Approval Date: By:
-L�
�Jr Zoning File: # Resotution: # Resolution Dace:
Shoreland District:
Av�. Setback: Bluff Setback: L,ot Covera�e:
Existina Proposed
�
Hardcover: 0-75'
7�-2�0'
2�0-SGO'
500-1CCfl'
Hardcover Variance Required: Yes No Date of Council Approval:
�2EVIARKS (in house):
. .
.
�
BUILDING REVIEW CHECK LIST
�C� _ � ' 3 CONSTRUCTTON TYPE: �/�
Sq Footage $Per Sq Ftg
Basement z =
lst Floor z _
2nd Floor x =
Garage z =
R =
TOTAL .
00
Estimated Construction Value: $ g,�00
Inspections Required: `Vork Requiring Separate Permits:
Site _�Plumbing Fire
Hardcover Removal _�Mechanical Water Connection
Footing ` Septic Sewer Connection
_ a�Framin� Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
�Wall Board ) Well (State Permit)
(Mfo•
"� F�� Grading/Filling _,�Electrical (State Permit)
Other
RENIARKS(ni 1 HOUSE): - --r---
---------------------------------------------------------------------------------------------------------------
REV�`V BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy:
---------------------------------------------------------------------------------------------------------------------
REI�LARKS (TO BE NOTED ON PERl�iI'I�: No vx D✓�5�� d �-Q� p�c�c /a.r.Gac,.�e�9
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