HomeMy WebLinkAbout2004-P07901 - addn/remodel/repair PERMIT
C ITY �F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07901
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 9/13/2004
SITE ADDRESS: 2265 North Shore Dr
Wayzata,MN 55391
PI D: 10-117-23-33-0005
DESCRIPTION: UBC Occupancy U1
Construcrion Type VN
Proposed Use: Residential /�� I
Buildin "`"�'��°' �3�
Permit Class: g
Permit Type: Addirion/RemodeURepair Pemut Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate perxnits required: Eiecaicai(siaie�
NOTICES/REMARKS:
^--�---- ---=-�=---�---��-------- --=-=---� --._�____�---- o- ,-�-:,:---
:.���:;:��:.::,��W� ��k�:����::;........... :.�::::.... ....... ._. ��.�.:;;.�.
b ....b...... b...»........,.. b
FEE SUMMARY: Pernut Fee: $ 853.75 Valuation• $ 79,200.00
Plan Review Fee: $ 555.03
State Surcharge Fee: $ 40.10
TOTAL FEE: $ 1,448.88
APPLICANT: Aulik&Associates OWNER: Gregg&Denise Steinhafel
6401 Wayzata Blvd Blvd 2265 North Shore Dr
St.Louis Pk.,MN 55426 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 ORDINANCFS AND STATE OF
MINNESOTA BUILDING CODE RE UIREMENTS.
IC T PERMITEE SIGNATURE I D BY SIGNATURE
Conies: 1-File(Signitures Reouiredl. 1-Avplicant, 1-Monthlv Reuorts, 1-AssessinQ, 1-Finance Page 1
�
4s�� �/
��, �, ,Total�'ee: $ �7 , Date Received: �-?�J-U`�
�'h ` Entered By: Permit#: ;�U "7�D I
��
i
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 O�CONTRACTOR,i'
JOB SITE ADDRESS: 2`��; j�,�,� .�a �i�;'i-� '! rl.i�;�L ZIP: >�� l
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: L-�-�-��- �=�-�����-1,�.t=�-�- PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: . �i t1 � c�G-i� lN - PHONE: '��Z -`�`'��-' U�2' ( o i 1
CONTACT PERSON. - MOBILE/PAGER. t;l Z Z�c -��ji� �
MAILING ADDRESS: ���f C�r�,��.�.� ��.t,%;� CITY: �T�ur�>��.+tiu ZIP: ��4��-L
STATE LICENSE: # L �.t� �.�-
ARCHITECT/ENGINEER:�L�u cc �.�%�,����:• �� PHONE: �)Ci �� - �"6l - f Sa-�
MAILINGADDRESS: (,¢c;% ,�-�n. �.�.%i� CITY: �-*�;u�� �ti:tct ZIP: ��¢Z_�
NAME: �,P, ,��..,,,,.,� �,,�iu� REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeVAlteration � Land Alteration
PROPOSED WORK(describe in detai�: � ,;�.—,o,_, � �-- i..r + „ ;�,��
'� G=i`� �..�►,.;.��_ ���• ,,,�.s��.—,�9,� `� e ��,,,�:
STORIES: � SQ. FEET OF EACH FLOOR: /� ���Z
NO. OF BEDROOMS: � GARAGE STALLS: ATT.�y� DET. /�l�l
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ '% '� , '�- �-�
I hereby apply for a building permit 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 pemut; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: DATE: `C�� �3
�
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. Intormation required to be given individual.An individual asked to supply private or confidential data concerning himself shall be
informed ot: (a)the purpose and intended use of the requested data within the collecting 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 confidential data;and(d)the identity otother persons or entities authorized by state or federal law W 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 eniorcement officer.
The commissioner ot revenue mav olace the notice reauired under this subdivision in the individual income tax or nroaertv tax refund
instruMions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is ciassified as public,private or confidential. Upon his further request,an individual who is the subject of
stored private or public date on individuals 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 informed o[its meaning,the data need not be disclosed to him tor six
months thereafter unless a dispute or action pursuant to t6is section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or public data upon request by the individual subjeM of the data. The responsible authority may
require the requesting person to pay the aMual costs ot making,certifying,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 of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within
that time,he s6a11 so inform the individual,and may have an additional£ve days within w6ich 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 himselL To exercise t6is rig6t,an individual shall notify in writing the responsible authority describing the nature ott6e disagreement The
responsible authority shall within 30 days either: (a)correct the data tound to be inaccurate or incomplete and attempt to notlfy past recipients of
Inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes t6e data to be rnrrect. Data in
dispute shall be disclosed only if the individual's statement oi disagreement is included with the disclosed data.
T6e determination o(the responsible 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 informarion.
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 egtent 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 yourseif.
6. Your full name is required to process this application or p 't.
� G�t� �'- t�L so N
First Middle La
�,��-O � � `J D
Address
�t.� 'S'-,4- �l�Z - `�9' -��� /a/�
CjtY State Zip Phooe
I understand my lrts a sta e.
:'
Signature
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: �S iv o 2 Tc1 5 H-o� ��
PID:
DESCRIPTION OF WORK: (Lc—�ST�(UC �o<►-r /�-o��
ZO�TG REVIEtiV BY: DAZ�E APPROVED: 9=�b -6 y
BLTII,DING REVIE`V BY: DATE APPROYED; 9 -i o - o y
F'EES TO BE CHARGED: Misc. Fees Calculated By:
PER11�1IT Yes c/ No
PL?,�� REVIEW Yes v' No SEWER COi�TNECTION
STATE SURCHARGE Yes �/ No WATERCONNECI'ION
TNVESTIGATION FEE � Yes No PARK FEE
SAC Yes No STTEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CH�CK LIST Zoaing District: /U o Cf-�� �.
Fire Department: Post Office: School District: •
Lot Area: Sq�.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Sid
Reaz (Street): Left Side:
Adjaceat Structures: We land:
Building Height: Def. Hgt. Pe -Hgt.
Lot Coveraae:
Gradina: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Date: BY:
Zoning File: # Resolution: # Resolution Date: �
Shoreland District:
Avg. Setback: Bluff Se ack: LotCovecage:
Existing Proposed
Hazdcover: 0-75' .
75-250'
250-500'
500-1000'
Hazdcover Variance Required: Yes N Date of Council Approval:
REMARKS (in house):
�
BUILDING REVIEW CHECK LIST
�C: — v— ( � CONSTRUCTTON TYPE: Y�"�
_ Sq Footage $Per Sq Ftg
Basement . . . x _ �
lst Floor x . _ .
2nd F1oor x = �
Garage x = �
z —
TOTAL
Estimated Construction Value: $_ 7°I, Zop m�
Inspections Required: �Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing ` Septic Sewer Connectioa �
_,�Framing Fireplace Lawn Irrigation
�_Insulation (Masonry) Other
_��Vall Boazd � (Mfg.) Well (State Permit)
� F�� Grading/Filliag _�Electrical (State Permit)
Other
REIVZ.A.RKS(IN HOUSE): .
------------------------------------------------------------
REVIEW BY OTHERS: DATE:
Access: Existing New .
Access Approval: Date gy; �
----------------------------------------------------------------
RENIA RKS (TO BE NOTED ON PERA�II7�:
8