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Home My WebLink About2001-P04278 - addn/remodel/repair . � PERMIT C I TY O F O RO N Q Permit Number: 2750 Kelley Parkway- PO Box 66 P04278 Crystal Bay, Minnesota 55323 Permit Type: aaaition�temoaevxepai� (952) 249-4600 Date Issued: 9iai2ooi SITE ADDRESS: 128o Lyman Ave WAYZATA,MN 55391 P ID: 3 5-118-23-34-0014 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: ttesidentiai Permit Class: Building Census Code 434 Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 293.25 Valuation: $ 17,500.00 Plan Review Fee: $ 190.58 State Surcharge Fee: $ 8.75 TOTAL FEE: $ 492.58 APPLICANT: OWNER: Steven A.Kleineman 1280 Lyman Ave Wayzata MN 55391 THE UNDERSIGNID HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WTI'H ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUII,DING CODE REQUIREMENTS. � � �y�, �� -� SI ISSUED BY SIGNATURE Copies: 1-File(Signitures Required),1-Applicant, 1-MondilyReports, 1-Assessing, 1-Finance Page 1 . < � Total Fee: $ �� .�j� Date Received: Entered By: �_ Permit #: Q z/a7�Q CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) THE APPLICANT IS: (circle one) OWNER OR CONTRAC OR JOB SITE ADDRESS: 'L p ZIP: �53�� i r� � �a �v� � ewc NA1�TE OF OWNER: J�, j�gy� PHONE: (home) `1�j3•��,•S 1�- ' (work) _7(03• �Rl-(ol!S MAILING ADDRESS: ��,��,�r�,,,-�, (�,�_ CITY: '�uA,,,�,�, ZIP: SS�� —��`�" v CONTRACTOR: i S PHONE: �63• S4�• �50 _ CONTACTPERSON: MO ILE/PAGER: 6)Z-�¢p. bS¢�- MAILING ADDRESS: s� �� CITY: ZIP: S��kN STATE LICENSE: # p ARCHITECT/ENGINEER: PHONE: 7��-S�! - (pIl� MAILING ADD SS: � ` ` CITY: ZIP: �� NAI�IE: � REGISTRA ION# �1{-J�} TYPE OF WORK: New Addition �_ Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: � ` � s � STORIES: 1 SQ.FEET OF EACH FLOOR: LL� 'L�� ; II/l•(� � ZSD NO. OF BEDROOMS: �' GARAGE STALLS: ATT. -- DET. -- ESTIMATED CONSTRUCTION VALUATION(excluding land): $ I'1��8�.' I hereby apply for a building permit and I acknowledge 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 permit; and that the work will be i ccor an e with the approved plan. APPLICANT'S SIGNATURE: � DATE: $ Zn Zo�� NOTE! Parade of Homes events require se arat permit approval by Police Department and City Council 60 days prior to the event. Non- itted events will not be allowed. � 9 , , , Sec.13.04 R/GNTS OF SUBJECTS OF DATA Subd�visron 1. Type ojdata. The rights ojindividual on ivhom the data is stored or to be stored shall be as set forth in this section. Subd.2. Injormation required to be given individuaL An individual asked to supply private or confidentia[data concerning himselj shall be informed of.' (aJ the purpose and intended use ojthe requested data within the collecting state agency,political subdivrsion,or statewide system;(b)whether he may rejuse or is legally requrred to supply the requested data;(cJ any known consequence arisrng from his supplyrng or refusing to supply private or confrdential data;and(d)the identity of otherpersons or entities authorrzed by state orfedera!laiv to receive the data. Thrs requirement shall not apply when an indivrdua!is asked to supply investigative data,pursuant to section 13.82, subdivision 5, to a Imv enforcement officer. The commissioner ojrevenue mav place the notice required under this subdivision in the individual income tax or propertv tar refund instructions instead o/on those forms. Subd.3. Access to data by individuaL Upon request to a responsible aurhority,an indivrdua!shal!be informed whether he rs the subjecr ojstored data on individuals, and whether it is classrfred as public,prrva[e or confidential. Upon his further request,an rndividua!who is the subject ojstored private or public data on individuals shal!be shoivn the data without any charge to him and, if he desires,shall be informed oj the content and meaning of'that data. After an individual has been shoivn the prrvate 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 rs pending or additiona!data on the indrvidua(has been collected or created. The responsible authority shall provide copres of the prrvate or public data upon request by the indivrdual subject oj the dafa. The responsrble authority may require the requesting person to pay the actual costs ojmaking,certifying,and compiling the copies. The responsible authoriry shall comply immediately,iJpossible,with any request made pursuant to this subdivisron,or within five days of the date of the request,exck�drng Saturdays,Sundays and legal holidays,rf immediate compliance rs not possrble. /f he cannot comply ivrth the request wrthin that time,he shall so inj'orm the indivrdual,and may have an additional ftve days tivrthrn which to comply tivrth the request,excluding Saturdays,Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete. An indrviduaf may contest the accuracy or completeness ojpublic or private data concerning hrmselj. To exercise this right, an individua!shal!not�in writing the responsible authorrty describing the nature of!he disagreement. The respoi:srble authoriry shal!within 30 days either: (a)correct the datafound to 6e inaccurate or rncomplete and attempt to notify past recrpients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual thaf he believes the data to be correct. Data in drspute shall be disclosed only if the rndividual's statement of disagreement is included with the disclosed data. The determination of the responsrble authority may be appealed pursuant to the provisions of the adminrstrative procedure act refating ro contested cases. ' DATA PRIVACYADVISORY /n accordance with M.S.l3.04,Subd.2, "Rights ofsubjects ojdala",we woufd like to inform you thnt your requestfor a permit orlicense from the City oJOrono or any of its departments may require you to furnish certarn private or confrdentra!information. You are notifred that 1. The information you furnish wrll be used to determine your qualifrcalion jor the permit or license requesled. 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 olher local,state or jedera/agencies!o the extent necessary to process the permit or [icense. �1. Ifyour requested permit or license requires Counci/action to approve,some information may become publrc. S. You have certain rights under MS. 13.0�1(see jolfotiving page)to review private data on yourselj. 6. Your full name is requrred to process this application or permit. PL A E PRINT First Middle Last �� . �. C�� 6�-��-�s�o Address l�� '� I�ti s�� C�� 6�� 4s�� City State Zip Phone 1 un r and y ri hts as slated bove. Sig ture /0 � � � CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: l 2$o c.,y ww.rv q�•.p PID: ' DESCRIPTION OF WORK: /4/�/�r Tt o�15 — c.��n�I.•v o/L�w.vAc. �or�t.res --------------------------------------- _--- _____------------------------------------------------------------------- ZONING REVIEW BY.• DATE APPROVED: �- �.�-�r BUILDING REVIEW BY: DATE APPROVED: � -3 0 -v� FEES TO BE CHARGED: Misc. Fees Calculated By: PERMIT Yes � No PLANREVIEW Yes r/ No SEWER CONNECTION STATE SURCHARGE Yes �/ No WATER COIVNECTION INVESTIGATION FEE Yes No PARK FEE SAC Yes No ' SITE INSPECTION Number of SAC Units OTHER (specify) ----------------------------------------------------------------------------------------------------------------------- ZONING CHECK LIST' Zoning District: /Vc) G H A p�Q Fire Department: Post Office: School District: Lot Area: Sq.ft. Acres idth Depth Survey Submitted: Yes No Date of Survey: Proposed Setbacks: Front (Lake): Right Side: Rear (Street): Left Side: Adjacent Structures: Wetla • Building Height: Def. Hgt. Peak H t. Lot Coverage: Grading: Sta,ff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: By: Zoning File: # Resolution: # esolution Date: Shoreland District: Avg.Setback: Bluff Setback: Lot Coverage: Existing Proposed Hardcover: 0-75' 75-250' asasoo� 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS(in house): 32 � .- , BUILDING REVIEW CHECK LIST ' ' � � UBC: � ' 3 `CONSTRUCTTON TYPE: v� Sq Footage $Per Sq Ftg Basement x = Ist Floor x = 2nd Floor x = Garage x = x = TOTAL Estimated Construction Value: $ /7�Spt�°s'� Inspections Required: Work Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical Water Connection Footing Septic Sewer Connection Framing Fireplace Lawn Irrigation Insulalion (Masonry) Other Wall Board (Mfg.) Well (State Permit) _�Final Grading/Filling Electrical (State Permit) Other REMARKS(INHOUSE): REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date By: REMARKS (TO BE NOTED ON PERMIT): 33