HomeMy WebLinkAbout2004-P07359 - addn/remodel/repair • j PERMIT
CITY OF ORONO
Permit Number:
2750 Kelley Parkway - PO Box 66 P07359
Crystal Bay, Minnesota 55323 Permit Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: 5/7/2004
SITE ADDRESS: 20 Orono Orchard Rd N
Wayzata,MN 55391
PID: 35-118-23-33-0009
DESCRIPTION: UBC Occupancy UI
Construction Type VN
Proposed Use: Residential 4
Permit Class: Building Census Code 4.3'1
Permit Type: Addition/Remodel/Repair Permit Sub-type(s): Building Undefined
DETAILS:
Approved per resolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 251.25 Valuation: $ 15,000.00
Plan Review Fee: $ 163.28
State Surcharge Fee: $ 8.00
TOTAL FEE: $ 422.53
APPLICANT: Classic Builders Remodlers OWNER: Old Orchard Farm LLC
2418 Black Lake Rd 20 Orono Orchard Rd N
Spring Park,MN 55384 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.
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APPL NTPERMITEESIGNA IRE vIS SUED BYSIGNATURE
Conies: 1-File(Sienitures Required), 1-Applicant, 1-Monthly Reports. 1-Assessing, 1-Finance Page 1
Total Fee: 42.2-_53. Date Received: RD i35°1
Entered By:_ `-4 / 6/(0 Permit#: '11
IT OF ()RUING - J CJILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 20 C.\a O ce_karc1 1A ZIP: 553//
Will this be a Para of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes I kr 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
'-7— be allowed.
NAME OF OWNER: T I Yh Vtur ky PHONE: (homeS-2.)1(76- age/
(x'Cr‘a (work)
MAILING ADDRESS: 20 b O rGh ar d Fd CITY: O rorl o ZIP: 553`1(
CONTRACTOR: ] e j sS1 c 'tv i(ciers RCat ode(er'S PHON 2 q ( ' L(4
CONTACT PERSON: [' k E'e_c,vt v� MOBILE/PAGER 1 226- ZZ`�
MAILING ADDRESS: 2 q1 ? 1, CITY:S . • c _ ZIP: 553P
STATE LICENSE: # Zao(564,
ARCHJT.ECT/ENGINEER: C. ce c v Act-i`v\ PHONEC; ` c-111 -9 qgq
MAILING ADDRESS: '$ 4 t-t CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure ✓
Addition Move
tf45J pk� - \e Remodel/Alteration Land Alteration
\ . , ( )o )(o' Z�,l
"PROPOSED WORK(describe in detail): Tern.,v� exZe�,�n `� C t vS S�c� ,r.c(
04) °t1 r c.)c Sccc 00--.04_1
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROO S: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /Si E7bO1. (DO
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.
APPLICANT'S SIGNAT `A _� DATE: 76-
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 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 tax or property tax refund
instructions instead of 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. 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 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,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 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
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.
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.
First Middle Last
Rt 3tadk (V
Address
r �� , c.�>eL( c7??) yr( 9 ,
City I State Zip Phone
I understand my rights as stated above.
siglrnt,.fe—
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LI GAL: Z o c�i21�ru o v r c H a R-� i2t,p,r1)
PID:
DESCRIPTION CIF WORK: $}T-rtc r;2vsses 0.4 t_--x 6A,V46e•
ZONING REVIEW BY: i. I _ DATE APPROVED: 5'-S-O'.(
BUILDING REVIEW BY:— AIM*.. DATE APPROVED; S-_ -o 1
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW Yes v No SEWER CONNECTION
STATE SURCHARGE Yes ,/ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SACfr Units OTHER(specify)
1 -
ZONING CHECI LIST Zoning District: No CHA/46e
Fire Department: Post Office: School District: •
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Si. .
Rear(Street) Left Side:
Adjacent S ctures: W tland:
Building Height: Def Hgt. • ak Hgt.
Lot Coverage:
Grading: Staff Appr al Date: By: Council Approval Date:
Septic: Staff Approv Date: By:
Zoning File: # j Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setbac La Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes i o Date of Council Approval:
REMARKS(in huse): • T AC k 0,1 Iwo 4r, 0 +J N o ivn e'"/
V eat c-1 c7 as c,i if 2���►o r ( (? (1.1/41 ca v w4v oar s r
_
7
BUILDING REVIEW CHECK LIST
UBC: U—1 CONSTRUCTION TYPE: t./tJ
Sq Footage $Per Sq Ftg
Basement x .
1st Floor x =
2nd Floor x _
Garage x
x =
TOTAL
Estimated Construction Value: $ /5'';()OO°ti
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing " Septic Sewer Connection
Dc Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board • (Mfg.) Well(State Permit)
X Final Grading/Filling pt Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE: _ M
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT):
•
8
GERMAN, III, FREDERICK H
•. . ' ' ?.f State of Minnesota
`,' Department of Commerce
:ti ?r ;
COURSE COIPLETION CERTIFICATE ;`_ ' Licensing Unit
, - ,."1. 85 7th Place E.,Suite 600
v )�: St.Paul,Minnesotaerre 55101-3165
`/'...-• .•'.... (651)296.4026
Course Title Completion Date
2004 METRO CONT CTOR UPDATE 3/22/2004
School/Sponsoring Entity
PROSOURCE®Educational Services, Inc.
This course has been approved by the Minnesota Department of Commerce for: Credit Hours MN Department of Commerce Course Number
CONTRACTOR CONIINUING EDUCATION 7.50 M032422N
REAL ESTATE CON INUING EDUCATION 7.50 M032422N
I hereby certify that the above named student has completed the required studies for the above class and that class has been approved by the Commissioner of Commerce pursuant to Minnesota Statutes.
If you have any comments about this course offering,please mail them to the Minnesota Commissioner of Commerce.
`, Date 3/22/2004
Mailing Address:
r
FREDERICK GERMAIN, Ill
2418 BLACK AKE RD
SPRING PA , MN 55384
L —J
REPORTING PROCEDURES
For Real Estate Credit For Appraisal Credit
IN For Course I,bring this certificate to the test center for • For appraiser licensing courses, attach a photocopy of this
admission.For Course I,Course II,Course III,and Broker's certificate to the license application.
Course,attach a photocopy or this certificate to the license
application. I For appraisal continuing education courses,complete the
education verification section on the license renewal form.
I ■ For real estate continuing a cation courses,the Primary For Residential Building Contractor Credit
Broker must complete the education verification section on
the license renewal form. ents transfer information from II For residential building contractor continuing education
this form to Form RE-9 whe total hours are completed. courses,complete the education verification section on the
Agents submit Form RE-9 their Primary Broker. license renewal form.
\ For Insurance Credit Sponsor
■ For insurance licensing courses,attach a photocopy of this PROSOURCE® Educational Services, Inc.
certificate to the license application. 1295 Bandana Boulevard,Suite 245
St. Paul,Minnesota 55108
IN For insurance continuing education courses,complete the (651)641-1000
education verification section on the license renewal form. www.prosource.com
• Retain this certificate for your records.
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ger, DATE TIME
CITY OF ORONO CA
ger,
IN
INSPECTION NOTICE SCHEDULED (c/ZZ/cy t Y)
PERMIT NO. ,PQ 47 3v/ COMPLETED
ADDRESS ,=== 0 " Cr0rI(D 0c i:;' l�;i
OWNER i CONTR. 0. /o,c- /C /dre
TELEPHONE NO. 1 9� .9-- C/ 7( – 944/-4/-
DESCRIPTION rt7e:Vn ( —IL o r –
LU 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. I112 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 114 SEWER HOOK-UP 06 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 115 SEPTIC INSTALL. 22 FOLLOW-UP
LU 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES JI NO
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LU ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W XORRECT WORK&PROCEED F, ISSUE CERTIFICATE OF OCCUPANCY
0 10CORRECT 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.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contrac • s•n i e:
Inspector. f�/�
spe I
White Copy/Inspector's File Canary Copy/Site Notice
DAT TIME
CITY OF ORONO CALLED IN 9-air
INSPECTI• - _j SCHEDULED _/4_1-051 ///
PERMIT NO. 'S COMPLETED
ADDRESS I/•ehtC 0ACit-a c/(
OWNER 'ii - CONTR. e0(Lir /ClAdi
TELEPHONE NO. 1111P01 43S
PHONE NO. 1.41.44,40.44
LL. 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
• 02 FRAMING 13 M=CHANICAL FINAL 19 LAKESHORE/WETLANDS
" 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
▪ 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
LU 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
CC ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
• ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING 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 fort next inspection 24 hours in advance. (952) 249-4600
Owner/Co 4irsite:
Inspector. -
White Copy/Inspector Fi Canary Copy/Site Notice