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Home My WebLink AboutRe: escrow t .. . . � . • • � • emo To: Finance Department From: Chnstine Mattson, Planning Assistant � CC: Street File Date: November 3, 2015 G/L: 101-22205 Re: Escrow Refund Building permit #2014-00553 pertaining to 1645 Shadywood Road is incomplete and was retumed. Please refund the advance plan review fee of$1,564.39 to Real Assets LLC. The following is attached: • Copy of cash register receipt showing escrow amount received Mail to: Real Assets LLC 550 25�'Ave N St. Cloud, MN 56301 w:�.street files�.shadywood road\1645�advance plan reivew refund 201400553.docx i� .- CITY O� ORONO * 2 B 1 4 — 0 0 5 5 2 * 2750 KELLEY PARKWAY DATE ISSUED: 06/03/2014 ORONO,MN 55356- 952 249-4600'FAX: 952 249-4616 ADDRESS : 1645 SHADYWOOD RD ' PIN : 17-117-23-22-0013 LEGAL DESC : UNPLATTED 17 11�23 : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW ACTIVITY : 434-RESIDENTIAL VALUATION : $ 325,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 325,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: ADV PLAN REVIEW FOR NEW STRUCTURE PERMIT#THIS PRE-PAYMENT IS TIED TO:201400553 APPLICANT ADVANCED PLAN REVIEW 1,564.39 TOTAL 1,564.39 ATi,AS HOMES INC Payment(s) 14450 11TTH AVE N CHECK 009142 1,564.39 D�,YTON,MN 55369- (763)691-9044 Minnesota State License#:BUIL-BC20269686 � ' ` • --, ' , ` � ;. ; �_`ity o�'�r�aa , � .�tt t��l�y Pat�kway �`� ; �,:� t3� 1� ,S"� :� E4�9�4� , �:y.:; OWNER j ,: ��1•� ##0`.3:�33#�l#4�� ° 3� �s ��4 " . ;. LANDSOURCE �,` • � � • � 550 25TH AVE N �.` •��ia� F�e�.,ReBi �set�t.l.� : ST CLOUD,MN 56301- t . ' � °� r ' J � =` �ev�'�ala�4s �+ ;� ,� '� `..'I � ° �a�.#�,: � ' . ',� � �1�� 45 ''�,� 39 ` �i R$ t` I AGREEMENT AND SWORN STATEMENT , �� '�� . _ : I I� . .P1a�r t�t�Stte-.�Ex�p �� . The work for which this permit is issued shall be performed according to � _,,,� ��. the approved plans and spec�cations,applicable City approvals,and the k � T��1�p, , f i State Building Code. This permit is for only ffie work described and does t � .- t` . �� ,! not grant permission for additional or related work which requires separate ( : �'!IE'Ck ; ' i permits. All provisions of laws and ordinances goveming this type of work ; �k �!1G �i�f?9I+� - 1��:� � sh a ll b e com pi e d wi t h wh e t h e r o r n o t s p e c i fi e d h e r e i n.T h i s p e r m i t w i ll �' ' � � expire and become null and void if construction authorized is not � �+��I �5@�fi �,f"r�'. j commenced within 1 80 days o f the date of issuance,or if construction is f' ' � fi��a�'�p��d`+:,�. gy�� suspended for a period of 180 days at any time after work has commenced. � � •�'-°+---�=+�•. ,:; The applicant is responsible for asswing all requ'ued inspections are � �� ` �'� .�# + requested in conformance with thc State Building Code.This permit may be �"`----*~�—T•--- t� revoked at any time for due cause. ' `�� f�. . - `� i i ,. � � Applicant Permitee Signature Date Issued By Signature Date CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS O Mailing Address: Permit number: �D/ -UDSS� � �O PO Box 66 Crystal Bay, MN 55323-0066 Date received: �'3�� StreetAddress:' Received by: S. � 2750 Kelley Parkway Plan review fee: � oZ0/�j-DO.SS� �`qkESH��G Orono, MN 55356 �i Jc-��,39 � -r`jj�� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: � .� Job Site Address: -�-j� � Gluc� �4�_�� L- Will this be a Parade of Homes, Remodelers howcase 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. Shuttle bus service will be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: ,=� ��5 —�G:��> State License# �:;�Z�� (,�� Expiration Date: �y 3 I / 5 Phone: cell '1 �, �-�c � t� office �1 � �t Z5 �� > � Mailing Address: j��Isd t � r.� �c� 'l�� Cit � � L ZIP: ^s ��j Contact Person: Jt,tr�� r� Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: v4�u�� A h5 Hvti�.S w�ti - c:c.� ✓�1 '7� � ��ti(� UC 5`� PROPERTY OWNER INFORMATION: ��I L� (� � ` ;�- �� , 7 0��. � �1� �� I��.�I 1� Name: itie�� Phone (day): �� 3 � Zc�c�o _ � Address: D Z � Cit : '1� � �O` `� ZIP: � �' � � > Email and/or Fax �:t�n,; �x-� �a f�o � �t vL�u� � �-�"vl ARCHITECT/ENGINEERINFORM TION: �I�` Z��.'"1� Name: �=��v i � ��5� �l I�L1�" ��a� -_ � � Phone (day): 7b 7 � S� - r�;� 7 �t�(�.-�-r z�P: � 6 �a,/ Address: ZG !c� L'�,`t� ,� ;'1, wr City: � -l Email and/or Fax: -�TTr�c;-7 - �(3 � 3 PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� Water Supply �New Construction �Single Family with �.Residence `�❑ Addition ' attached garage ❑ Garage/Accessory Bldg. � Public Sewer ❑ Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Oifice/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage �Public Water **Any earth movement may also require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � Z�� L'� �' \ � , , ..� . , STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction a. Length(ft.)= �L Number of bedrooms=� '�f Wood/Frame I'"� b.Width(ft.)= `� � Number of garage stalis: ❑ Masonry Areas in sauare feet Attached= / ❑ Metai ❑ Pole Bidg. c. Basement= Detached = ❑ ICF d. 1 S`Story = � ❑ On-site Prefab @. 2�d StOfy= 1 ��G�� ❑ Off-site Prefab f. '/z Story = ❑ Other(please specify): g.Total Area= REQUIRED SUBMITTALS: Atl of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Permit A lication ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form O ❑ Surve meetin all re uirements '� ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: AF'PLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; . Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information, the application may not be issued. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site improvements. r , / _ 3 _ / L' ApplicanYs Signature: �' Date: � � Owner's Signature: �� Y Date: `� � � C re ;,, , � � '