HomeMy WebLinkAbout2004-P07623 - attached deck r . �
R N PERMIT
C ITY O F O � 0 Permit Number:
2750 Kelley Parkway- PO Box 66 P07623
Crystal Bay, Minnesota 55323 Pel'CYllt Typ2: Addirion/RemodeURepair
(952) 249-4600 Date Issued: 6/30/2004
SITE ADDRESS: 50 Myrtlewood Rd
WAYZATA,MN 55391
PID: 36-118-23-33-0006
DESCRIPTION: uBc occupancy R3
Construcrion Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Deck-Attached
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 5,000.00
Plan Review Fee: $ 72.28
State Surcharge Fee: $ 3.00
TOTAL FEE: $ 186.53
APPLICANT: R D Bulm�an Consiruction Co OWNER: S&M CHAMPLIN
15665 C 24th Ave.N 50 MYRTLEWOOD RD
Plymouth,MN 55447 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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APPLIC T PERMI E SIGNATURE SSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required). 1-Avnlicant,1-Monthlv Reports, 1-Assessins, 1-Finance Page 1
r . , l/ `�
(P�2�1� b�l
Total Fee: $ 1g6.S� Date Received: � � ���
Entered By: _ Permit#: d �o�3
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�zt all i�iformation)
-------------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: -�j U � � �2f",�,� w oo d �� ZIP: S S3��
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 approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: ���u� C- �w w' n l �j �`, PHONE: (home)
(work)
MAILING ADDRESS: .�G ���2,��a-wo o� �I CITY• C�l�o,ta ZIP• SS3
CONTRACTOR: �4 s5 e..l,� �� ��-L ��nn�i y�) PHONE: ��3 �?S - 3�� 3
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: l S�US C- z� *`���� � � CITY: l�� mc��. /Y1r ZIP: S'S�
STATE LICENSE: # �a�a
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeUAlteration�_ Land Alteration
PROPOSED WORK(describe in detai�: �ma �,� o�ti� �� �J��e�. oZ ��c.�
lQxlt -� �� � �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �GG O
I hereby apply for a building pernut 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 not to start without a pernut;and that the work will be in accordance with
the approved plan.
_.�
APPLICANT'S SIGNATURE: DATE: � Z 2 c�'
��
, • ,
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 this section.
Subd.2. Informatton required to be given individual. An individusl asked to suppty 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,polittcal subdlvision,or statewide system;(b)
whether he may refuse or fs legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or conRdential data;and(d)the identity of other persons or entities authorized by state or federa!Iaw to receive the data. This requirement shall
not apply when sn individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a Iaw enforcement otticer.
The commissio�er of revenue mav place the notice reauired under this subdivision in the Individual income t$x or orooertv tax refund
instructions tnstead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible suthority,an individual shall be informed whether he is the subjeM of
stored data on individuals,and whether[t is classified as public,private or confidential. Upon his further request,an individusl who is the subject of
stored private or public data on[ndividuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and
meaning of that data. After an individual has been shown the private data and tnformed of Its meaning,the data need not be disclosed to him for six
months theresfter unless a dispute or action pursuant to this section is pending or additional data on the Individual has been rnllected ar created. The
responsible aut6orlty shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible authority may
require the requesting person to pay the actual costs of maWng,certitying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the
date otthe request,excluding Saturdays,Sundays and legai holldays,if immediate compliance is not possible.If he cannot rnmply with the request withtn
that time,he shall so inform the indivldual,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�ot accurate or complete. An individual may contest the accurscy or completeness of public or private data
concerning h[mse1L To exerctse this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or(nrnmplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be rnrrect. Data in
dispute shall be disclosed only if the indlv(dual's statement of disagrecment is included with the disclosed data.
The determination of the responsibte 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 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.
� �ss�� r ��;�� � �, ��a►,��1
First Middle Lsst
�,SGIQS C- z ¢'S' ;p� N •
Address
f-�-,o �, �l i�• �y�f �1�,3 , �s -3�a
Ctty State Zip Phone
I unders nd my rights a ed above.
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Signatu
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Sv �y(Z��Woo D �.�
PID:
DESCRIPTION OF WORK: (J Ecxs
ZO�G REVIE�V BY: DAT'E APPROVED: 6- �.�-�'1
BUILDI�i 1G REVIEW BY: DATE APPROVED; _�-zq •o y
FEES TO BE CHARGED: Misc. Fees Calculated By:
PER1vIIT Yes �/ No
PLAl�t REVIEW Yes _� No SEWER CONNECTION
STATE SURCHARGE Yes _� No WATER CONNEC'I ION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoning District:
Fire Department: Post Office: School District: •
Lot Area: Sq.ft. Acres � Width Depth
Survey Submitted: Yes_/ No Date of Survey: 5-243-7f3
Proposed Setbacks: A k �
Front(Lake): b S t o� Right Side: y�"a �lLv
Reaz(Street): Iy0 � �� Left Side: � �� L>�
Adjacent Structures: A��+��� �Vetland: N K
Building Hei.�aht: Def. Hgt. � Peak Hgt.
Lo�Coverage: �-
GradinD: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: # Resolution Date:
Shoreland District: n!�
Avg. Setback: Bluff Setback: L.otCoverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
, „
BUII.DING REVIEW CHECK LIST
UBC: R`3 CONSTRUCTION TYPE: �I/�'
_ Sq Footage $Per Sq Ftg -
Basement . , x =
lst Floor x _
2nd F1oor x =
Garage x = �
x =
TOTAL
Estimated Construction Value: $ S,Ooa pd
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
. � F���g � Septic Sewer Connection �
'� Fr�g Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Boazd • (Mfg.) Well (State Permit)
°` F�� Grading/Filling Elecuical(State Permit)
Other
REMA,RKS(IN HOUSE): .
---- ---------------------------------------------
REV�W BY OTHERS: DATE:
Access: Eusting New .
Access Approval: Date gy;
-------------------------------------------------------------
REMARKS (TO BE NOTED ON PER11�II'1'):
8
� � 1V�innesota Cominerce Page 1 of 1
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Commerce Home�North Star Home�
���'�',�+j Tuesday,June 22,2004
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Services Certification
License Detail
Here are the details for the license you are currently looking for:
Licensee Name: BULTMAN RUSSELL (DBA: R D BULTMAN
CONSTRUCTION CO)
Licensee Address: 15665 C 24TH AVE N
City State Zip: PLYMOUTH ,MN 554470000
License Number: 4012
License Type: Residential Building Contractor
License Status: ACTIVE
License Effective Date: Feb 10, 1992
License Expiration/Renewal Date: Mar 31, 2005
Qualifying Person: RUSSELL BULTMAN
Number of hours of continuing education required to renew license: 7.0
Enforcement Action: No
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https://www.egov.state.mn.us/Commerce/license_lookup.do?LIC_NUM=4012&LIC_TYP... 6/22/2004
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DATE TIME V
CITY OF ORONO CALLED IN �_ �
INSPECTION NOTICE SCHEDULED ��-?�
PERMIT NO. p�7Co� COMPLETED
ADDRESS �5'� �rf/Ptclod� �--ci
OWNER CONTR. R l� �[�I trMGt(/L
TELEPHONE NO. �7C� ?J LI�� � Z Z "�
`
� DE PTION
L� 1 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 F NG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 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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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WFLL RETURN ❑CITATION ISSUED
�STOP ORDER POSTED.CALL INSPECTOR
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ext inspection 24 hours in advance. (952) 249-46��
OwnerlContr site:
inspector.
White Copyllnspector' File Canary CopylSite Notice
DATE TIME �
CITY OF ORONO CALLED IN 7 -2�
INSPECTION NOTICE SCHEDULED `7� Z -O`� �
PERMIT NO. �223 COMPLETED
ADDRESS ��-��� �-� -
OWNER CONTR. � ���MG�I'\
TELEPHONE NO. �( D � �-F�� �.3�'Z 3
� DESCRIPTION ��
t� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 LL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� O-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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WlLL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the ext inspection 24 hours in advance. (g52) 249-46��
OwnerlCon site:
Inspector.
White Copyllnspecto s File Canary CopylSite Notice
J
C��jI� �" / ` D / TIME
CITY OF ORONO CALLED IN '1 ��
INSPECTION NOTICE SCHEDULED ��'�
PERMIT NO. P�7�oZ� COMPLETED
ADDRESS r�t/e`'`X�� �
OWNER CONTR.
TELEPHONE NO. ��� ' `7"7S �Z��
� DESCRIPTION _ � ������-S �--/�/�'1G�P �
� 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES�NO
c�., COMMENTS: �
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V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the xt inspection 24 hours in advance. (952) 249-46��
OwnerlCon site:
Inspector.
White Copyllnspector' File Canary CopylSite Notice
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5calA: 1" � 100' L:�nci �?iruP�ror and Planner
Ik�t� : 5-26-78 Lon� LakP, hiinnesotia
o . Iron mr�r.�c�r
Owner: Alan L. I3ai,croft, 5� t��*rtLewood Road, `�i�ivzata, P�1innPsot� 553y1.
A.re�.: AFFroxim+.�tely 6.5 acros.
Ihtwn for topogr��•hic survey is eFproximate, bein� sca]-ec� rrom U. S. I�partment of the Interior
Ceological Slzrve,y "�celsior t�uadran�le" ivap, 7.: n�inute seriPs.
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