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Home My WebLink About2004-P07710 - addn/remodel/repair � � PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 Po��io Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair (952) 249-4600 Date Issued: �i2si2ooa SITE ADDRESS: 30 Myrtlewood Rd Wayzata,MN 55391 PID: 36-118-23-33-0011 DESCRIPTION: UBC Occupancy R3 Construction Type VN Proposed Use: Residential Pernut Class: Building Census Code 434 Permit Type: Addition/Remodel/Repair Pernut Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: Yiumoing iviecnanicai irrigazion �,iecfficai �s�aiej NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 1,452.95 Valuation: $ 182,000.00 Plan Review Fee: $ 973.63 State Surcharge Fee: $ 95.50 TOTAL FEE: $ 2,522.08 APPLICANT: D S Building Blocks Inc. OWNER: Bruce&Lori Paulson 938 Brooks Ave 30 Myrtlewood Rd Roseville,MN 55113 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. ' � _t ,�,/' �'��-� APPLICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1 t , 2_ S 2�_ . ��%� Total Fee: $ � Date Received: ��.'' 7V7/C' Entered By: �I� Permit#: �7 - /S c��/ '� f ti'�`�'� %��c`I CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please pri�zt all i�iforrnatio�z) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR J JOB SITE ADDRESS: 3 v � ►�`�� P�� I� zir: �5�� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �io If yes, a special event permit is required with Police Depc�rtment and City Council appYova160 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: ��-e- �-� ��'u�J � �� -. PHONE: (home) S�L - �f 7 3 � Z z_�� ' (work) MAILING ADDRESS: 5�w--� CITY: ZIP: CONTRACTOR: �S ��--� �'��--��S L^� � PHONE• 6�2 -��6 �-�i'Y Z Z CONTACT PERSON: � �� L��1�,.�,�J Lr'e-�- MOBILE/PAGER:• MAILING ADDRESS: �t 3� �b r�'o�`' �Y CITY: 1�� e ZIP: S�j�(3 STATE LICENSE: # Z 0< 3 3 �, 7� ARCHITEC /ENGINEER: C �trs � � �,`� PHONE: �� "6�d l 2�S G ADDRESS: i��t� �h e��,�-(- CITY: S 7-- ��c ZIP: �.i !l 6 NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition Move RemodeUAlteration i� Land Alteration PRO OSED WORK(describe in detai�: K-�'� �,-.c ��V � l��b��.� � �� ✓��,.,�, ��;I � ��. r�,.._.�� e..,� w-;� , dw, a ,� � - �r STORIES: L- SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: � GARAGE STALLS: ATT. ✓ DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � � 2� �a `� I hereby apply for a building perm.it 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 pernut and work is not to start without a permit; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: � e `-�� DATE: ��S '� , ► Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. Type of data. The rights ot individual on whom the data is stored or to be stored shall be as set forth in this sectton. Subd.2. Informatton requ(red to be given individual. An individual asked to supply private or contidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,pol(tical subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arlstng from hls supplying or refusing to supply prtvate or confldential data;and(d)the identity of other persons or entities suthorized by state or federal Iaw to receive the data. This requirement shall not apply when an lndividual is asked to supply investigative data,pursuant to sect[on 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or orooertv tax refund instructions Instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible suthority,an individual shatl be informed whether he is the subject of atored data on individuals,and whether It is classitied as public,private or confidential. Upon his further request,an Individual who is the subject of stored prtvate 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 indivldual 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 coliected or created. The responsible authority shali provide copies of the privste or public data upon request by the individual subject of the data.The responsible authority may require the requesting person to pay the actual rnsts of making,ceKifying,and compiling the rnpies. The responsible suthorlty ahall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate complisnce is not possible.If he cannot comply with the requestwithin 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 and legal holidays. Subd.4. Procedure when data is not accurate or complete. An tndividual 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 responaible authority shall within 30 days either: (a)rnrrect the data tound to be Inaccurate or incomplete and attempt to notify past recipients of inaccurate or inrnmplete data,including reclpients named by the individual;or(b)not[fy the individual that he belleves the data to be correct. Data in dispute ahall be disclosed only if the indlvtdual's statement of dissgrecment is included with the disclosed data. The determination of the responstble authority may be appesled pursuant to the provisions of the adm(nistrative procedure sct relating to contested csses. DATA PRIVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rights of subj ects 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 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.13.04(available upon request)to review private data on yourself. 6. � Your full name is required to process this application or permit. c�✓l0\ �1v�e-�.,�a ,l�� First Middle Last � 3� �7/`-v v((;f �-l�� Address �2�s�i �� n ti s",��r3 � r z - ;�� r 2 z City State Zip Phone I understand my rights as stated above. � � �/L-- Signature i . . CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY A►DDRESS OR LEGAL: 3c� !tit 2 Y T C.c:Gv ov/J /� � PID: DESCRIPTION OF WORK: ''Ww�p�—z ZOVTIG REVIE�V BY: 1tJ (t� DATE APPROVED: BUII..DI�i IG REVIE`V BY: DAT'E APPROVED: 7 -27. �y FEES TO BE CHA.RGED: Misc. Fees Calculated By: PERIVIIT Yes ✓ No PLAN REVIEW Yes � No SEWER CO�]NECTION STATE SURCHARGE Yes �/ No WATERCONNECTION TNVESTIGATION FEE � Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC�Units OTHER (specify) ZONING CHE.CK LIST Zoaing District: N� C ct�� . J Fire Department: Post O�ce: School District: � Lot Area: Sq.ft. Acres � idth Dep[h Survey Submitted: Yes No ate of Survey: Progosed Setbacks: Front(Lake): Right Side: Rear(Street): Left Side: Adjacent Structures: Netl . Building Hei;ht: Def. Hgt. Pe - gt. Loc Coverage: Gradina: Staff Approval Date: By: Council Approval Date: Sep[ic: Staff Approval Date: By: Zoning File: # Resolution: # Resolution Date: � Shoreland District: Avg. Setback: Bluff Setbac : Lot Covera?e: Eaisting Proposed Hardcover: 0-75' 75-250' � 250-500' 500-1000' Hardcover Variaace Required: Yes No Date of Council Approval: RE1��IAARKS (in house): 7 . . . E BUII,,DING REVIEW CHECK LIST �C� - � ' � � CONSTRUCTION TYPE: �(/'� _ Sq Footage $Per Sq Ftg Basement . . , x _ lst Floor x . _ 2nd floor x = � Garage x = � x = TOTAL Fstimated Construction Value: $ I '3 Z� 0 c,�J �� Inspections Required: `vork Requiring Separate Permits: Site �Plumbing Fire Hardcover Removal �Mechanical Water Connection .� Footing ' Septic Sewer Connection • _�/ Framing Fireplace _�Lawn Irrigation �,_Insulatioa (Masonry) Other �Wall Boazd � (Mfg.) Well (State Permit) F�� Grading/Filling �Electrical(State Permit) Other , 1tE1VZARKS(IN HOUSE): . ------- ------------------------------------------------------- REVIEW BY OTHERS: DATE: Access: Ezisting New . Access Approval: Date gy; ��-------------------------------------------------------------- REIVZP�KKS (TO BE NOTED ON PER1vIIT�: 8 ✓ DATE TIME CITY OF ORONO CAL�ED IN ��S"U INSPECTION NOT�I^C�E /'�'� SCHEDULED �—c�-v�l 3•� P.� PERMIT NO. ,�lJ^� �� v COMPLETED ADDRESS U .�C� �f • 'c��c�' OWNER CONTR. � S � .� ��u� � TELEPHONE NO. �� ZZ � DESCRIPTION �2SC.,V�-C'L'� - l� 01 FO 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING G 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL _ . Z 04 WALLB . 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 � COMMENTS: � W a � J O >. � O � W � Q � 2 W � W � � d W WORKSATISFACTORY:PROCEED C� PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED !-! ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR W4LL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED � INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the next'nspection 24 hours in advance. (J52� 249-4600 Owner/Contracta� Inspector. White Copyllnspector's File Canary CopylSite Notice DAT�E_,,,� TIME � CITY OF ORONO CALLED iN `��_��- INSPECTION NOTICE SCHEDULED -v ��d -'''� PERMIT NO. ��Q COMPLETED ADDRESS � .� r � OWNER CONTR b`"-S �l�P - �1a�cS TELEPHONE NO. �,P �� 'C�' ��ZZ-- � DESCRIPTION �-�- �� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � ALL BD. 12 WATER HOOK-UP 17 SITE INSPECT�ON Z Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTAIL. 22 FOLLOW-UP ? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � J O >. � O � W � Q � Z W � W � � � d W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOA REfNSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETIJRN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CAILINSPECTOR ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Ca11 for th next inspection 24 hours in advance. (952� 249-4600 Owner/Con ct site: Inspector. White Copyllnspector's ile Canary CopylSite Notice � DATE TIME � CITY OF ORONO CALLED IN INSPECTION I SCHEDULED � � D PERMIT NO. D COMPLETED ADDRESS 7� � OWNER CONTR. ,� S ��,P TELEPHONE NO.— lv��/ g�IO � �Zv � DESCRIPTION I�d G�'" � 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 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 i09 PLUMBING RI 23 SEPTIC FINAI 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEEf YOU:_YES_NO � COMMENT : � W a � � O a � O � W � Q � Z W � W � � � d W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CAIL INSPECTOR �CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the nex i spection 24 hours in advance. (g52) 249-46�� OwnedContr si Inspector. White Copyll�spector's File Canary CopylSite Notice