HomeMy WebLinkAbout2003-P06721 - plumbing � ~ PERMIT
CI�'Y OF ORONO Permit ►vumber:
2750 Kelley Parkway- PO Box 66 P06721
Crystai Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 9i9i2oo3
SITE ADDRESS: 2660 Mapleridge La
F�ccelsiar,MN55331
P I D: 21-117-23-24-0051
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Permit Class: Building Census Code 434
Permit Sub-type(s): Addn/Remodel/Repair
Permit Type: Addition/RemodeURepair
DETAILS:
Approved per resolution#:
Sepazate pemuts required: riumoing iviecnanicai Eiec�icai�siaie�
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 664.75 Valuation: $ 52,400.00
Plan Review Fee: $ 432.18
State Surcharge Fee: $ 26.70
TOTAL FEE: $ 1,123.63
APPLICANT: Doug Dzurik Construction OWNER: Karl&7ulie Yeager
16717 Gras Bay Blvd 2660 Mapleridge La
Wayzata,MN 55391 Excelsior,MN 55331
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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PLICANTPERMITE NATURE ISSUEDBYSIGNATURE
Conies: 1-File(SiQnitures Required), 1-Aunlicant,1-Monthlv Revorts, 1-AssessinQ, 1-Finance Page 1
Total Fee: $ ��� -� : �( � Date Received: fl��'' ���"/ � �
Entered By: ,�;�fL�. Pernut#: {�� "`/�G' �;
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CITY OF ORONO - BUILDING PERMIT APPLICATION
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l All information must be submitted in full before plan review will be started.
(please print all information) �
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THE APPLICANT IS: (circle one) OWNER OR ONTRACTO
JOB SITE ADDRESS: ai�����' ��/'� �,��:�.� C,y� z�:. �-`�A"_s=�.�' 1
NA:'�iE OF OWNER: ����� -��,1.��� �2���.v._ PHONE: (home) ����{�l"=�`�'3C�
. �- (work)
MAILI�i TG ADDRESS: �"°Z��,� )'��� (P����CITY: �r�n�;. ZIP: �__;.�� �, I
�'�t.
CO\'TRACTOR: ��w,o �-Z . � , PHOl�TE: �v��-�I -��-I��
COti-TACT PERSON: � i MOBILE/PAGER:
NLAII�Pi tG ADDRESS: ���'S � w,� S�' CITY: ZIP: _�"�S-S��/�
ST�,TE LICENSE: # �����_3 J�
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ARCHITECT/ENGliYEER: �-- PHOi�TE:
MAII�ING ADDRESS: CITY: ZIP:
�1A_I�LE: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration�� Land Alteration
PROPOSED WORK(describe in detai�: ��;t;'L ;,t;L�,�1 .�[y"}'t'�7�/t 4 �r2�CS jc�CE? f����'�1
i,�l J i;n���.�,�� _S`�c�� �t,�v�K��,, l��•�� inl�.vs.:�oLvS � .�cxr�- a r�.�rxj r��� S a,.
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��T�� �-t�.�r;h� E�►�����r' ��'-.�.�s�!� a r��' n�.a j�r a c�c�.�- :�':th a. n�c•� h e�4.� �r/�'�
S T O R I E S: x ��. F E E T O F E A C H F I.O O R:
NO. OF BEDROOMS: � � GARAGE STALLS: ATT. DET.
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f�✓l��r' r b��wt ;i'!1`c `�1 z �.�:i�T i�►�" �"��,�:-+� ,@,,:
�STL�IA.TED CONSTRUCTION�ALUATION (excluding land): $ ''>t� . ��'�` ��
I hereby apply for a buildin; 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 wiR be in accordance with the approved plan.
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APPLICANT'S SIGNATURE: � ,�;,i � � ''��� DATE: `` i �" �
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NOTE! Parade of Homes events require separate permit approval by Police De�artment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be given indiridual. An individual asked to supply private or confidential data concerning himself
shall be informed of: (a)the purpose and inceoded use of the requested dara wichin the cotlecting state agency,polidca!subdivision,or sratewide
rysum;(b)whecher he may refuse or is legally required to supply the requested dara;(c)any Imown consequence arising from his supplying or
refusing to supply private or confidenaal data;and(d)the idenary of other persons or enrides authorized by srate or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply invesNgadve data,pursuant to secdon 13.82, subdivision S, to a law
enforeement o�cer.
'he commissioner of revenue mav olace the noece reauired under this c��bdivision in the individual income taz or n ertv tax refund
instrucdons�nstead of on those forms.
Subd.3. Access to data by indiridual. Upon request to 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,privau or co�denaal. 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 desiros,shall be informed
of rhe content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the dara need not be
disclosed to him for six months thereafter uniess a dispute or acaon pursuant w thissecaon is pending or addiaonal data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data.
The responsible authoriry may require the requesdng person w pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any mquest made pursuant to this subdivision,or within five days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request wirlvn that time,he shall so inform the individual,and may have an addiaonal 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 eaercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of[he
, disagreement. The responsble authoriry shall within 30 days either: (a)correct the data found ro be inaccurate ar incomplete and aaempt to nodfy
past recipiencs of inaccurate or i�omplete data,including rocipients named by the individual;or(b)no6fy the individual 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 dererminadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relaang
to contested cases.
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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 �iry of Orono or any of its departments may require you to furnish certain
private or confidential information.
You are notified that: �
1. The information you furnish will be used to detemune 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
Addross
C�h' State Zip Phone
I understand my rights as stated above.
,
SignaNre •
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CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY .
ADDRESS OR LEGAL: Z 6 6 o w�A P t� Rlnb c� Gv4-��
PID: /
DESCRIPTION OF WORK: /�-�vwdc;Z
ZOi�tING REVIEW BY: DATE APPROVED: �- $�-03
BUII.DING REV�W BY: DATE APPROVED: � -g-�-3
FEES TO BE CHARGED: Misc. Fees Calculated By:
pERMIT Yes �� No
pLAN REVIEW Yes r/ No SEWER CONNEC"TION
STATE SURCHARGE Yes c/ No WATER CONNECTTON
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No �/ SITEINSPEC"fION
Number of SAC Units OTHER (specify)
ZOr'ING CHECK LIST Zoning Districr. /vo Gffi4,v(,�
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: Wetland
Building Hei�ht: Def. Hgt. Peal:H .
Lot Coverage:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: By:
Zoning File: # Resolution: # R solution Date: . . .
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
EaistinD Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house):
.
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BUILDING REVIEW CHECK LIST �
� �C� �' 3 CONSTRUCTION TYPE: y^�
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x _
Garage x =
z =
TOTAL
Estimated Construction Value: $ 5 2,y n o°Q-
Inspections Required: Work Requiring Separate Permits:
Site _�Plumbing Fire
Hazdcover Removal _�Mechanical Water Connection
�� Septic Sewer Connection
_�Framing Fireplace Lawn Irrigation
_�Insulation (Masonry) Other
�_Wall Boazd (Mfg.) Well (State Permit)
� F� Grading/Filling _�Electrical(State Permit)
Other
RENIARKS(IN HOUSE): . �
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REVIEW BY OTHERS: DATE:
Access: Eusting New
Access Approval: Date gy;
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REMARKS (TO BE NOTED ON PERNIIT�:
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DOUG DZURIK GQNSTRUCTION, INC. � ►
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DAT TIME
CITY OF ORONO CALLED IN 10_ �
INSPECTION NOTICE SCHEDULED ��� l :3�
PERMIT N0.�O 7�� COMPLETED
ADDRESS a��D �,
OWNER CONTR. �wr��
TELEPHONE NO.�n� Z Z Z/ Z T-3 I
� DESCRIPTION Y�
l� 01 FOOTING 11 ECHANICAL RI � 7 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
Q 3 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
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 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP OROER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTfON RE�UIFED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-4600
OwnerfCon e:
Inspector.
White Copy/inspector's File Canary Copy/Site NoNce
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