HomeMy WebLinkAbout2001-P04125 - attached deck CIT`r' OF ORONO PERMIT
2�750 Kelley Parkway - PO Box 66 Permit Number: Po412s
Crystal Bay, Minnesota 55323 PeC'llllt Typ@: Addition/Remodel/Repair
(952) 249-4600 Date Issued: gi3i2ooi
SITE ADDRESS: 1119 Loma Linda Ave
Mound,MN 55364
PID: og-ti�-23-23-002�
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 12525 Valuation: $ 6,000.00
Plan Review Fee: $ 81.38
State Surcharge Fee: $ 3.00
TOTAL FEE: $ 209.63
APPLICANT: PROJECT FACILITATORS OWNER: W�lliam Pollard
5057 THREE POINT BLVD 1119 Loma Linda Ave
MOLIND, MN 55364 Mound MN 55364
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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APPLICA PE MITEESIGNATURE ISSUEDBYSIGNATURE
Copies: 1-File(SiQnitures Reauired), 1-Applicant. 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
� ' .
- Total Fee: $ �(,�g. (03 Date Received: 7�a����
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Enrered By: Q'�,�f'yL. Pernut#: ��f/a,
G� �jl CITY OF ORONO - BUILDING PERNIIT APPLICATION
� , �- All information must be submitted in full before plan revie�r• w-ill be started.
i? (please print all information)
THE APPLICAi�1T IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: �`�Y Ga�i,¢ G,wD� t/l� ZIP: ��S-3� y
NA_�tE OF OWNER: Gr�� � L��''" � �o L G��O PHO�IE: (home) %S�- L/�z Si.r3
. (work)
l�IAILI�i TG:�DDRESS: �/�� Lo�i/�- �,t'N,D.� /�(�CITY: ��a.cJD ZIP: S,S`'36 �
/�'�'1 J N�✓.O/
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CO\�'RACTOR: �'Rw�--r �-��-«"�o� PHO��• 9SZ-- 4�21�Za
CO��TACTPERSON: (�o�, ��n�c��us�.�. 1�IOBILE/�: E��z- 2�0 -3os�
iVL4ILL�1G ADDRESS: sos� -t�i�� Po��rs B� CITY: Yviov,N� ZIP: ��6 4-
ST�iTE LICENSE: # 2020 9 2�� �,g�
ARCHITECTlENGINEER: PH0�1E:
I�I�I�i'G ADDRESS: CITY: ZIP:
�T�`IE: REGISTR�,TIO\n
TYPE OF `VORK: New Addition Accessor�� Structure
Move Remodel/Alteration� Land �lteration
PROPOSED WORK(describe in detai�: �EP�kc:� f�fl �L��c �l-ST��G �=zK'
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROO�IS: GARAGE STALLS: ATT. DET.
ESTLI-IATED CONSTRUCTION VALUATI0�1 (eYclud.ing land): � ;, e v�
I hereby apply for a buildin� perm.it and I acknowledge that the information above i� complete and
accurate; that the work will be in conformance with the ordinances and cedes of the City and with
the Scate Buildin� Code; that I understand this is not a permit and work is not to start without a
perm.it; and that the work wilI be in accordance with the ap roved plan.
APPLICAi�T'S SIGNATURE• .; DATE: � S J� � o f
NOTE! Parade of Homes events require separate permit approval by Police Department and
.
City Counei160 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SL`BJECTS OF DATA �
�
Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be givea indiridual. .�n individual asked to supply private or confidential data conceming himself
shall be informed of: (a)the�rpose and intended use of the requestd data wi[hin rhe collecang state agency,polidcal subdivision,or statewide
ryscem;(b)whecher he may refuse or is IegaUy required to suppty the requested data;(c)any lmown consequence arising from his supplying or
refusing to supply private or coafidential dara;and(d)the identiry of o�er persons or entiaes authorized by sra[e or federal law co receive the data.
This requirement shall not apply when an individual is asked to s�ply invesagadve data, pursuant to secdon 13.82, subdivision S, to a law
enforcement o�cer.
The cemmissioner of revenue mav olace the noece rcwired under this a�bdivision in the individual income taz or oro rtv tax refund
instrucrions mscead of on those fortn .
Subd.3. Access to data by individual. Upon request w a responsible authoriry,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidenaal. Upon his further request,an individual who
is the subject of stored privare or public data on individuals shall be shown[he dara without any charge to him and,if he desires,shall be informed
of the content and meanin�of rhat dara. After an individual has been shown the private data and informed of its meaning,the data need not be
disciosed to him for six months the�eaf[er unless a dispute or acdon pursuant to this secaon is pe�ing or addirional data on[6e individual has been
colizcted or created. The resporuible authoriry shall provide copies of�e private or public data upon request by the individual subject of the data.
The responsible aurhoriry may require the requesang person to pay the actual costs of making,certifying,and compiling the copies.
Tht�espotuible authority shall comply immediately,if poss�le,with any request made pursuant to this subdivision,or within five days
of[he dace of the r_quest,exciuding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
che request wichin that time, he shall so inform the individual,and may have an addiaonal five days within which to comply with the requesc,
excluding Saturdays,Sundays and legal holidays.
Subd.�i. Procedure when data is aot accurate or complete. An individual may contest the accuracy or completeness of public or
private dard concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing the t�ature of the
disagreement. 'lhe responsible authoriry shall withir►30 days either. (a)correct the data found to be inaccurate or incomplete and atumpt ro noafy
past recipiencc of iraccurate or incomple�e dara,inctuding recipients na�cd by the individual;or(b)noafy the individual that he believes the data
to be correct. Daa in dispute shall be disclosed only if the individual's statement of disagreement is included with the disctosed data.
The dewaninaaon of rhe iesponsible authoriry may be ap�a!ed pursuant to the provisions of the administrative procedure act relaang
[o contested cases. �
DATA PRIVACY ADVI ORY
In accordance with N1.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 �ity of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze 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.Q4(available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
lil/.`�- C.� � �o L L/�,/�,D
F�rst Middle ' Last
�// � Go�.t �,��J.� //�J
Address
�i���D �� Ss3�y 95�. y�z r�s3
C�ry State Zip Phone
I understand my rights as state bove.
Signamre �
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
� FOR OFFICE USE ONLY
� ADDRESS OR LEGAL: ►�� � (�c�,�w4 (.i,v,� A A v �
PID:
DESCRIPT'ION OF WORK: �`Z(�
n -----------------------------------------�_----
ZO.�TI�i 1G REVIEW BY: cT DAT'E APPROVED• t o�
BUII..DING REVIEW BY: DATE APPROVED; {� -� —o t
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes �/ No
PLAi�i REVIEW Yes �' No SEWER CONNECTION
STATE SURCHARGE Yes � No WATERCONNECITON
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�TING CH�CK LIST Zoning District: GR-� (3
Fire Department: ry��w b Post Office: y�,rt.o�,�..,o School District: W p s ro�Ic.�
Lot Area: Sq.ft� • �s---i Acres , 1 Q�90( Width 1 YZ•iS Depth /YD
T
Survey Submitted: Yes�_ No Date of Survey: / -/7-g b (o n� +�c:�)
Proposed Setbacks:
Front(Lake): .�Z� ± Right Side: �l 5��' N
Rear(Sueet): 53� ± Left Side: Z� +
Adjacent Structures: _�-�-�.u-� Wetland: N �4
Building Height: Def. Hgt. 6��C' Peal:Hgt. 6��
Lot Coverage: ���� '�
Grading: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: -- By:
Zoning File: # — Resolution: !i Resolution Date:
Shoreland District: �./�� o
Avg. Setback: �t!(/i- Bluff Setback: /1l//f Lot Coverage: /0"�
Eusting Proposed
Hardcover: 0-75'
75-250' Z1.`-t V �-Z��
25Q 500'
500-1000'
Hudcover Variance Required: Yes No� Date of Council Approval:
REMARKS (in house):
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BUILDING REVIEW CI�CK LIST
�C� - � ' 3 CONSTRUCTION TYPE: �/N
� Sq Footage $Per Sq Ftg
Basement x _
lst Floor x _
2nd Floor x _
Gazage x _
x =
TOTAL
Estimated Construction Value: $ G� ppp o0
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanic�l• � Water Connection
—.�FO°��8 � Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) ' Well(State Permit) -
-�F�� � Grading/Filling Electrical(State Permit)
Other .
REMARKS(IN HOUSE): .
--__---------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Date By;
-------------------------------------------------------------
RENIARI�,S (TO BE NOTED ON PERNIIT�:
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HARDCOVER CALCULATION WORKSHEET
SETBACK ZO1VE: (CIRCLE ONE) 0-75' 75-250' 250-500' S00-1000'
EXISTING AARDCOVER IN ZONE
A. House 2G•Z x S�'(•y = !�/ Z� S.F.
Length Width
x = S.F.
z = S.F.
x = S.F.
B. Garage z = S.F.
C. Driveway z = �(p�/p S.F.
z = S.F.
D. Sidewalk x = S.F.
x = S.F.
E. Patio/Deck x = y Z� S.F.
x = S.F.
F. Landscape x = � S.F.
Underlain x = S.F.
By Plastic x = S.F.
Or Fabric
G. Other x = S.F.
TOTAL HARDCOVER IN ZONE - '3 5'?�( S.F. A
TOTAL PROPERTY AREA IN ZONE - I lo Po S� S.F. B
A 35?� - B ( b �� x 100 = Z �.`1l� %
PROPOSED HARDCOVER IN ZONE
A. House x = 1 �{ Z S S.F.
Length Width
x = S.F.
x = S.F.
x = S.F.
B. Garage x = � S.F.
C. Driveway x = I (O�� S.F.
x = S.F.
D. Sidewalk x = S.F.
x = S.F.
�{ Z.d�
E. Patio/Deck x = —�'2G r S.F.
x = � �'?�_S.F.
F. Landscape x = QS�( S.F.
Underlain x = S.F.
By Plastic x = S.F.
Or Fabric
G. Other x = S.F.
TOTAL HARDCOVER IN ZONE - 3,C9�1� S.F. A
TOTAL PROPERTY AREA IN ZONE - S.F. B
A �6ci.( - B ��P/` �� x 100 = 2'�-,( a %
� �-/ —c�(
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a � �� r,, �f.�,0-?o<h- fN.�'r�9�r�, Certificate of Survey a�oNo COP
• or IJilli � ` �
f an J. Pollard
/D�X /cS� LDNG��TE P�40 rw of Lots �3,24,?_5 Loma Linda
F�Pv.�r o�= �.�RA6�,� Iiennepin County, Minnesota
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c�,� 3�so� �* a so'- s�v � �APPROV�Q - OLLI< /
4�„J q '15.0.6 307 a.so' - s-oo' � C A�f'�t�VEG 'JV:�'r' �'�"v�:! y5
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T hereby certif,y that thi.s is a true and correct representa�tion��� ��'
of a sur•vey of the boundaries of Lots 23,24 and 25, Loma Linda, �
the location of all �X1SL1.�C� b�aildings thereon, and a gra�i�l.
driveway, deck, ►valk, steps, retaining wall and concrete slab. � �
It does not purport to sf�ow other improvements or encroachments.
COFFIN � GRONBERG, INC.
Date : 1- 17-8G a��r���ron erg ic. o. 1�755
Scale: �" = s0' Fngineers & Land Surveyors
o : Iron marker Long Lake, hiinnesota LuK�, M�.►�o�o�k
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'1 �I�ECIA�L. NOTE
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FOR �on���' oT1�.e��
� NA`TU�`� gc.���""� CODE REQUIREMENTS
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DATE TIME
CITY OF ORONO CALLED IN �-/ `�'/
INSPECTION ZICE SCHEDULED �7.--� C� v
PERMIT NO. �G � COMPLETED , � � s- C�
ADDRESS �-
OWNER CONTR.
TELEPHONE NO. �s � �� �f 3
� DESCRIPTION ���.
11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q MING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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 REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNEfl/CONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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W� j�WORKSATISFACTORY:PROCEED ❑ PFOJECTCOMPLETE
W �O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CAIL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �95Z� 249-4600
OwnedContrac r on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
�
DATE TIME
CITY OF ORONO � CALLED IN
INSPECTION NOTICE `' ,��" SCHEDULED D- %
PERMIT N0. v��"� COMPLETED "'?/Q� ___�xC;�
ADDRESS �
OWNER CONTR. ��
TELEPHONE N0. ��� ���I�3 -�l�J" �_
� DESCRIPTION �/ � u-'�`
� 01 FOOTING 11 MECHANICAL 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 OS 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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W� �WORK SATISFACTORY:PROCEE �ROJECT COM
W L�apRRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O l❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
O INSPECTION REQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContr ctor on site:
Inspector. ,iC- � � `
White Copyllnspector's File Canary Copy/Site Notice