HomeMy WebLinkAbout2004-P08204 - addn/remodel/repair 4 ,
CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: P08204
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 11/17/2004
SITE ADDRESS: 4510 North Shore Dr
Mound,MN 55364
PID: 07-117-23-31-0029
DESCRIPTION: UBC occupancy R3
Proposed Use: Residential Construction Type VN
Permit Class: Building Census Code 434
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 139.25 Valuation: $ 7,000.00
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 143.25
APPLICANT: Owner/Self OWNER: Pete&Kathy Sawicki
MN 4510 North Shore Dr
Mound MN 55364
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 ORDINANCES AND STATE OF
MINNESOTA 3UIL G CODE REQUIREMENTS.
*1PESIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(Sienitures Required). 1-Applicant,l-Monthly Reports. 1-Assessing. 1-Finance Page 1
Total Fee: $ Date Received:
Entered By: Permit#:
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 _ OWN �OR CONTRACTOR
JOB SITE ADDRESS: G. / ZIP: �S
Will this be a Par de 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: CK PHONE: (home)
(work) -d7 —/C I W(C%wl'
MAILING ADDRESS: CITY: .&&&C/ ZIP: '5,73/'
CONTRACTOR: 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/Alteration Land Alteration
PROPOSED WO escribeJ detail): S
STORIES: SQ. FE�r OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.. fes,
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
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 sta ithout a permit; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: DATE:
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. . Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be
informed of: (a) he purpose and Intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether be may r fuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confide tial 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 a individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may lace the notice required under this subdivision In the individual income tax or roe tax refund
Instructions
Just d of on those forms.
Subd. . 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 in ividuals,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 ata. 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 authrity shall provide copies of the private or public data upon request by the individual subject of the data.The responsible authority may
require the requting person to pay the actual costs of making,certifying,and compiling the copies.
Ther ponsible authority shall comply Immediately,If possible,with any request made pursuant to this subdivision,or within five days of the
date of the requ4t,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 holidas.
Subd 4. Procedure when data Is not accurate or complete. An Individual may contest the accuracy or completeness of public or private data
concerning him elf.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible aut ority 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 a e 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 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. Ypp have certain rights under M.S.13.04(available upon request)to review private data on yourself.
our full name is required to process this application or permit.
6. .
,107hx / 11 Txc,:L)�41
Fi tMiddle Last
l�-+`7cc / (/ T f t✓ u
Addr i � x%�o
City State Zip Phone
I understand in s ated above.
Signa re
CHECK OFF LIST FOR ISSUANCE OF PERttiIITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: -
PID: '
DESCRIPTION OF WORK:
----------------------------------- -- -----------------------------------------------------------------------
ZONINGREVIE TVBY: b DATEAPPROVED: //-17-0y
B UILDING REVIEW B Y: DATE APPR0 6'ED: /I_/
------------------------------
FEES TO BE CHARGED: / Misc. Fees Calculated By:
PERMIT Yes ./ No
PLAN REVIE LV Yes No SEWER CONiVECTION
STATE SURCHARGE Yes No WATER COMVE
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning Distinct: o
Fire Department: Post Office: I School District:
Lot Area: Sq fit. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): RI ht Side:
Rear(Street): L t 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: # Resolution: # Resolution Date:
Shoreland District:
Avg.Setback: Bluff Setb ck: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REIVARKS(iii house):
31
i
B UILI ING REVIEW CHECKLIST
UBC: R ' 3 CONSTRUCTION TYPE: U�
Sq Footage S Per Sq Ftg
Basement x =
1st Floor x =
2nd Floor x =
Garage x =
x
TOTAL
Estimated Construction Value: S -7,000 '0-
Inspections Required: Work Requiring Separate Permits:
,Site Plumbing Fire
klardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg) Well(State Permit)
_�C 'Final GradinglFilling Electrical(State Permit)
Other
REJV,ARICS(IN HO USE):
i
----=rr- ---------------------------------------------—�_w�------_______w��__---___-- ____---------
BEVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
-----r-----------------------------------------------------------___---_--____� -------------------____ ----
REI MRKS(TO BE NOTED ONPERtv1IT):
32
01 DATE TIME
CITY OF ORONO CALLED IN
INSPECTIONT C / SCHEDULED
PERMIT NO. P®7 COMPLETED
ADDRESS yJ`�® /)O)e
OWNER 5AW4 CONTR.
TELEPHONE NO. (_1Zero
DESCRIPTION
1 FOO5FG
11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
13 MECHANICAL FINAL 19 LAKESHOREIWETLANDS
h 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL 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
v 07 DEMO-FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP
09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
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WU WORK SATISFACTORY:PROCEED 11PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
U BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contra site:
inspector.
White Copylinspector's Ile Canary CopyUSke Notice �:
BRUNJ COPY ORONO COPY
94.79
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CERTIFICATE OF SURVEY
FOR KATHY M. SAWICKI
OF LOT 4, BLOCK 1 , WILDHURST TRAIL
HENNEPIN COUNTY, MINNESOTA .am
P147°34
FO`'�51
L ���
CITY OF ORONO
SITE PLAN GRADING PLAN
[i XPPROVED— 000e -r 5-171-
12
k,PPq!()V E0 WITH REVISIONS 1
Btyq/
1 �
DAVE
-- r
Shore
4.
wood"/ nj
- - ball�• `} p�0
At
o �
= zr'So' z5.zo
I N86°Zro E
North -SDriv�
Scale: 1 " = 40'
County Qioac� 19 Date 3-17-86
o Iron marker
I hereby certify that this is• a true and correct COFFIN & GRONBERG, INC.
representation of a survey of the boundaries of
Lot 4, Block 1 , WILDHURST TRAIL, and the location
of all existing buildings thereon. It does not
purport to show other improvements or encroachments. Mark S. Gronberg Lic. No. 12755
Engineers, Land Surveyors & Planners
Long Lake, Minnesota