HomeMy WebLinkAbout2006-P10623-VOIDED PERMIT �er�-,-,i� U�IC�
CITY OF ORONO --�
�` Permit Number:
2750 Kelley Parkway- PO Box 66 P10623 ���,.w, p�
Crystal Bay, Minnesota 55323 Permit Type: �v�
(952) 249-4600 New Structure
Date Issued: 12/29/2006 b�c,<.�
SITE ADDRESS: 3165 North Shore Dr Unit#
Wayzata,MN 55391
PID: 09-117-23-33-0002
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential Census Code 101
Permit Class: Building
Permit Type:
New Shuchzre Permit Sub-type(s): New Home-Single Family
DETAILS:
Approved per resolution#:
Separate permits required: Plumbing Mechanical Fireplace Sewer Connection Irrigation Well(state)Electrical(state)
NOTICES/REMARKS:
SAC Paid#4278 - 11/24/75 -Reclaim Demo Credit P10472- 10/23/06
FEE SUMMARY: Pernut Fee: $ 6,238.75 valuation: $ 1,200,000.00
Plan Review Fee: $ 4,055.19
State Surcharge Fee: $ 580.00
TOTAL FEE: $ 10,873.94
APPLICANT: Owner/Self OWNER: Allen&Deanna Munson
� 3165 North Shore Dr.
Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL[MPROVEMENTS SPECIFIED
' ND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
;'I�ESOTA BUILDING CODE REQUIREMENTS.
1.
i;
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�--� �_ t Q (��?�l�c l% /��
A ANT PERMITEE SIGNATURE [SSUED BY S[GNATURE
'y
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
, � -��
; J � � � , ��
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� Total Fee: $ � �I�J �� Date Received:
Entered B : � , ,� �erirut#: 'J
� y ���� , /C �O
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 CONTRACTOR
JOB SITE ADDRESS: 3( � �� /U S h�D I� E j7R w�y 2 AT,�Ip� � r5 3 9/
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �No Ifyes, a special eventpermit is required with Police Department and City Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
sufficient on-site parking is available. Non permitted events will not be allowed.
i i3a3
NAME OF OWNER: A L L F�/ /LI l/i!/S '�5/f/ PHONE: (home) �� 2.. �'
(work) �/z ,si��3 D 3
MAILING ADDRESS: �(�� /1� .s�io�e� �CITY: �qZ Z� �,,Q ZIP: 5,3-3 9'/
CONTRACTOR: �4 G �.�..v � t�ti_s o ti PHONE: ( � �. Sr�� 3 � 3
CONTACT PERSON: i4 � ���ti,��� d��OBILE/PAGER: ( i 2 �l,� � � a �
MAILING ADDRESS: 3l��� �s„q���R CITY: y��,.Z��,4 ZIP: ��3 9 t
STATE LICENSE: #fa/aM 1: �w2i�.0 EXPIRATION DATE:
�s �� S� l �3a3
Ac.G..6•�• � ✓.vs a .�, !SZ �s'3 63c o
ARCHITECT/ENGINEER: u�`,? «G PHONE: �G 3 S�� x.,�o 0
MAILING ADDRESS: s.�",c .q���z!�- CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New �_ Addition Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(describe in detai�: �o u.v o.�r.o�v wA+-� s R c o r� �-aT.�-n
L..9.�.v sc.�y7�,E�t�,�
STORIES: Z SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED� DETACHED_
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ J� a 40, O�D �'
I hereby apply for a building 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 will be
in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: �� ��o �
31
• �
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 section. �
Subd.2. Information requ'ved to be given individual. An individual asked to supply private or confidential data conceming himself shall be
infonned of: (a)the purpose and intended use of the requested data within the coll�ting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
private or confidenrial data;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 investig�ative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice requ'ved under this subdivision in the individual income tax or pro�rtv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individuai. Upon request to a responsible authority,an individual shall be informed whether he is the subj�t 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 informed 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 disctosed 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 shall provide copies of the private or public data uponrequest by the individual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply unmediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe
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 shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and leg�l holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
conceining himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disageement. 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 incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct Data in
dispute shall be disclose�only if the individuaCs statement of disagreement is included with the disclosed data.
The determination of the responsible suthority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRNACY 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 fiunish certain private or
confidential�information.
You are notified that: .
1. The information you fiunish 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 infoimation 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 petmit.
�`f L�.�^./� cJ ol�� �viv � �
First Middle Last
���6 ,.5� /IJ .S.;�n�,°��n�',
Address
t,e,�y z•4�"� ��� Ss.3 9> �/2 �/� 13a�
City Statc Zip Phone
I understand my rights as stated above.
.
Signa ure "
32
' -CHE�� p�`F i,IST FOR ISSUANCE O�' PE��IT5
• FOR OFFICE USE ONLY
ApDRESS OR LEixAL: 3165 �� �N�°� �-
PID:
�ESCR.IPTI4�T OF WORK: �� G' - -------------------
-------------------------- -
___------------ -- ---------- ,z -z�- o�.
_��---- pATE APP�OVED:
ZOY.I�IG REVIE�V BY: �
gUTLDII\G REVIE�V BY:
. ..0 DATE APPROVED: ,2-L� -�6�
---=--------- —�----- -------------------------__---------------------- ---------
F`EES TO BE CHARGED: Misc. Fees Calculated By:
�E�T Yes ✓ No
PLAN REVIEti�1 � Yes —� No SEti�E.R CO�INECTION
�VATER CONNECTT.Oi�
STATE SURCHARGE �'eS � N0 p�g� FEE
INVESTIGATION FEE Yes No �
Yes No � SITEINSPECTION
SAC # � OTHER (specify)
__Number of SAC�Units A,o ��-zv-�s y2� - � /a�� �
� � _1 c�..i!L�.__�'��-'�_�='�' � ----�-.1_u.�7�
---------------------------------
-----------�-- 1� /p
C� ,
ZOiVIi�IG CHE.CK LIST Zaning District: L 2-/� •
Fire Department:
Pos[Office: School District: •
�r p,rea: Sq.ft. (�(�,0 21 Acres � � 3`� � Width Depth
gurvey Submicted: Yes �(
�o Date oE Survey: � Z�• 0`�
Proposed Setbacks';
Front(Lake): ( S6 � Ri�t Side: I 2. Z ,
Rear(Streetj:
�c> � Left 5ide: Z-�
Adjacent Structures: /'v�.4 �Vetland: /���
Buil�lin�Height: Def. Hgt, � � � Peak.Hgc. —
Lot Coverage: o��'�- ���^
�z_� -o�
I 2•27-"ljfi`,: LGwiCu r�l�,�:CV3.� n3t?: �---
Gradin�: S�aFf Approv�l Date: ow. -
Septic: Staf� Appra��a� DacP: N (� E;�:
Zooing Fue: R o�'7v�3S Resolutioe: n__ Resolution Date: I 2-I►- �b
Sheretzr.d District: y�5 BluEf 5etback: N (� I.o[Coveta;e; �•�� _
AvQ. Setback: C�•K
� E�istino Proposed
v
Hzdcover: 0-75' 2S
75-2�0'
2�0-500' z� •7
�00-:GC�'
�_ �,._ �� �'���-,��� c.,�.ovz:
::a-�CC',.,- �,'_"�,C� �.�y'u.:_�. .,._ . • :
F.E�L�RKS (in hou�el;
.
$�nING �vrEtiv c�cx LIST
v�sc: R• � � corrszRvcTTorr�E: �/N ,
Sq Footage $ Per Sq Ftg
' Basement • . . .. x _ . ,
lst Floor ' x • . . . � '
2nd Floor x _ � � ,
Garaoe x _ .
x =
TOTAL
Estimated Construction`�alue: $_I, 2 0 0,o 0 0 °`�
Inspections Required: Wark Requiring Separate Percnits:
Site _�Plumbing Fire
• Hardcover Removal _�Mechanical Water Connection
. —�FOO��g ` Septic pc Sewer Cannection �•
—�Fz�o • _�Fireplace _�Lawn Irrigation
�_Insulation (Masoary) Other
_�Wall Board � (Mfg,) �- Well(State Permit)
��F�� Grading/Filling _�Electrical (State Permit)
Other
REMARKS (IN HOUSE): � . -. ---.. _
REVLEW BY OTHERS: -------------DAZ'E:-------------------------------------------------
Access: Eusting New .
Access Approval: Date gy; �
-----------------------------------------------------------------------------------
REI��.A.RKS (TQ EE N4T'ED O�I PEF.�I�:
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