HomeMy WebLinkAbout2002-P05406 - addn/remodel/repair �
' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P05406
Crystal Bay, Minnesota 55323 Pel"t111t Typ2: Addition/Remodel/Repair
(952) 249-4600 Date Issued: ai2i2oo2
SITE ADDRESS: 4215 North Shore Dr
Mound,MN 55364
P��: 07-117-23-43-0006
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Pernut Class: Building Census Code 434
Permit Type: Addirion/Remodel/Repair Perniit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 83.25 Valuation: $ 3,000.00
Plan Review Fee: $ 54.08
State Surcharge Fee: $ 2.00
TOTAL FEE: $ 139.33
APPLICANT: Owrier/Self OWNER: Douglas Waldoch
� 4215 North Shore Dr
Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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I' �L�-�t" L' li`1��� ��� ��, �'l�`�`'"L O�?"� �`� �A�j��
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Revorts, 1-AssessinQ, 1-Finance Page 1
, � �
' �.Total Fee: $ /,� ; , " Date Received: � e -,��� �
Entered By: �. ��_-- Pernut#: � �S%�Z_
���''� CITY OF ORONO - BUILDING PERNIIT APPLICATION
,
/, All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) ( OWNE�,OR CONTRACTOR
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JOB SITE ADDRESS: ��� �Q V2`�l ��'� � �� ZIP: rj�j�(�, �
NAME OF OWNER: G � ��til.F �'�1�. � �1 PHONE: (home) �Jc�'�1�-�0���
MAILING ADDRESS: � � `I'U1 ' (work) I�i;.�k �ID 3 .S,�0--a'0 4�-I-
"�F'c� �1 ��/1p{2.P��_ CITY: ��t� ZIP: 5 3��
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: N�w Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �C�,L���_�� � �,-� u,�l�1L,t,h.�-
Lt.x/:�1L Lti�� 5�� �i"�� �,y��-1 �� �l 1�-�-� k3 ,�i`1 r:i,1Cc,N� 91�, C:t,�,Utx,�Lf'
��`� � �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � , (>�O
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 i accordance with the approved plan.
APPLICANT'S SIGNATURE: ti� [� ' �' 1 DATE: �II r�'��!�}-
NOTE! Parade o�'Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGIiTS 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. InformaHon reqwSred to be given indivtdual. An individual asked to supply private or confidential data conceraing himself
shall be informed of: (a)the purpose a�intended use of the requested data within the collecting state agency,poliacal subdivision,or statewide
system;(b)whether he may refuse or is legatly required to supply the requested data;(c)any lmown consequence azising from lris supplying or
refusing to supply private or coafidential data;and(d)the identity of o�er persons or entides authorized by state or federal law to receive the data.
Tlus requirement shall not apply when an individual is asked to supply investigadve data,pursuant to section 13.82, subdivision 5,to a law
enforcement officer.
The commissioner of revemie mav olace the nofice reauired under this sabdivision in the individual income talc or nrooertv tax refuaci
instrucdons instead of on those forms.
Subd.3. Access to data by individual. U�n request to a responsible authority,an individual shall be informed whether he is the
subject of swred data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who
is�e subject of stored private or public dah on individuals shall be shown the data without any charge to tum aad,if he desires,shall be informed
of die 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 moiuhs thereafter unless a dispute or acdon pursuant to this secdon is pend'mg or addidanal data on die iadividual has been
wllecoed or creaoed. The respons�ble authoriry shall pmvide 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 maldng,certifying,and compiling the copies.
The responsble aud�ority 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 shall so inform the individual,and may have an addidonal five days within which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not acc�mate or complete. An individual may contest the accucacy or completeness of public or
private dara concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the�nature of the
disagreement The responsible audiority shall within 30 days either: (a)correct the data found to be iaaccurate or incomplete and attempt to�tify
past recipients of inaccurate or incomplete data,i�luding recipie�named by the individual;or(b)noufy the individual that he believes ihe 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 die responsffile 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�ity of Orono or any of its departments may require you to furnish certain
private or confidential information.
You aze 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 information may become
public.
5. You have certain rights under M.S. 13.04(available upon request) to review private da.ta on yourself.
6. Your full name is required to process this application or permit.
�'i� � I,°�d1
First C Middle Last
�315 � �cn.e �-;e-
Address
�►�v�,�,,.� � � �s`�3�� ��a--�7�����-7
C�ty State Zip Phone
I understand my rights as stated above.
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Signature
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._ . CHECB OFF LIST FOR ISSUANCE OF PERMITS
' FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Y Z I S !V'o��/ s�aot,� D!L -
PID•
DESCRIPTION OF WORK: c:Z�2 ,� �c,s n�'d Q¢�.cc„
ZONING REV�W BY: DATE APPROVED: 7• 3 0 • �
BUILDING REVIEW BY: DATE APPROVED: -�• 30•o Z
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes v� No
PLAN REVIEW Yes � No SEWER CONNECTION
STATE SURCHARGE Yes �- No WATER CONNECTION
INVESTIGATION FEE Yes Na . PARK FEE
SAC Yes No � SITEINSPECTION
Number of SAC Units OTI�R (specify)
ZONING CHECS LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes C No Date of Survey: p� �='�`r,
Proposed Setbacks:
Front(Lake): Right Side:
Reaz(Street): I.eft Side:
Adjacent Structures: Wetland:
Building Height: Def. Hgt. Peak Hgt.
Lot Coverage:
� .
� Grading: Staff Approval Date: By: Council Approval Date:
(� Septic: Staff Approval Date: By:
Zoning File: �i Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-5�' ,
500-1000'
Hazdcover Variance Required: Yes No Date of Council Approval:
REMARKS(in house):
7
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BUILDING REVIEW CHECK LIST
UBC: �' .3 CONSTRUCTION TYPE: '�N
Sq Footage $ Per Sq Ftg
Basement x =
1 st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ � d ov�'
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
DC Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well (State Permit)
o'-Final GradinglFilling Electrical (State Permit)
Other
REMARKS(IN HOUSE):
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REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
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REMARKS (TO BE NOTED ON PERMI�:
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Phone: (816) 891-2800 ♦ Fax: (816) 891-8018 ♦ Internet:http://wwwsoftdesk.com
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DATE TIME
CITY OF ORONO CALLED IN =� �
INSPECTION OTICE SCHEDULED
PERMIT NO. `- � COMPLETED
ADDRESS � ` '� �
OWNER CONTR. �
TELEPHONE NO. ��.�- - U �� — �l'y�'�
� DESCRIPTION �or/N���,
� 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-S�TE 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
� OWNERICONTRACTOR TO MEET YOU:_YE, NO
� COMMENTS:
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W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. p p OTOTAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR �CITA ON ISSUED
❑ INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS. �-,
� .,
Call for the next inspection 24 hours in advanc . (952) 249-4600
OwnerlContract o site:
Inspector.
White Copylinspector's File Canary Copy/Site Notice
DATE TI
CITY OF ORONO CALLED IN '
INSPECTION N �CE.�j� SCHEDULED � ��"� �
PERMIT NO. � � COMPLETED
ADDRESS J
OWNER I.�Xt NTR.
TELEPHONE NO._ ��v�-�"� ��-— LO �l- v1-�
� DESCRIPTION +- I l�?C� �—�y��--� �
ty 01 FOOTING 11 MECHANICAL RI 18 D(CAV/GRADING/FIWNG
Q02 FRAMWG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z Q�WAII BD• 12 WATER HOOK-UP 17 SITE INSPECTION
_�.NAL. 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMpUUNT
� 07 DEMO-FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FlNAL t� 36 FOUNDATION/REMOVAL
� OWNER►CONTRACTOR TO MEET YOU:_YES�NO
y COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK$�PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORREGT WORK�►LL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL AETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-46��
Owner/Con or site:
Inspector.
White CopyMspector's le Canary Copy/Ske NoUce