HomeMy WebLinkAbout2005-P08792 - pool w
- PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p08792
Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures
(952) 249-4600 Date Issued:
6/13/2005
SITE ADDRESS: 425 Oxford Rd Unit#
Long Lake,MN 55356
PID: OS-117-23-41-0023
DESCRIPTION:
Proposed Use: Residential Census Code 329
Permit Class: Building
Permit T e: Accessory Shuctures Permit Sub-type(s): Pool-Outdoors-In Ground
YP
DETAILS:
Approved per resolution#:
Separate permits required: Electrical(state)
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 492.25 Valuation: $ 35,000.00
Plan Review Fee: $ 319.96
State Surcharge Fee: $ 17.50
TOTAL FEE: $ $29.71
APPLICANT: Dolphin Pool&Spa OWNER: Jon&Jane Schwartzman
3405 Highway169 North 425 Oxford Rd
Plymouth,MN 55441 Long Lake,MN 55356
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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APPLIC PERMI E SIGNATURE 13 UED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
� � " � . 6 ��0�
� I
Total Fee: $ -1 � DateReceived: �3�'D�
Entered By: Pei-mit#: �108 79�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it all information)
--------------------------------------------------------------------------------------------------------------------
THE APPLICAI�TT IS: (circle one) OWN O CONTRACTOR
JOB SITE ADDRESS: Z� - ZIP: �S� ��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display I�ome?
❑ Yes ❑ NO If yes, a special event perrnit is required with Police Department and City Council appr-oval
60 days pr-ior ta the event. STzzrttle bzrs service will be required unless ayplicant demonstrates
sz ff cier7t on-site parkrng is available. Non pe���nitted events will not be allowed.
/i � � � , " � �,c�
NAME OF OWNER:�J�1� ���T�Z1^'LY"lTV PHONE: (home) �` � (d S
(work)
MA.ILIiV'G ADD �c- CITY: ZIP:
CONTR.ACTOR: C � ,p�- Pxo�:`?63 ���d��
CONTACT PERSON: �L MOBIL AGER: 3-�}O�-�Qa„s�
MAILING ADDRESS: ., [ CITY: � ZLP: r
STATE LICENSE: # 1 C �?�i 4 -z� EXPIRATION DATE:�-�o,�
ARCHITECT/ENGINEER: PHONE:
1VLAILING ADDRESS: CITY: ZI�':
NAME: REGISTRATION: #
TYPE OF WORK: New _� Addition Accessory Structure
Move Home Remodel/Alteration
. �
PROPOSED WORK(describe in detai�: ��•�U Lf-t�-1 c�,1 G (�
STORIES: SQ.FEET OF�ACH FLOOR:
NO. OF BEDROOVIS: GARAGE STALLS: ATTACHED DETACHED
�
ESTIMATED CONSTRUCTION VALUATION(excluding land}: $ �.�1,. d�O —
T
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.
APPLICAIVT'S SIGNAT . DATE: 3 '4
.
31
Sec.13.04 RIGIiTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom the data is stored or W 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 conceming 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 rotuse or is legally required to suppiy the requested data;(c)any known consequence azising from his supplying or refusing to supply
private or confidential daca;and(d)the identity of other persons or entities suthoriud by state or federai law to receive che data.This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section]3.82,subdivision 5,to a law enforcertient o�cer.
The commissioner of revenue mav nlace the notice required under this subdivision in the individual income tax or properev 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 privace data and informed of its meaning,d�e data need not be disclosed to him for six
months thaeafterunless 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. I'he responsible authority
may requite the requesting person to pay the actual costs of makirtg,certifying,and compiling the copies.
The responsible suthority shal!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 comp(y 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 3aeurdays,
Sundays and legal holidays.
Subd.4.Procedure when data is not accurate or complete. An individual may contes[the accuracy or completeness of public or private data
conceming himself.To exercise this right,an individual shall notify in writing the responsible aathority describing the nature of the disagreement.The
responsible suthority shall within 30 days either: (a)conect 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 cotrect.Data in
dispute shall be disclosed oniy if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administraHve 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 revie�v private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
C�ty State Zip Phone
I understand my rights as stated above.
Signature
32
_ . �
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
A.DDRESS OR LEGAL: �/Z S p l���� IZ-o A-�
PID:
DESCRIPTION OF WORK: o a1
zo�vG x�v�w BY: DATE APPROVED: �-fg—oS
BUII.DING REV�tiV BY: DATE APPROVED: b -43 -os'
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No
PLAN REVIEW � Yes �/ No SEWER CO�TNECTION
STATE SURCHARGE Yes � No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZO�TING CI�CK LIST Zoning District: L2-1/3
Fire Department: Post O�ce: School District:
u,a c� s/f-o.�,�
Lot Area: Sq.ft. Z.033 Acres ��,51�i Width 22g Q �S'S��S�rlc Depth
Survey Submitted: Yes_� No Date of Survey: v�, zc���-/
Proposed Setbacks:
Front(Lake): i 5'3� �- Right Side: Z-o'
Rear (Street): �y7 Left Side: 1 y3� �
Ad;acent Structures: ,y� � Wetland: �tJ��
Building Height: Def. Hgt. �1� Peak Hgt. /Jj�
Lot Coverage: Nllq-
Grading: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: — By:
Zoning F�le: # dS-31�e� Resolution: # Resolution Date: -Zs'os
Shoreland District:
Avg. Setback: �iariR.a�nrt�.,% Bluff Setback: I.otCovera?e:
Existing Proposed
Hardcover: 0-75' o v
75-250' S"3 , 3•3
2�Q-500' 2 2.t, z 2.�
500-1000'
Hardcover Variance Required: Yes No o�_ Date of Council Approval:
REI�IARKS (in house): _
�
� + � � .
BUILDING REV�`V CHECK LIST
�C� `'� CONSTRUCTION TYPE: —
Sq Footage $Per Sq Ftg
Basement x _
1st Floor x _
2nd Floor x _
Garage z =
x =
TOTAL
Estimated Construction Value: $ 3 S,o o� `='
Inspections Required: `Vork Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
_�Footing ' Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg,) Well (State Permit)
—�F�� Grading/Filling �Electrical (State Permit)
Other
REIVZARKS(1N HOUSE): .
-------------------- -------------------------------------
REV�W BY OTHERS: DATE:
Access: Existing New
Access Approval: Date gy;
REI�IARKS (TO BE NOTED ON PERitiII'1�;-------------------------------------------------------------
8 �
MEMBER
�
� DOLP�ll1V POO.L � SPA NAT��
3405 Highway 169 North, Plymouth, MN 55441 SPA&POOL
office (763) 542-9000, fax (763) 542-9001 �NSTITUTE
Minnesota Contractors License#BC-20266452
CUSTOMER .��� � �CL�Z DATE � �7 �'J'
ADDRESS ��-�� C
CITY TATE�t ZIP ' " —��.5��
PHONE#HOME S L—S � OFFlCE ' CELL�Z�L —36%S`+
SALESMAN G SUBMITTED BY
POOL DATA
POOL SIZE �D C F� POOL SHAPE ���
STEP TYPE C,U•�iu-4 /'/�1S I j �,_ LOCATION •
CAPACITY GALS. TURNOVER RATE HRS
PERIMETER /2� LIN. FT. RATE OF FLOW GPM
SURFACE AREA �C�� SQ. FT. MANIFOLD&SIZE
/ CONSTRUCTION EQUIPMENT
PANELS -S t�L
LINER o ��.. Jc.GCilj7t.cr�.cc
COPING C�L' � �r�.
BOTTOM MATERIAL i',/�vh!r� _ �
DECK BRACES
ADDITIONAL EXCAVATION
FILTERATION EQUIPMENT
PUMP /e�t�lf/`,/CG�t�,�.., SP.3c'�/�'
FILTER � a� S �� s
HEATER cfi. 3s3''" 7?/d
SKIMMERS 'L SO
INLETS �f � F' l�,O
MAIN DRAIN Z- r 0 "l
SANITATION ['h ���r2c. /c.�.c� GLZtao
DECK EQUIPMENT
DIVING BOARD �i ' Sp�'/�1�; ,B-c�� �I Qlc.S-c__
SLIDE --
IADDER rc-c:`�s«L, S•� S-r��
HANDRAI� L .�-�n�r'a i!S S.2�rr� r�i
ANCHOR CUPS 8�ESCUT
UNDERWATER LIGHT (,�-+�1 6d Cc�Ia� �, t�z:�i.- 1
OTHER
MAINTENANCE EQUIPMENT
AUTO CLEANER '—"
SOLAR COVER ^4
SOLAR REEL """"
WINTER COVER r AZ�
AUTOMATIC COV R ' !� LID TYPE
CHEMICAL KIT
MAINTENANCE KIT includ .c�wat _r t .ct kit—th .rmomet r—va �� �m h .ad—vac�� ,m hoc .—t .I .c�i��
OTHER
EIECTRICAL LG!/ GAS LINE
FENCING RETAINING ALL WORK ---
DECK WORK
ACCEPTED BY DATE
\�\`r���� � DATE TIME �
" CITY OF ORONO CALLED IN �� �j
INSPECTION NO ICE SCHEDULED � �� _��_
PERMIT NO. �S �`� �' COMPLETED " � �V �.�`� �
ADDRESS �{ � � �X ��ro) �� '
OWNER CONTR.�r�� l �In�� ���b(", I
TELEPHONE NO. � �° � J�� ^' ����`
�O C: L �` �
� DESCRIPTION � r C�G T_/I��—��
� 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
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
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
I = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
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� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W� �WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WlLL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
Cl INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �952� Z49-46QQ
OwnerlContractor on site:
Inspector. � 7'
White Copyllnspector's File Canary Copy/Site Notice
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