HomeMy WebLinkAbout2004-07680 - addn/remodel/repair CITY OF ORONO PERMIT NO.: 2004-07680
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 07/14/2004
952 249-4600 FAX: 952 249-4616
REPRINTED ON 10/14/2010
ADDRESS 270 NORTH SHORE DR W
PIN 06-117-23-23-0019
LEGAL DESC IDYLLVALE FARM
LOT 002 BLOCK 001
PERMIT TYPE ADDITION/REMODEL/REPAIR
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
NOTE: P07680-THIS PERMIT WAS APPLIED FOR AND KEYED INTO WRONG ADDRESS(270 NORTH SHORE DR W),DISCOVERED
ON 9/23/10 BY PLANNING&ZONING. ASKED TO CHANGE TO CORRECT ADDRESS(2 10 NORTH SHORE DR W).
APPLICANT PLAN REVIEW 682.43
9355 EAST
N WAYZATA BLV
L PERMIT FEE SCHEDULE 1,049.75
AST BROS
WAYZATA,MN 55391 STATE SURCHARGE(VALUATION) 55.50
TOTAL 1,787.68
OWNER
TASTAD,JOHN M&KIMBERLEY
210 NORTH SHORE DR W
MOUND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will f
expire and become null and void if construction authorized is not �t
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced. f
The applicant is responsible for assuring all required inspections are 'g.
requested in conformance with the State Building Code.This permit may be 7
revoked at any time for due cause.
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY PERMIT OF ORONO Permit Number:
2*750 Kelley Parkway- PO Box 66 P07680
Crystpl Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 7/14/2004
SITE ADDRESSg /210 North Shore Dr W
Mound,MN 55364
PID: 06-117-23-23-0018
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: Plumbing Mechanical irrigation Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 1,049.75 Valuation: $ 110,000.00
Plan Review Fee: $ 682.43
State Surcharge Fee: $ 55.50
TOTAL FEE: $ 1,787.68
APPLICANT: Lundgren Bros OWNER: Lundgren Brothers Const.
935 East Wayzata Blvd. 545 E.Indian Mound
Wayzata,MN 55391 Wayzata,MN 55391
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 BUILDING CODE REQUIREMENTS.
s
L123
APPLICANT PERMITEE S NATURE SSUED BY SIGNATURE
Cosies: 1-File(Sienitures Required).1-Asslicant. 1-Monthly Resorts. 1-Assessine. 1-Finance Page 1
j Total Fee: $ Date Received: 7-& -0
Entered Bv: Permit
CITY OF ORONO - BUILDING PERiMIT 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) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 2-10 NO-24-t-, S 1-Na+e ZIP:
Will this be a Parade 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. Nora permitted
events will not be allowed.
NAME OF OWNER: Lvtj d��-r. &-voS. CewsT PHONE: (home)7.5.2-9 73 - ►z3 1
_ (work) It►Z-47 r rr- os 73
MAILING ADDRESS: q33` C W-*� CITY: WtZ4Jni ZIP: 5 5-391
CONTRACTOR: L d . Pr•5_ C�s'r`• PHONE:
CONTACT PERSON: A-L MOBILE/PAGER: &tZ - 9 r 9 6S 73
MAILING ADDRESS: -1,45- 6. WA--, -A -CITY:tLA y 7_,4z ZIP: S.S3c I
STATE LICENSE: # ® /q/3 EXPIRATION DATE: of
ARCHITECT/ENGINEER:
5-
ARCHITECT/ENGINEER: L -8r"S PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Stricture
Move Home Remodel/Alteration X
PROPOSED WORK(describe in detail): Fpv r s t-. L-e-, w Lsw s�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: 4- GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): SD I Dm
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. l , L
APPLICANT'S SIGNATURE: DATE: 7/ `�
9
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. I. 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 supplying or refusing to supply
private or confidential 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 investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tar or property tae refund
instructions instead of on those fors.
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. 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. Atter 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 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 requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,orwithin 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 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 public or private data
conceming 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.t 3.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request
for a permit br 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.
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 data on yourself.
6. Your full name is required to process this application or permit.
Allef-A., r/ . Ly.., d
First Middle Last
57 3 S k l r
Address
City t State Zip Phone
I undersyfiy my rights as stated abov
Sign re
10
CHECKOFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: Z I O Nb RTK SH-6n-C 04
PID:
DESCRIPTION OF WORK: LOwe-R.
----------------------
ZONING REVIEW BY. DATEAPPROVED: -7- 4- 0f
BUILDING REVIEW B DATEAPPROVED:
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes No
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes (/ No WATER CONNECTION
INVESTIGATION FEE Yes No ✓' PARK FEE
SAC Yes No SITEI7VSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECKLIST Zoning District: /V 0 c��►-�c�Q
Fire Department: Post Office: School District:
Lot Area: Sqft. Acres Width Depth
Survey Submitted: Yes NoDate of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
/-
Adjacent Structures: 6 etland:
Building Height: Def.Hgt. P k 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 Setbac Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS(int house):
31
BUILDING REVIEW CHECKLIST
UBC: I? ' 3 CONSTRUCTION TYPE: VN
Sq Footage S Per Sq Ftg
Basement x =
I st Floor x =
2nd Floor x =
Garage x =
x =
TOTAL
Estimated Construction Value: $ 110,0 Ga
SZ
Inspections Required: Work Requiring Separate Permits:
Site ___< Plumbing Fire
Hardcover Removal c_Mechanical Water Connection
Footing Septic Sewer Connection
X Framing Fireplace �D _Lawn Irrigation
_Insulation (Masonry,) Other
T Wall Board (Ibtfg.) Well(State Permit)
Final Grading/Filling �_Electrical(State Permit)
Other
REMARKS(INHOUSE):
REVIEW BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS(TO BE NOTED ON PERMIT):
32
►✓
DATE TIME
CITY OF ORONO CALLED IN 19L-O(/
INSPECTION NOM-71,090
E SCHEDULED 7-2-o-d V •` �`
PERMIT NO. COMPLETED
ADD RE ,Z A_)dl_i.� --
OWNER CONTR. LtMdQ)r?A, B/�•
TELEPHONE NO. &/A
DESCRIPTION ! -
tu 01 FO G 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
2 RAMING 13 MECHANICAL FINAL 19 1 AKESHORE/WETLANDS
y 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 PLU G FI 36 FOUNDATIOWREMOVAL
OW R/CONTRACTOR MEET YOU:_YES_NO
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WWORK SATISFACTORY.PROCEED El PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
Cj BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance. (952) 249-4600
Owner/Co n
Inspector. !!!� k tcgAA
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