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Home My WebLink About2004-P08031 - plumbing ` � PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Poso3i Crystal Bay, Minnesota 55323 Pet'tlllt Typ@: Addition/RemodeURepair (952) 249-4600 Date Issued: ioisi2oo4 SITE ADDRESS: 3635 North Shore Dr WAYZATA,MN 55391 PID: 08-117-23-34-0008 DESCRIPTION: UBC Occupancy R3 Proposed Use: Residential Construction Type VN Pernut Class: Building Census Code 434 Pernut Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/RemodeURepair DETAILS: Approved per resolurion#: Separate permits required: riumoing iviecnanicai r,iecincai(staie� NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 125.25 valuation• $ 6,000.00 State Surcharge Fee: $ 3.50 TOTAL FEE: $ 128.75 APPLICANT: Catherine 1v1 Sallas OWNER: Z&M LIBERMAN 3220 Bohns Pt La 3635 NORTH SHORE DR Wayzata,MN 55391 WAYZATA MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO O ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNE A B DING CODE REQUIREMENTS. \�_�� /� '/�!C ��_ '��—' ( /�- APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-AssessinQ, 1-Finance Page 1 . �_ ^ Total Fee: $ Date Received: �� 5 —U� Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please p�i�zt all informatio�:) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle o�ze) OWNER OR CONTRACTOR, JOB SITE ADDRESS: �� -Q �� ZIP: �7 � � / Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a special event pef•mit zs required with Police Departrnent and City Cozciicil appr�oval 60 days prior to tlae event. Non perfnitted events will not be allowed. � � �Z � � ,/ NAME OF OWNER: � C� PHONE: (home)��`� � � ��'� ��i�. (work —� MAILING ADDRESS: 7iZC� tCITY: ZIP: �� CON�'RACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition Move Remodel/� �� Land Alteration � PROPOSED WO �(describe i�z etai�: , � � ,. Cts"� dLj L 0 STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $_�r ��Z�?J I hereby apply for a building pertnit 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: �«� ��ATE: ��/ —'S —D _ '� ' Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. Thc rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data�vithin the collecting state agency,political subdivision,or statewide system;(b) �vhether he may refuse or is Icgally required to supply the requested data;(c)an,y known consequence arising from his supplying or retusing to supply private or conGdential 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 suppl}�investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or nropertv tax refund instructions instead ot 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 classified as public,private or confidential. lipon his further request,an individual who is the subject of stored private or public data on individuals shall be sho�vn the data without any charge to him and,if he desires,shall 6e informed of the content and meaning of that data. After an individual has been shorvn the private data and informed of its mcaning,the data need not be disclosed to him for sis 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 upon request by the individual subject of the data. The responsible authority may require the requcsting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possiblc,with any requcst made pursuant to this subdivision,or within five days o(the date of the request,escluding SaturdaYs,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requestwithin that time,he shall so inform the individual,and may have an additional flve days within which to comply with the req�est,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An iitdividual may contest the accuracy or completeness of public or private datu concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagrcemenL The responsiblc authority shall within 30 days either: (a)correct the data found to be inaccurate or Incomplete and attempt to notiCy 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 bc disclosed only if thc individual's statement of disagrecment is included with the disclosed data. Thc determination of the responsible authority may be appcaled 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 oti Orono or any of its departments may require you to furnisli certain private or contidential 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 pernut 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. First Middle Last Address City Sta � Zip Phonc I understa y rights as stated above. � Signature r • �F - CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: 3�35 /(/02�-7 f s'i°to� �� PID: DESCRIPTION OF WORK: �e� ZOY�IG REV�`V BY: �✓/�4 DAT'E APPROVED: BUII�DPIG REVIE�V BY: DATE APPROVED:�� -S—G�f FEES TO BE CHARGED: Misc. Fees Calculated By: PERNIIT Yes _� No PLAI�i REVIEW Yes �° �/ SEWF�COivNEC'ITON STATE SURCHARGE Yes �/ No WATERCONNEC'I'ION INVESTIGATION FEE � Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC�Units OTHER (specify) ZO�TING CHE.CK LIST Zoning District: /f�� G_�fl �. Fire Department: Post Office: School District: � Lot Area: Sq.ft. Acres � Width Depth Survey Submitted: Yes N Date of Survey: Proposed Setbacks: " Front(Lake): Right Si Rear (Street): I.eft Side: Adjaceat Structures: Netl d: Building Height: Def. Hgt. Pe Hgt. Lot Coveraoe: Grading: Staff Approval Date: By: Council Approval Date: Septic: Staff Approval Date: BY: Zoning File: # Resolution: Resolutioa Date: _ � Shoreland District: Avg. Setback: Bluf Setback: L.oc Coverage: Ezist ; Proposed Hazdcover: 0-75 . 75-250' 250-500' 500-1000' Hazdcover Variance Required: Yes o Date of Council Approval: REMARKS (in house): 7 _ ..* . . . BUII.,DING REVIEW CHECK LIST UBC: 1�- • 3 � CONSTRUCTION TYPE: �/� _ Sq Footage $Per Sq Ftg B�sement . . . x _ � lst Floor x . _ 2nd floor x = � Garage x = � z — TOTAL d.. Estimated Construction Value: $_�,v b U— Inspections Required: '�Vork Requiring Separate Permits: Site �Plumbing Fire Hazdcover Removal Mechanical Water Connection Footing ' Septic Sewer Connectioa � iC Framing Fireplace Lawn Irrigation �Insulation (Masonry) Other _j�`Vall Boazd • (Mfg.) Well (State Permit) 'G--F�� Grading/Filling �Electrical (State Permit) Other 1�ENIA.RKS(I�i T HOUSE): . -------- ----------------------------------------------------- REVIEW BY OTHERS: DATE: Access: Ezisting New . Access Approval: Date gy; ---_----------------------------------------------------------- RENLARKS (TO BE NOTED ON PERiI�II'1�: S � c �� DATE TIME CITY OF ORONO CALLED IN �O—��'6`� INSPECTION NO IC SCHEDULED �� / �04 PERMIT NO. O�O � COMPLETED ADDRESS �� OWNER � CONTR. C�UJ� TELEPHONE NO. `P I� �II�l lYI,�I� � � DESCRIPTION � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS 03 INSULATIO 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z . 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP O6 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 ti COMMENTS: � W a � J O >. � O � W � Q � Z W � W � � � d � ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WFLL RETURN ❑CITATION ISSUED ❑STOP OROER POSTED.CAIL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the n xt inspection 24 hours in advance. (952) 249-46�0 OwnedCon c r ite: Inspector. '" White Copyllnspector's File Canary CopylSite Notice