HomeMy WebLinkAbout2007-P108 - plumbing PERMIT
ClTY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p10805
�Crystal Bay, Minnesota 55323 P21'r711t Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued:
4/10/2007
SITE ADDRESS: 3550 Ivy 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
Addition/Remodel/Re air Permit Sub-type(s): Addn/Remodel/Repair
Permit Type: P
DETAILS:
Approvcd per resolution#: 5579
Separate permits required: Plumbing Mechanica) Electrical(state)
NOTICES/REMARKS:
Add 114 sq. ft.bow to lake side
FEE SUMMARY: Permit Fee: $ 349.25 Valuation: $ 21,564.00
Plan Review Fee: $ 227.01
State Surcharge Fee: $ 10.80
TOTAL FEE: $ 587.06
APPLICANT: Owner/Self OWNER: William Dampier
MN 3550 Ivy Pl
Wayzata MN 55391
TI�jE IdN,pERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
,AND`AGREE TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA UILDING CODE REQUIREMENTS.
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� PLICANT P I EE SIGNATURE [SSUED BY SIGNATURE
Copies: 1-File(Signatures Requirecf), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: $ , � Date Received: ���"l�Z
Entered By: ,���,�.� i `�� Permit#: �, /O�D�$'
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CITY OF ORON�O - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle orze) OWNER R CONTRACTOR
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JOB SITE ADDRESS: S��S(� � (� � �`��C f' ZIP: 5`-� 5 � l
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �10 lfyes, n specia!event pern7it is required tivrth Police Depardment and Ciry Coirncil approva!
60 days prior to the eve��t. Shzrttle bus service wil!be r•equii-ed unless applica��t demonstrates
sz fftcient on-site par�king is available. Non-per�mitted events will not be allowed.
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NAME OF OWNER: � �/�.f� ` �`Z �'i�PHONE: (home) �r S Z ��� Z 5 /3
MAILING ADDRESS: �.21 � CITY: (W�ZIP: � ,Z Z 2� C���3 p
CONTRACTOR: `� � �- PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: �'ITY: ZIP:
NA1�IE: REGISTRATION: #
TYPE OF WORK: New Home Addition X Accessory Structure
Move Home RemodeVAlteration (ie: Siding, Windo�vs)
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detai�: 1�j I ��� S�� � ��J 1 D Lfl-l��
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STORIES: Z SQ.FEET OF EACH FLOOR: J I�I
NO. OF BEDROOMS: � GARAG� STALLS: ATTACHED�_ DETACH�D_
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � ,��'��.��
I hereby apply for a building permit and I aQ�nowle g th tthe information above is complete and accurate;
that the work will be in conformance wit �e or n ces and codes of the City and with the State Building
Code;tllat l understand this is not a per i and w rk i no to start without a permit;and that the work will be
in accordance with the approved pl .
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APPLICANT'S SIGNATURE: L DATE: �2� ��6 2D�7
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type 6f 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 requi�ed to be given individual.An individual asked to supply private or confidential data concerning himselfshall 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 refuse or is legally required to supply the requested data;(c)any kno�vn consequence arising from his supplying or refusing to supply
private or contidential data;and(d)the identity of other persons or entities suthorized by state or federal law to receive the data.This requirement shall
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 may place the notice required under this subdivision in the individual income tax or�rop�tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be infortned whether he is the subject of
stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuRher request,an individual who is the subject of
stored private or public data on individuals shall be shown the data without any chazge 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 infortned 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,if possible,with any roquest made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediaze compliance is not possible. [f 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 himsel£ To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement.The
responsible authority shall within 30 days either: (a)cortect 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 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 furnish certain private or
confidential information.
You are notified that:
l. 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 Ciry 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 ceRain rights under M.S. 13.04(available upon request)to review private data on yourself.
6. Your ful!name is required to process this application or permit.
First Mi dle Last
Cl'f / �A�'r'J /<'C/Z
Addres
S �1 C 'E
Ciry ��/ r � %� S� Z� 3` I Phon����/ �S 1�
1 unders a m �ri 1 t �s stated ab ve. `� '
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Signature � � '
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Reset Form 32
, CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE E ONL Y
ADDRESSORLEGAL: 3SS0 ,rv� ��}PO.
PID:
DESCRIPTION OF WORK �,o p Q,
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ZONING REVIEW BY.• �.- DATEAPPROTrED:
BUILDINGREVIEWBY.• DATEAPPROitED: 3 • �y- o�
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes �/' No SEWER CONNECTION
STATE SURCHARGE Yes �/ No tiVATER CONNECTION
INVESTIGATION FEE Yes No_�C PARK FEE
SAC Yes No ✓ SITEINSPECTION
Nzmzber of SAC Units OTHER (specify)
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ZONING CHECK LIST Zoning Drstrict: �., — � �
Fire Department: Post Offrce: School District:
♦
Lot Area: Sq.ft. Acres �, ��idth �3 Depth �}}t1�2.. Z�d
Siuvey Submitted: Yes No � Date of Sz�rvey: � Q ��, (riu� ��
S�,r„r.t FiY..+,�i!,� U'��-
Pr•oposed Setbacks: n� � �
Front(Lake): �t Side: 3. �
s� � � �
Rear(Street): /7 q L�f Side:
Adjacent StrTrctzires: �'!/} Wetland: rli�
Bcri(ding Height: Def Hgt. Peak Hgt.
Lot Coverage:���� *
Grading: StaffApprova!Date: N 0 GWAn�b(� By: Coia�cil,4pproval Date:
Septrc: Staff�lppr•oval Date: /v 1�/i B}�:
-� 7_onirrg File: # OG� �J2. � Resola�tio�7: � Reso/artioj7 Date: � ��
Shoreland District: ✓ MCGI�D Permit:
rlvg. Setback: BILffSetbacic: LotCoverage:
Exrsting Pi�oposed
Hardcover•: 0-7�' (� Q
75-�so' �18.Y5� �tpprtn�.d Y5.39%S ��
250-�00' �' —
soo-�oon� -- -
��I-furcicover Varinnce Required: }es�� �Vo Date of Cozrncil flppi•oval: �����
rev�s�r-�. �-o resai�h,� Y`��-7
REMARKS(in ltouse):
/�/
By �
»
BUILDING REVIEW CHECK LIST
USC: iZ•� CONSTRUCTION TYPE: �!N
Sq Footage $Per S9 Ftg
Basement x =
1st Floor x =
2nd Floor� x =
Garage x =
x =
TOTAL
Estimated Co�astr��ction Value: $ Z 1. S 6�'(,d�
Inspections Req«ired: 6�a�k Requiring Sepnrnte Permits:
Site _�Phrmbing Fire
flardcover Rernoval _�c Alecha»ica( I�i'ater Con�aection
�Footing Septic Selver Connection
_�( Framing Fireplace Lmvn Ir•rigation
�c Instrlation (A�(asonr•y) Other•
� Wall Bonr•d (��ffg.) Well(State Perrnit)
_�Final Grading/Filling K Electrica/(State Permit)
Other
REMARKS(INHOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Appr�oval: Date I3j%:
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REMARKS (TO BE NOTED ONPERMIT):
34
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� . CerCiftcate of Survey for.
„ Wiltiam S. Oampier ' '
� ' of Lat 173, TFlYLORS SU�DiVISI�N Of
� SPRING PARY, �OTS
Hennepin County, Minnesota
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LEGFlL DESCRIPTION OF PRE�HISES SUR4EYED•
. lot 173, TAYLOf2S SUODIVISION OF SPRING PARK LOTS.
�roposa.d o�dc���no�.
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� I hereby cArtify that this sui•vey was prepared by me
v or under my direct supervision, and'that I am a duly
v� ^+ registered Civil Engineer and Land Surveyor under the
m laws of the State af Minnesota.
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, , m � Englnenrs.; lAnd Surueyars, Planners
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