HomeMy WebLinkAbout2004-P08096 - addition/remodel PERMIT
.CI�Y OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P08096
Crystal 3ay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952� 249-4600 Date Issued: ioi2o�2ooa
SITE ADDRESS: 3560 Ivy Pl
WAYZATA,MN 55391
PID: 2o-i i�-23-�2-002�
DESCRIPTION: UBC Occupancy U1
Proposed Use: Residential Construction Type VN
Census Code 434
Permit Class: Building
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Pernut Fee: $ 41.80 Valuation• $ 1,100.00
State Surcharge Fee: $ 1.05
TOTAL FEE: $ 42.85
APPLICANT: Owner/Self OWNER: G A CHRISTENSEN ET AL
MN 3560 IVY PL
WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES T DO ALL WORK IN STRI OMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA DING CODE I S.
�
ICANT PE ` GNATU SUED BY SIGNATURE
Couies: 1-File(SiQnitures Required). 1-Annlicant, 1-Monthlv Reuorts, 1-Assessin¢, 1-Finance Page 1
� Total Fee: $ Date Received: / D -o�D - D�
Entered By: Permit#:
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�:t all information)
---- ====- --------------------------------------------------------------
THE APPLICANT IS: (circle one) OR CONT CTOR
��._.. ..__--
JOB SITE ADDRESS: `J L�G C� �A z�T ZIP: ���9�
Will this be a Parade omes,Remodelers Showcase Home or other Display Home?
❑ Yes o If yes, a special event permit is requirec�with Police Department and City
Council approval 60 days prior to the event. Non peYrnatted events wall not
be allowed.
NAME OF OWNER: si �z rT �+21 TI�n/ c(/ PHONE: (home)�SZ" '�7�' ��5$
(work)
MAILING ADDRESS: S � .4 r� CITY: f���.�.�-,c; ZIP: SS�9�
CONTRACTOR �v(JN � �7 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 WORK(describe in detai�: f-i�l ��I �S /� c�� � L�olZ � /�
c�{� fZ�kQ., ��L ��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARA.GE STALLS: ATT. DET.�_
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �/ O�
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 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 st 'thout a permit;a d that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: � DATE: !� - Z o ' d�
Sec.13.04 RIGHTS OF SUBJECTS OF DATA �
Subd.l. Type of data. Thc rights of individual on whom the data is stored or to be stored shall be as set torth in th(s section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall 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 Iegally required to supply the requested data;(c)any known consequence arising from his supplying or retusing to supply
private or confidentiai data;and(d)the identity of other persons or entities authorized 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,subdivislon 5,to a law enforcement ofCcer.
The rnmmissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or urooerlv tax refund
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 classifed 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 the rnntent and
meaoing of that data. After an individual has been shown the private data and in[ormed of its meaning,the data need not be disclosed to him for siz
months thereafter unless a dispute or action pursuaot to this section is pending or additional data on the individual has been mllected 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 authorlty may
require the requesting person to pay the actual rnsts of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within eve days ofthe
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.It 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 compiy with the request,excluding Saturdays,Sundays
and legal holidays.
Subd.4. Procedure when data is not accurate or rnmplete. An individual may contest the accuracy or completeness of public or private data
concerning himselL To exercise this right,an individual shall notify in writing the responsible authority describing the nature of t6e disagreemen4 The
responsible suthority shail within 30 days either: (a)wrrect the data found to be inaccuratc or incomplete and attempt to notify pest recipients of
inaccurate or(nrnmplete data,including recipients named by the individual;or(b)notity the individual that he believes the data to be correc� Data in
dispute shall be disclosed only if the individual's ststement 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 notif ed 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 informatioa 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 re uest)to review private data on yourself.
6. Your full name is required to process this application or 't.
,
r�/�� rZ � ��" w
First Middle Last
� �",� (fCj � � �J [,L—/L-tsL��
Addres� �
/�� � � z�5 y ys'T� � ?/ - ���
City — State Zip '�— Phone
I understand my ri ts s stated above.
Signature
, •
CHECK OFF LIST FOR ISSUAIYCE OF PE.R1ti.fITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 3�o �N ��"`'P
PID:
DESCRIPTIO:V OF 6vORK: '��"��
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ZOtVI�VGREUIEY[�BY: DATEAPPROVED:/� ���
B UILDItYG.REVIEW B Y: DATEAPPROVED: �v'�+�•vy
----------------------------------- -
FEES TO BE CHARGED: tL�Iisc. Fees Cc�lccciczted By:
PER11�fIT Yes ✓ No
PLANREVIEGV Yes tVo � SEYVER GOtViYECTION
STATE SURCH.4RGE Yes_�� �vo yVATER COtWi ECTIO�V
INVESTIGATIOtV FEE Yes No PARK FEE
SAC Yes No SITE tNSPECTIO�V
Nctrnber of SAC Units OTHER (specify)
-------------------------------------
ZO�YI[VG CHECh'LIST Zor�ing Disd•ict: � �'
Fire Deparhreerrt: Post Office: Schoo!District: __.
Lot.�trea: Sq;�1. �lcres 6Yidth Depth
Scuvey Subr�iitted: Yes No DRte of Sccrvey:
Pr•oposec!Setbacks:
F,•ait(Lalce): Rigl:t Side:
Rear(Street): Left Sicfe:
Adjacent Struct�u•es: Y�etland:
Bccildirig Height: Def. Hgt. Peak K t.
Lot Coverage: �
G�'ctding.� Staff Approvccf Date: B, : Council Approval Date:
Septic: Staff.�lpproval Date:
Zoning File: # Resolutiai: # Resolution Date:
Shoreland Dish•ict:
Avg.Setback: Bluff Set ck: Lot Cove:•age:
Existing P�•oposed
Ha�•dcover: 0-7.i'
75-250'
250-500'
500-!000' _�
Kardcover Variance Required: Yes No r�. Date of Council Approval:
RE111ARKS(ire hotcse):
31
!
B UILDI�VG REVXEtY CHECh'LIST
UBC: (>'I CONSTRIiCTIOtYTYPE: ��
Sq Faotage .�Per Sq Fr,;
Basentent r =
1 st Floor x =
�rtd Floor i =
Garcge c =
� _
TOT,�tL
Estiruated Construclio�i Vali�e: �S �,I (�j J
Irespections Requi�•ed: 6York Requiri��g Separate Pern�its:
Site Plcunbing Fire
Hardcover Rernoval Nfec/ianical 6f�ater Gainection
_�[Footing Seplic Sex�er Conrcection
Frnmirtg Fireplace Latiwt b•rigatiat
Insulation (A�lasonry) Other
GYc�ll Board (blfg.) 4Vefl(Stnte Per•ntit)
_�Final Gradi�tg/Filfirio Electrical(State Permit)
Other
ILE�YIARl'iS(INHO USE):
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RE IjIE 6V S Y OTHERS: DATE:
.4ccess: EYisting New
Access�lpproval: Date By:
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RE�'�I�1Rh'S (TO BE NOTED O�V PERtY1XT):
Ir
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�\\ DATE TIME "
CITY OF ORONO CALLED W �/
INSPECTION NOTIC�E- SCHEDULED l J-.�O�d� =�;lS ��-�
PERMIT NO. �C 7�Lt � COMPLETED
ADDRESS_����� � r�'i.f �—�� ��t C-Q
1
OWNER ('__�_=-t'��l '������f����.� CONTR. �-.��L�'Y1.��'--�
TELEPHONE NO. � Ca S I �c�lS rY�7Ci
� DESCRIPTION k�CW( � c`� ��� �Gc�� � ��OCIC ���'�`r��C
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORK SATtSFACTORY:PROCEED PROJECT COMPLETE
� ❑CORRECT WORK 8�PROCEED r' ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUtRED.CALL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (J52� 249-4600
OwnerlContra te:
Inspector. _
White Copyllnspector's ile Canary CopylSite Notice