HomeMy WebLinkAbout2005-P08446 - addn/remodel/repair ♦ J
ITY OF RON PERMIT
�' � � Permit Number:
2750 Kelley Parkway- PO Box 66 P08446
Crystal Bay, Minnesota 55323 Permit Type: Addition/RemodeURepair
(952) 249-4600 Date Issued: 2�is�2oos
SITE ADDRESS: 4215 North Shore Dr
Mound,MN 55364
PID: 07-117-23-43-0006
DESCRIPTION: UBC Occupancy �
Construction Type VN
Proposed Use: Residenrial
Permit Class: Building Census Code 434
Permit Type: Addition/RemodeURepair Permit 5ub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolurion#:
Separate permits required: riumoing iviecnanicai rirepiace Eiecmcai�staie�
NOTICES/REMARKS:
n'--'---_..r.:._._t
FEE SUMMARY: PermitFee: $ 643.75 vaivation: $ 50,000.00
Plan Review Fee: $ 418.53
State Surcharge Fee: $ 25.50
TOTAL FEE: $ 1,087.78
APPLICANT' Timber Ridge Home OWNER: Douglas Waldoch
� 6345 Virginia Dr 4215 North Shore Dr
Excelsior,MN 55331 Mound MN 55364
Tf�UNDERSIGNED HEREBY REQUESTS PERNIISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MIl�INESOTA BUII.,DING CODE REQUIREMENTS.
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APPLICAN PERMTI'EE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(Si�nitures Required),1-A�licant 1-Monthlv Reports, 1-AssessinQ,l-Finance Page 1
, 1 c� a,��.�.s
Total Fee: $ �0�7. 7� Date Received: 01-/S- OS
Entered By: _� Permit#: R08�5�(n
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�zt all infornzation)
-------------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle o�ze) OWNER O�CONTRACTOR�
JOB SITE ADDRESS: �`-�1 S /`�d,��,� ����'�--��,� ZIP: �� � �'�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a special event permit is Yequired with Police DepaYtment ancl City
Council approval 60 days prior to the event. Non permitted events will not
be c�llowed.
NAME OF OWNER: ��,rG v�--�i�}��v �_ �t-�,�L�'>a�''� PHONE: (home)� Z�7 z ��z�
,/ (work)7�� �Z� 5LSL1 �,
MAILING ADDRESS: �f-�l� o� c����-- �/L� CITY: ��c��,,,�� ZIP: � ��
CONTRACTOR: /��3G.���-�,���S PHONE: �'�Z X�c� /L�v
CONTACT PERSON: 1--� � n ' ��.-S � MOBILE/PAGER: �,�,� Z�o--�S 7j �
MAILING ADDRESS: ��3 S �fLC�ti'/�;2 '17,�. CITY: �X�i{�S�o�C__ZIP: � 3 �
STATE LICENSE: # 2cx� , � � 5��
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�: �.�,E��f�,✓7— �i✓/S{�_
STORIES: �'����"'1`"� SQ. FEET OF EACH FLOOR: �Z-�j,�
NO. OF BEDROOMS: I GARAGE STALLS: ATT. DET.
�z,
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ SU ��
I hereby apply for a building pernut and I acknowledge that the information above is complete and accurate;that the
wark will be in conformance with the ordinances and code the City and with the State Building Code; that I
understand this is not a pernzit and work is not to start wi� t a 't� and that the work will be in accardance with
the approved plan.
i".-
APPLICANT'S SIGNATURE: /�/� ' DATE: ��� c��
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 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 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 supplyi�g or refusing to supply
private or confidential data;a�d(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 alace the notice required under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individuaf. 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. 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 informed 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 suthority shall 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 actuai costs of making,certifying,and compiling the copies.
The responsible authority shail comply immediately,if possible,with any request made pursuant to this subdivision,or within Cve 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 legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of publicor private data
concerning himself. To exercise 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 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 disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of 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 information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license requested.
Z. 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.
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First Middle Last
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Address
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City State Zip Phone
I understand my ' 'as ate "abo��
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Signature
CHECK OFF LIST FOR XSSUAtVCE OF PER�ti.tITS
FOR O.�'FICE USE ONLY •
ADDRESSORLEGAL: 4Z�5 NDRITI SH-oi'r.�` /J�2.
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PID:
DESCRIPTIOtYOF Y[�O.RK: �. ''veC-
---------------------------------- -------------------------------_ _
ZOtYItVGREVIEyVBY: DATEAPP�ZOVED: 2 1��oS '
BUILDXIYG RET�".EW 13I', DATEAPPR06'ED: 2- �?-os
-----------------------------------_
FEES TO BE CHA.RGED: .�Iisc. Fees Calccclated By:
pE�,j� Yes � No
PLAN.RET/IEyV Yes_,� tVo SEYYER GO�ECTION
STATE SURCHARGE Yes �/ tYo YV'ATER GOtVtVECTlOtV
� IiVVESTIG.�t TlON FEE Yes No ✓' P�iRK FEE
StJ.0 .Yes tVo � SITEINSPECTIOtV
Ni�mber of Sf1C Units OTHER (specify) '
2'O�YIlYG CHECh''LIST Zon�►tg oisa•Lcc: �vo c H�4>vC'.�,p
Fi1•e Deparhnent: Post O�ce: Schoof Dtstr•ict: �..
Lot.�rea: Sq.jt. �1cr•es G�icith Depd�
Survey Su6tnitted: Yes No Date of Seuvey:
Proposect Setbacks:
Frorit(La�e): Right Side:
Rear•(Sn•eet): Left 5ide:
Adjncent Structures: etland:
Bitilding Heiglit: Def. Hgt. Peak Kgt.
Got Coverage: �
G1�ading: Staff.4pprovalDRte: By: CouncilrlpprovalDate:
Septic: Stnff.�lpprot�al DRte: BY�
Zoning File: # Resolution: # Resotcction Date:
Slioreland Distr•ict:
Avg.Setback: Bluff Set ck: Lot Coverage:
� E.risting Proposeci
Hardcover: 0-7.5' ,
75-250'
250-500' ��
500-1Q00' ;;
Hardcover Variance Reguired: Yes No Date of Co�inci�'�lpproval:
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B UILDXtVG RE VXE yY CHECK LIST '
UB C: R• 3 CONSTR UCTIO!Y TYPE: YN
• Sq Foatage .�Per•Sq Ftg
Basemelu x =
�Sl F�001' � _
?nd Floor � _
Garage � _
c
TOTAL
' Estiu�ated Constructiaic Vali�e: � SO,ODo �
Lespectioas Required: 6Ya•k Reqcciring Sepr�rate Perneits:
Site �Pl��nbing Fire
Hardco4�er Rernoval /C A�f�chanica! GYater Connection
Footing Septic Sewer Connection
_�Frami�i�* � Fireplace Gawn!r-rigatia:
_�lns��latiaT • (r1�lnsont}f) Other
� GYall Board ot (ll�lfg.) 4Ve11(State Permit)
Final Grading/Filling �Electricctl(State Perntit)
Odrer '
r..E�tir.�x�s�tNxovsE�: �
ItE I�IE YY B Y OTX�'ERS: DATE:
�iccess: Existing tYew
.Qccess�Lpprova[: Date By:
RE�'I�hIRKS (TO BE NOTED OtYPEltttillT):
3�
�.� � DATE TIME �
CITY OF ORONO CALLED IN '��
INSPECTION NO CE SCHEDULED -�� '
PERMIT NO. � COMPLETED
ADDRESS ��- I S ���1 �l � ✓� ��
�
OWNER COIVTR. l /N� �2��G���.�
TELEPHONE NO. (1�I� ��(� �.J� / ��
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 0 NG-- 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
03 INSULATI 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 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 IIVSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 WARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
v�, COMMENTS:
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� WORKSATISFACTORY:PRQ�EED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR 1MLL REfI}RPl ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the nex inspection 24 hours irt advance. (952) 249-4600
OwnerlContract i :
Inspector.
White Copylinspector's Fil Canary CopylSite Notice
J
��� �� AT TIME �/
CITY OF ORONO �C LLED IN �� �j�'J
INSPECTION NOT. ,E / I�( ' �cHEDULED �
PERMIT NO. �U�`�`� COMPLETED � � � �� `"� �—
ADDRESS / a I � 'V , �✓�� ��' �
OWNER CONTR. � /�q .`?�4 C�—
TELEPHONE NO.� �`"( �'�� �`-�� � ^7S 7� T��l�
� DESCRIPTION ° t�l �Q � � � ��VLt �.
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FR,4MING 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 FINA� 14 SEWER HOOK-UP 06 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 (n/IG�36 FOUNDATIO/�MDVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO G!k/� `t� .
� COMMENTS: � (Q.CJ� �� � � �
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W� ❑WORK SATISFACTORY:PROCEED ROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALLINSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �95Z� 249-46QQ
OwnerlContractor on site:
�
Inspector. � �lr����
White Copylinspector's File Canary CopylSite Notice
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