HomeMy WebLinkAbout2004-P08183 - addn/remodel/repair _ .
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Posis3
Crystal Bay, Minnesota 55323 PECCTIit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: iii29i2ooa
SITE ADDRESS: 3508 Livingston Ave
Wayzata,NII�I 55391
PID: 17-117-23-43-0042
DESCRIPTION: UBC Occupancy U1
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Pernut Type: Addition/Remodel/Repair Pernut Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
w.�T rnm wr�m r�r�nr�c+r n��r nrmr.rr�n ��mnrr�wr�n
FEE SUMMARY: Pernut Fee: $ 6620 Valuation: $ 1,883.00
State Surcharge Fee: $ 1.45
TOTAL FEE: $ 67.65
APPLICANT: Owner/Self OWNER: Mark&Shirley Spalding
MN 3508 Livingston Ave
Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION 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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LICANTPERMITEE NATVkE � � ISSUEDBYSIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
Total Fee: $ (,P�•(� Date Received: ��"/�' �7`
Entered By: �!� Permit#: D8/83
1 �9� CITY OF ORONO - BUILDING PERMIT APPLICATION
�`1,��A All information must be submitted in full before plan review will be started.
(please pri�zt all information)
THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: ��� ��V L�- C7ST�� �U� ZIp; S�) � �
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 OWNER: �VL���1�C��(' ��i Iw�,�PHONE: (hom �52� `T �I� "3�'��
(work)
MAILINGADDRESS: �SOg �,ULh-C�S�j'� �� CITY: fivr f�1",fl- ZIP: 3ei �
CONTRACTOR: l,�I���T1[�-1JI,YL C� PHONE:
CONTACT PERSON: MOBILE/PAGER:�C9�Z. �G� - (6 C1(
MAILINGADDRESS: ,� 1'�'i� 1�'S A-�olJ�: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition I / Move
Remodel/Alteration V Land Alteration
PROPOSED WORK(describe in detai�: p�1(`�`�l� ���5 � ��- ���`7�-
0►' � �Inh(,P
STORIES: L SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ l��� �—
I hereby apply for a building permit 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 no without a permit;and at the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE:' � DATE: 1 l �S G y
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in th(s sectton.
Subd.2. Information required to be given individual. An indivldual asked to suppiy private or contidential data rnncerning h(mself shall be
informed of: (a)the purpose and intended use of thc requested data within the collecting state agency,political subdivlsion,or statewide system;(b)
whether he may refuse or is legally requlred to supply the requested data;(c)any known conseque�ce arising from his supplying or retusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to recelve the dsta.This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivlsion 5,to s law enforcement ofticer.
The rnmmissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or nronertv tax refund
instructions instead of on those forms.
Subd.3. Access to dsta by indivldual. Upon request to a responsible authority,an indivldual shall be informed whether he is the subject of
stored data on iadividuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is t6e 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
meaning of that data. After an lndividual has been shown the private data and intormed 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 shsll provide coples of the private or public data upon request by the indlvidual subject of the data.The responsible authority may
require the requesting person to pay the actual costs of making,certitying,and comp(ling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within fve days ofthe
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compltance is not possible.IChe cannot comply with the requestwithln
that time,he shall so intorm 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
concerning himself. To exercise this right,an individual shall notify in writing the responslble authority describing the nature of the disagreement. The
responsible authority shaii within 30 days elther: (a)correct the data found to be inaccuratc or incomplete and attempt to notity past recipfents of
inaccurate or inrnmplete 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 it the individual's statement o[disagrecment 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 notifed 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 full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
I unders d my ri ts ove.
Si at
, �
CHECK OFF LIST FOR ISSUANCE OF PER1ti.fITS
FOR OFFICE USE ONL Y
ADDRESS OR LEGAL: 350� L�ViNGsroN ��E
PID:
DESCRIPTION OF Yf�ORK: [LGPch(.G �2-0�� �s��c.�v� o^� � (o11�lc.�
------------------------------------ - -- _ ------------------------------------------------------------- ---
ZONING REVIEyV BY: _ DATEAPPROVED: /�-�& '��
BUILDItVGREVIEWBY: DATEAPPROVED: 1�—i(9 �oy
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FEES TO BE CHARGED: Nlisc. Fees Calciclated By:
PERI�IIT Yes r/ No
PLANREVIEtiV � No t/ SELVER GO�VNECTION
STATE SURCH.4RGE Yes r/ �Vo tiVATER COtWt ECTION
INVESTIGATIO�V FEE Yes tVo PARK FEE
SAC Yes tVo SITE INSPECTIOrV
Nunzber of SAC U�zits OT'HER (specify)
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ZO�VI�YG CHECb'LIST Zorting Disb'ict: A�0 G I�FA1`�Q
Fir•e Departmerct: Post OfJcce: School Distr•ict: _.,,
Lot.�iren: Sq.ft. Acres GVidth Depth
Sic�vey Subrr�ittecl; Yes No Date of Scuvey:
Proposeci Setbacics:
Frortt(Lake): Righ Side:
Rear(Streei): Left S e:
Adjc�cent Sn•ucteu•es: Y(�etland:
Building Heig/it: Def. Hgt. eak Kgt.
Lot Coverage: �
Graclirig: St�ff.4pprovccl Dccte: By: Coc�ncil Approval Dccte:
Septic: Staff,4pproval Date: By; - ,
Zoning File: # Resolictiaz: # Resolution Date:
S/ioreland Dish•ict:
Avg.Setbnck: Bluff S back: Lot Cove1-age:
Existin Proposed
Hardcave�•: 0-7�'
75-�SO'
250-500'
500-!000'
Hardcover Variance Reqacir•ecf: Yes No Date of Coccrzcil Approval:
REMARKS(i�t lsottse):
31
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B UILDING RE VIE IG'CHECh'LIST
UBC: � U�� CONSTRUCTIO�V TYPE: �/�
Sq Footave .S Pe�•Sg FcQ
Basemert� � _
!sr Floor x =
?nd Floa• x =
Gm•age 1 =
.� _
TOTAL
o:
Estimated Constructioit T�alue: S �,��3
Lzspectioits Required: lG'ork Reqcciriiig Sepa�•ate Pern�its:
Site Plcurtbing Fire
Hardcover Rernoval Mechailical G�ater Coririection
Footr'ng Septic Sewer Co�ucection
�_,�'ramutg Fireplace Lativra !rr•igatio�i
�nsulation (r�lasanry) Other
GY�t!!Board (NIf,�.) 6Ye11 (S�nte Per�rtit)
D� Fi�tal Grezding/Fillin� Elech�ical(State Perntit)
Other
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RE�titARXiS(.(N HO USE):
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RE G7E y�B Y OTHERS: DATE:
Access: E,ristin� rVetiv
,�tccess .=fpprovccl: Date B�•,
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RE�tii�Rh'S TO BE�VOTED ONPEIZ1til.IT : ��'cu�
< � ►��s,- nr o T ��-cLo a= n�-n,t� 0 2
Ovc=.�l+�1r�c,S
32
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOT ( SCHEDULED , �( �_
PERMIT NO. COMPLETED
ADDRESS _ d� � � �/�/n✓�S��
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION J����
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAI 19 LAKESHORE/WETIANDS
y 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 FEMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
�DSTOP ORDER POSTED.CALL INSPECTOH
�O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-460�
OwnerlContrac on site:
Inspector. ,��`�
White Copyllnspector's File Canary Copy/Site Notice