HomeMy WebLinkAbout2004-P07651 - pool r � �
PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 Po�6si
Crystal Bay, Minnesota 55323 Permit Type: A��essory s�uo�es
(952) 249-4600 Date Issued: ��i2�2ooa
SITE ADDRESS: 560 Kokesh Farm Rd
Maple Plain,MN 55359
PID: 31-118-23-11-0012
DESCRIPTION:
Proposed Use: Residential
Buildin Census Code 329
Pernut Class: g
Permit Type: Accessory Structures Pernut Sub-type(s): Pool-Outdoors-In Ground
DETAILS:
Approved per resolurion#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 2�9•25 Valuation• $ 17,000.00
Plan Review Fee: $ 181.48
State Surcharge Fee: $ 9.00
TOTAL FEE: $ 469.73
APPLICANT: Peterson Pools&Spas Inc. OWNER: Brian&Nancy Siska
13110 Excelsior Blvd 560 Kokesh Farm Rd
Minnetonka,MN 55343 Maple Plain,MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMI5SION 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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C T PERM SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Repuired), 1-Avnlicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
r . �
Total Fee: $ �� � ��� Date Received: �..l���o��
Entered By: /.� ����j Permit#: j��� �)(,�5�/
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all iizforination)
-------------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle o�ze) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �Z � �/�j� ��2�� �'U'i ZIP:
Will this be a Para e of Homes, Remodelers Sho�vcase Home or other Display Home?
❑ Yes �No If yes, c� special event permit is Yequired tivith Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: �l-S�� PHONE: (home) �'�Z-ZZ-� "Y(o(c,s-
(work)
MAILING ADDRESS: S �"```-�-- CITY: ZIP:
CONTRACTOR: i'£-����"'P��.-s °tS�'='k-_3 PHONE:
CONTACT PERSON: � ��� MOBILE/PAGER: l,�/'z - Z2 ► -3��.�
MAILING ADDRESS: ; ' ' � ; CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILIIV'G ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition jC Move
RemodeUAlteration Land Alteration
PROPOSED WORK(describe iiz detai�: '��i�� .��c,� .^�, ✓�O ��' �� L
STORIES: SQ. FEET OF EACH FLOOR: Zc'.� �C � �,; �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ r q, � cs �
�
I hereby apply for a building pemut 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 start without a pernut; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: DATE: � ��� Q
� . ,
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of tndividuai on whom the data is stored or to be stored shall be as set forth in this sectlon.
Subd.Z. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be
informed af: (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 shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a Iaw enforcement ofticer.
The commissioner of revenue mav alace the notice reauired under this subdivision in the individual inrnme taz or urooertv 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 classified as public,privake 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 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 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 authority may
require the requesting person to pay the actual costs of making,certifying,and compili�g the copies.
The responsible authority shall comply immediately,if possible,wtth any request made pursuant to this subdivision,or within five days of the
date of the request,ercluding 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
und legal holidays.
Subd.4. Procedurc when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himself. To exercise this right,an individual shall notify in wrlting the responsible authority describing the aature otthe disagreement. The
responsible authority shall within 30 days either: (a)correct the data found to be inaccuratc or incomplete and attempt to notify past recipients oC
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individuat 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 determinution of the responsible authority may be appealed pursuant to the provisions ot the administrutive 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 noti�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 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 upoa request)to review private data on yourself.
6. Your full name is required to process this application or permit.
,
First Middle Last
Address
City State Zip Phone
I understand my rights as ate above.
'�.
��
Signature
. . �
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 56 v ic.n I�s K F,a�—
PID:
DESCRIPTION OF WORK: o o�
ZO�IG REVIE�V BY: DATE APPROYED: �•$-v./
BUII..DING REVIE`Y BY: DATE A.PPROVED; -�6 •0�1
FEES TO BE CFIARGED: Misc. Fees Calculated By:
PER�I�IIT Yes c/ No
PLA��I REVIEW Yes v' No SEWE.R CONNECTION
STATE SURCHARGE Yes � No WATERCONNECI'ION
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
Z011'ING CHE.CK LIST Zoaing District: .
Fire Department: Post Office: School Districr. �
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes� No Date of Survey: o"' �<<CF'
Proposed Setbacks:
Front(Lake): 2 35 � ± Right Side: $d �
Reaz (Street): '3�G � '�' Left Side: �N�7� �
Adjacent Structures: 70` Wetland:
Building Height: Def. Hgt. — Peal:Hgt. —
Loc Coverage: N ��
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: �' By:
Zoning File: # � Resolution: # Resolutioa Date: �
Shoreland District: i/�
Avg. Setback: Bluff Setback: Lot Coverage:
Existine Proposed
Hazdcover: 0-75'
75-250' �
250-500'
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMAR��S(in house):
7
« / i
BUILDING REVIEW CHECK LIST
��� -� N �� � CONSTRUCTION TYPE: -
- '_ Sq Footage $per Sq Ftg
Basement� � . . . � _
lst Floor z . _
2nd F1oor x _
Garage x _ .
x =
TOTAL
Fstimated Construction Value: $ /7�U 00 �
Inspections Required: `Vork Requiring Separate Petmits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�Footing ` Septic Sewer Connection •
' Framing Fireplace Lawa Irrigation
Iasulation (Masonry) Other
Wall Boazd � (Mpg,) Well (State Permit)
—�F�� Grading/Filling _�Electrical (State Permit)
Other
REI�ZARKS(IN HOUSE):
- -------_-------------------------____-------------
----------------------------------------------------------
REVIEW BY OTHERS: DAT'E:
Access: Ezisting New .
Access Approval: Date gy;
---------- -------------------------------------------------------------
REMARKS (TO BE NOTED ON PERivII�:
8
LIGH' STEP
APPL'.�<'i�tv A��LiC4T10�
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4.� f' i6' z 32' REC".;:N��� i -�- � ---�.
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I �-j� 6 I 8' � 12-6' PANE�S TYPE 7'i -�- !
i �� � I I 8-BRACE� , i ; �
� gt� I 35'-9" �g• I6• i -CORNEn ASSEMB�Y ScT t � ��,
I �; �I ! I � i -IE x32 COPING STRAIGHT SET E" r', ! i ! i
I � e'�� � �B' l� � -90" CO?ING CORNER SET � � � ' '• � �
a� �; 5 �
I LI 4' -S.TEE� HARDWARE K!' �—= � G+-+ H J ,.�_K_�. �
' g' L g' U g' g� 5teai gceo Ine wqaoia ' -b'itvYL �INER �
�'. To insi2li E'stesl at6p,uae<'fiper on YRher aqe. 5'Z= ; L . c . � D , c ! F I v �• H � J I K
; To instap 8'qeel step.uae 3'filler on eA�er 6qe. .,�. � 3�,�:� i�, . 32,� e, �,�,��
!' 2'^ 8' �i 8' n 8' F' Remow botn e�Dene�a t�+eaner s1ep. B" ! i c� ;5.c., a,c,��, ' '
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! � / � R1�TA,��;.�` .
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�' S" � /' i i -9G` CO?ING .,ORtv�� S�T
I � IJLf/ � �'4� L c I -5'EEL HARDWARE Ki- ' S�0 SUfTI ter Drive
i e� � s• e� e� s• F v ' -v'�`'� ��NE� � PaLS Fort WayPe. iN 4680�
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� s
st�s,����, ilation� i��n % STR-001 ��a 6 February 1991
� I To mstall G steel step.�e 5 Iiiier on either sqe. ���No1�: �
� To instaN 8'stee1 step,uae 5'fiUer on ehber sbe.
i.A1 verticai 6mensms are tom Ilna �8�� +itle�
I Re�ravabotne Pane�canda paneito�e�cne�stea. �'0��"�'u�s N/A Rectangies, 6" fdCjlUs comer i
Exwvauon Naes�
� � � Soil to twe mmmum beanng ypadry o� THIS BRrJCHURE IS FOF ILLUSTRATIVE P,IRPOScS ONLY
� � 2IXIGP.S.F. ThemanufacLramakesailytl�osereoresa�pDorsw!�iUixea¢teC;niawnRenwxrann '
i2 Locate top of pod af leas;6'apwa I My otner represenudcr,s,sta�mFnts,a cmCacts made q Ne ostie�lcontraaa r re'
, sunwdng larp eievatlm. astaner reqarEng an�ma�erials produoea q pr myutacn�er be arri0u�ade io r:E
i 3. E:wvaoon shall bc 71x9x man pod al 6eye andror cancaaar my.The dealer n contacta wn:sel�s a nstatls you pod w a
, xar+� Fil�voCsunderDawolpa�dsan� ���eDe�Oen:cmvafaantlno,anaoencaempoyeeav�ema�wtr_vrer Thewnsc.:-:
wma re1i. memods�usca�ee xesugoes�ms anc�pr my e nor�a awnc conweor�'nN
� t. Badc la w:^�ezpartsrve materla� I be aod:nona�yecar.�ms arW�a�memods ef ansuucn�n. The respa�sat.�
�con�r;x�: �
D T TIME �
CITY OF ORONO CALLED IN ����
INSPECTION N CE SCHEDULED �D ��
PERMIT NO. � � COMPLETED
ADDRESS �60 � ^�
OWNER CONTR. !�1'1
TELEPHONE NO. ��Z �.g� �TJ? Z�
� DESCRIPTION�8� — ��vrD�f�t� ��" �
� 01 FOOTING 11 MECHANI L RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
��., COMMENTS:
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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALI INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACGESS.
Call forthe next'n ction 24 hours in advance. (g52) 249-4600
OwnerlContra site.
Inspector. �
White Copyllnspector's File Canary CopylSite Notice
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-_ {-- --� ,-- .:. `-., "., ' . - __
._ _.
C-- - ; • -- - _ __
' � Existing I __ " � p¢p, denotes Proposed Spot Elevafion ,,` ., -'�0 "
� House � _ � -"" denotes Drainage & Ut�7ity Easement � • __._ . - �
,.,
! �� PROPOSED ELEVATIONS:-'"� -- -- -- ------ --
_
� �-------, c.�:' -- pet-fhe plot of-KOKESH FARM � -.
�__.-__._.____.__ __, � �': Top of Foundation = 1040.5 �
; `,,, - - - - denotes Building Setback line _ � �
�_- Garage = f 040.i7 Fron t - 100'
Bosement Floo� = f031.5 - Side - 50' �
Too of fst Septic Tank = 1028.5 Rear - 100' � { �
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