HomeMy WebLinkAbout2005-P08904 - attached deck PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P08904
Crystal Bay, Minnesota 55323 Permit Type:
(952)249-4600 Addition/RemodeURepair
Date Issued: 7/8/2005
SITE ADDRESS: 50 Myrtlewood Rd Unit#
Wayzata,MN 55391
PID: 36-118-23-33-0006
DESCRIPTION: UBC Occupancy R3
Construcrion Type VN
Proposed Use: Residential
Census Code 434
Permit Class: Building
Permit T e: AddirionlRemodeURepair Permit Sub-type(s): Deck-Attached
YP
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 321.25 Valuation: $ 20,000.00
Plan Review Fee: $ 208.81
State Surcharge Fee: $ 10.00
TOTAL FEE: $ 540.06
APPLICANT: R D Bultman Construction Co OWNER: Mr.&Mrs.Champlin
10205 Heather Lane 50 Myrtlewood Rd
Corcoran,MN 55374 Wayzata MN 55391
'I'HE 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.
- �. � le �
APPLIC T PERMITEE SIGNATURE ISSUEII Y SIGNATURE �L f��
Copies: I-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
Total Fee: $ ��`-f� .�D - DateReceived: �-j,��.�
Entered By: �;'U'�. Permit#: � ��'�Y
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: (ci��cle one) OWNER ONTRACT�B
��___._-----
JOB SITE ADDRESS: .>�Q ���T��''��-'�� c� `� cr- ZIP: ����
Will this be a Pa►•ade of Aomes, Remodelers Showcase Home or other Display Home?
❑ YCS ��10 If yes, a special event permit is reguired with Po(ice Departtnent arTd Ciry Coc�ncil approval
60 dc�ys prior-to the event. Shuttle bus service tivill be r•eqceired tnzless applicant demonstrates
suffcie�it o�i-site parking is available. Non permitte�l events will not be cillowed.
NAME OF OWNER:�rTL'�� ��'�m,p� � IV' PHONE: (home 1,��-��'�7���(
(work)
MAILING ADDRESS: �� ���.�1s-�J�� �.a CITY��c�Q ZIP: �5,3`�'(
CONTRACTOR:�° �� rn ti �ri� PHONE:"�1��� �7�-5- ��a�
CONTACT PERSON: 4 sy � MOBILE/PAGER:
MAILING ADDRESS:/���S h<�s�T/�✓e �N CITY��.c.o�s a � �IVZIP: SS�
STATE LICENSE: # �a/�-� EXPIRATION DATE: o
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Acc ssory Structure
Move Home Remodel/Alteration �
m
PROPOSED WORK(descj•ibe in detai�: �L ��lH C� �� i ' i�>, �gC--�,
STOIt�ES: SQ.�'EE'd'OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE S'i'ALLS: ATTACHED DETACHED
ESTIIVIATED CONSTRITCTION�ALiJATION(excluding land): $ ���d��
I hereby apply for a building permit and I acknowledge that the inforniation above is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City and with the State Buildinc
Code;that I undeist�nd this is not a permit and work is not to start without a perniit;and that the work will be
in accordance with the approved plan.
APPLICANT'S SIGNATU ;� DATE: � � �-�
,
Sec.13.04 RICHTS 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 section.
Subd.2. Infonnation required to be given individual. An individual asked to supply piivate or confidential data conceming himself shall be
infonned oE (a)the pu�pose and intended use of the requested data within the co(lecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidentiai da[a;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav vlace the notice required under this subdivision in the individual income tar or pronertv tax refund
ins[ructions instead of on those fonns.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of
stored data on individuals,and whether it is classified as public,private or confidential. 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 desires,shall be infonned of the content and
meaning of that data. After an individual has been shown the private data and infonned 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 collected or created. The
responsible authority shatl provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of making ce�tifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant[o this subdivision,or within five days of the
date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot wmply with the request
within that time,he shall so infonn the individual,and may have an additional tive 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 piivate data
concerning himselE To exe��cise this tight,an individual shall notify in writing the responsible autho�ity describing the nature of the disag�•eement. The
responsible authority shall within 30 days eithec (a)con•ect the data found to be inaccuinte or incomplete and attempt to notity past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be con-ect. Data in
dispute shall be disdosed only if the individual's statement of disagreement is included with the disdosed data.
"I'he detennination of'the responsible authority may be appealed pursuant to the provisions of the adminisU�ative 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 fumish certain private or
confidential information.
You are notified that:
1. The infonnation 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 inforniation may be shared with other local, state or federal agencies to the extent necessary to
process the permit or license.
4. If your requested perniit 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 Nliddle L,ast
Address
City Statc Zip Qhone
I underst nd mv ri h s stated above.
, _ __`
� __
��' __ -=
Signat e
. CHECK OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �p �YRT l�W oc�rJ i 7A.�4�p
PID:
DESCRIPTION OF WORK: -<<
ZOVING REV�W BY: DATE APPROVED: 7-�-a j
BUILDING REVIEW BY: DATE APPROVED: -�. -�.-a S
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes f No
PLAN REVIEW � Yes � No SEWER CONNECTION
STATE SURCHARGE Yes ✓ No WATER CONNECTTON
INVESTIGATION FEE Yes No v� PARK FEE
SAC Yes No ✓ SIT'EINSPECTTON
Number of SAC�Units OTHER (specify)
ZO�TING CH�CK LIST Zoning District:
Fire Department: Post Office: School Disuict:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes�_ No Date of Survey: 5-Z8 -7`a CN r�u�.�
Proposed Setbacks:
Front(Lake): 7�� Right Side: s�o� *
Rear(Street): 130' Left Side: 125 � '�
Adjacent Structures: �,-r�ct�t�� Wetland: .�od� �'
Building Height: Def. Hgt. /1//19 Peal:Hgt. �/i9
�
Lot Coverage: N/�
Grading: Staff Approval Date: — By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning File: # — Resolution: !# Resolution Date:
Shoreland District: Nc�
Avg. Setback: Bluff Setback: I,ot Covenge:
Ezisting Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
RENIARKS(in house):
7
BUILDING REVIEW CHECK LIST
UBC: �Z• 3 CONSTRUCTION TYPE: v^�
Sq Footage $Per Sq Ftg
Basement x _ �
lst Floor x _
2nd Floor x _
Garage x _
x =
TOTAL
Estimated Construction Value• $ 2 u.d�o �''"t
Inspectioas Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
_�Footing ' Septic Sewer Connection
pC Framing Fireplace Lawn Irrigation
Insuladon (1Vlasonry) Other
Wall Board (Mfg.) Well(State Permit)
—�F�� Grading/FIIling Electrical (State Permit)
Other
REMARI�.S(IN HOUSE): .
REVIEW BY OTHERS• DATE: �---------------------------------------------
Access: Ezisting New
Access Approval: Date gy_
-----------------------------------------------------------
RENIARKS (TO BE NOTED ON PERMI�:
8
'� ,� ��,*� DATE � TIME ✓
� � ,� ,
��CITY OF ORONO CALLED IN
./ INSPECTION TICE SCHEDULED � � �j �trrw'
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PERMIT NO. /'�% � �G�F COMPLETED
ADDRESS �C� /'Y�����/ t /����>cc� �/�
OWNER CONTR. �- � �� ����..
TELEPHONE NO. �� ' �fc�3 7 7� � ��` `�� ' `
�
� DESCRtPTION �i T-1 IV�C�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
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 SEP FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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� ❑ CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
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p ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS.
Call forthe xt inspection 24 hours in advance. (959� °'"'
Owner/Contrac ite:
Inspector.
�„� � , _ �
�3 ✓
DATE TIME
CITY OF ORONO CALLED IN j-�'��
INSPECTION OTIC� SCHEDULED �'- �� f J f U�
PERMIT NO. �� ��U� COMPLETED
ADDRESS �U m y r��� "`''�� �
OWNER C�`1.lLyru�-c-,-�. CONTR. /lC' � F�� 1,��'�'1 C�.-
TELEPHONE NO. 7 � 3 � �� 3� � �
� DESCRIPTION �-c.•�'�'v
� 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 12 WATER HOOK-UP 17 SITE INSPECTION
= FIN�� 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
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑CORRECT WORK&PROCEED C' ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTOTAKEN
INSPECTOR WlLL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR !� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �95Z� 249-46QQ
OwnerlCont s te:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice
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