HomeMy WebLinkAbout2017-00235 - demo ,� CITY OF ORONO * z 0 1 7 - 0 0 z 3 S *
i, 2750 KELLEY PARKWAY DATE ISSUED: 05/1U2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1750 SHADYWOOD RD
PIN : 17-117-23-21-0021
LEGAL DESC : SHADY-WOOD
: LOT 016 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE
ACTIVITY : 645-SINGLE FAMILY HOUSES(ATT&DET
NOTE: SAC GRANDFATHERED IN-H/U#2149 06/09/1969 AND HOME PRIOR.
l. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. INSPECTIONS DONE BEFORE BACKFILL[NG.
NOTE: A 24-48 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600.
SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUAL[F[ED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. CHECK
TO MAKE SURE TH[S PERMIT HAS BEEN PULLED BEFORE ISSUING TH[S PERMIT.
APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 75.00
DEMOLITION-ACCESSORY STRUCTURE 50.00
STONEWOOD, LLC STATE SURCHARGE DEMO 1.00
153 E LAKE STREET
WAYZATA, MN 55391- TOTAL 126.00
(612)462-4000 Payment(s)
Minnesota State License#: BUIL-BC594315 CHECK 14645 126.00
OWNER
SHAW,GRETCHEN& LYLE
7001 KENESTON DR
EDEN PRAIRIE,MN 55346-
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
expire and become null and void if construction authorized is not
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.
The applicant is responsi or assuring all required inspections are ';� -%�-�
requested in confor with the State Building Code.This permit may be /��(,��
revoked at any t r � •-- t
'�— ��� \1���V r' �::/ /
� 1� 17 � �� ' `-' � �
+'� c��,�
Applic rt gnature Dat Issued By Signat ce Date
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City of Orono � ci L,sE o:rL��
�O� P.O. Box 66 ��°'�����"" Date Receivec�: � Permit#�fU�7� �
� 2750 Kelley Parkway �
Crystal Bay, MN 55 � Amount: $ G SAC Credit:�� �� ����
��K 13 �U� ;' �� �
(952)249-4600 �� ,J
y ,� Homeowner(s)Signed: ❑Yes ��� ��7� � ��f��I
F G� C�TY OF OROt�O Resolutions(ifany)Signed:❑Yes ❑None Required
t�kESH��� Zonin Disclosure Si ned: ❑Yes ❑None Re uired
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Job Site / Owner Information:
Type: � Residential ❑ Commercial
Site Address: �7�� S-N�d��9 1'wc�v� �f � Di2O/U o �N ���3 E��
Owner: �I��T��►v �-�� �.��� S�}�„(�Ilailing Address: 7od l �,Ir-�'STaN l��
City: h � ��J O�p-�L�. Zip: SS3���
Phone: � I�-' 3��--� �--7 O Email: Gre-���r , S h�.,.� � are-ui%vy� _ ,`n�, c�,n-�
L y i� • .S �h o��✓� /�re�i r�?M- l�n�. Ce-v�-
Contractor/Applicant Information: �
Contractor/App.: S��N���fl � 1�1� Contact Person: /o��1-Q- ��1�S
Address: �S3 F L 19-I��_ S� State License#: �— s`i�3 � S
City: �YZP�-"�i°�- Zip: �� Expiration Date:
Phone: 6 I�� "�(,� — y�dC) Email: -1'o w.wr�o, S�.-,,�.�v��. ��-c„
SPE(::IAL CONDITIONS & HOLD H��RMLESS AGREEMENT
General Instructions:
1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24-48 hour notice is required for all inspections. Call (952) 249-4600.
4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued.
Demolition by means of: ❑ Manual Disassembly [Qf Heavy Equipment ❑ Other
Permit(s) Issued: [�Sewer Disconnection ❑ Well Abandonment#
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to:
1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which structures are
to be demolished.
2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in accordance with
Chapter 79, Construction Site Runoff Control.
3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will
not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating
permit(s) are not required.
Form Last Updated.� July 2015 �� r O��
150784
�
4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached).
5. Keep all structure{s)enclosed anti/or secured until such time as demolition is complete.
6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific prior
approval is obtained in writing for temporary use thereof.
7. Completely remove foundation(s)from tt�e ground.
8. Completely dispose of all demolition debris off site in accflrdance with all applicable PCA requirements.
9. Abandon water wells in accordance with State kiealth Department regulations.
10. Call for an inspection when ail debris has been removed, before backfilling.
11. Within 5 working days of superstructure removal, a final inspection shall be requested. The site shall be
left clean and clear of all debris, with any excavation filled with earth level with the adjacent ground
elevation (except when such excawation is to be used as part of a new building and such new building is
actually under construction).
12. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped, crushed
and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are
crushed and filEed.
13. The undersigned owner shal!and hereby does indemnify and hold harmless the City of Orono, its agents,
employees and assigns from and against all claims, damages, losses or expenses, including attomey
fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition
described herein as pertormed by the property owner, his employees, agents, subcontractors or assigns.
PERMIT TYPE AND FEE CALCULATION
� $75.00 - Principal Structure $ ?S . tiv
� $50.00-Accessory Structure x j (how many) SOo O�
1. Subtotal of above permit requested $ � , Dc�
2. State Surcharge 1.00 -
3: TOTAL PERMIT FEE {add lines 1-2 above) $ �1-` •�d
The undersigned herby applies to the City of Orono for issuance af a Demolition Permit, agrees to do
all the work in a strict accordance with the ordinances of the City and the regula6ons of the State of
Minnesota, and certifiss that all statements made on this application are complete, true and correct.
Applicant's Signature: Date: � `�
� , �
Owner's Signature: ��G,� �"�"'t� Date: --��' i� � r''
Approved By: Date: �`t� l
uilding icial}
'`Zoning Disclosure Required? ❑ YES �NO � '�'�Q4' � � �A'11� '���..�
*This must be filled out by Zoning DeRartment-For eit er answer, a Zoning Otficial must sign a I applications.
'�Approved By: Date:
{Zoning Official)
Fam Last Updated.• Jury 2015
i50784
BE R G 0 INC �RONMENTAL
To: Date: 5/30/17
Stonewood LLC
153 Lake Street E
Wayzata, MN,55391
Re: Letter of Completion
This is your formal notification that the following asbestos materials have been removed from
1750 Shadywood Rd in Orono:
- 984 SF of transite siding and tar paper under siding
- 11.6 SF of white tape on metal ducts
- 0.33 SF of gray caulking on metal ducts
We sealed off the areas of containment in the basement and installed a HEPA machine. The asbestos
materials were removed using approved engineered methods. The materials were bagged and manifested
to a certified asbestos landfill. Suits and respirators were worn by the workers while performing this
work
Thank you,
Blair Bollig
(C) 612-812-6791
4413 CRAWFORD RD (952j 920-8938
HOPKINS, MN 55343 BERGO.ENV@GMAIL.COM
Asbestos Survey and Building
Inspection Report,
1750 Shadywood Road
Orono, MN
For
Stonewood
Wayzata, MN 55391
Date
May 4, 2017
Hickey Consultants
Health and S afety S ervices
Hickey Consultants Occupational Health and 4301 Spruce Way
Environmental Safety Maple Plain,MN 55359
763-479-3214 phone/fax
Hickey Consultants Dhickeymn@yahoo.com
Tomar Jones May 4, 2017
Stonewood, LLC
153 East Lake Street
Wayzata, MN 55391
612-462-4000 Office
612-770-5231 Cell
952-697-5591 Fax
tomar�c�sto��ewood.com
Kenton@stonewood.com
Dear Tomar:
This letter and attached documentation reports the results of the Asbestos Inspection and Bulk
sampling performed by Hickey Consultants, in the building 1750 Shadywood Road, Orono, MN.
This study is significant in that it identifies asbestos-containing materials and provides guidance
regarding the relative location. When a building will have demolition of structural supports, the
MPCA (Minnesota Pollution Control Agency) requires that the friable asbestos, Freon, PCB and all,
mercury materials be removed prior to demolition of the structure.
SUMMARY
Building inspections, accompanied by bulk sampling of suspect asbestos-containing materials
(ACM), was conducted at 1750 Shadywood Road, Orono, MN. Hickey Consultants performed the
inspection. The ACM inspection covered all areas of the building. The building was a 2-story home
and basement with approximately a 1,000-square foot structure estimated to be built around the
1920's.
Asbestos containing materials>1%were found in three of the building materials. Building materials
sampled included, roofing shingles, tar paper, window caulk, window glazing, transite like siding,
tar paper under siding, fiber board soffit, cement board siding, seaming tape on metal ducts,
linoleum flooring and mastic. Fifteen PLM bulk samples were collected during the building
inspection and analyzed for asbestos. ACM is considered positive with indicating levels of greater
than one percent (>1%). The samples were analyzed and asbestos >1% was detected in the transite
cement board siding, the caulk around the metal ducts and the white tape around the metal ducts in
the basement. The white tape around the metal ducts and the caulk around the metal ducts are both
friable and will need to be removed prior to demolition. Asbestos>1%was also found in the transite
cement board siding. The transite siding is non-friable and will need to be removed prior to
demolition. If the home is to be torn down, or burned during fire training, all asbestos will need to
be removed by either the home owner, or an asbestos abatement company licensed by the state of
Minnesota prior to demolition.
The MPCA Demolition notification(attached)must be sent in 10 days prior to demolition.
The thermostats and fluorescent light bulbs must be removed and disposed of properly because of
the mercury concem. The smoke detectors need to be removed because of radiation concerns. The
water heater, water softener, air conditioner, furnace, kitchen appliances,washer and dryer needs to
be removed prior to demolition.
Current Environmental Protection Agency (EPA) statutes mandate control measures for friable
(easily pulverized) asbestos-containing materials. Non-friable materials (for example, tar paper, or
floor tile or mastic) do not pose an immediate exposure risk unless they are cut, torn, sanded or
otherwise abraded. Because non-friable materials have the potential to become friable during
certain activities,friable or non-friable materials have be�n identified in this building.
EPA's Asbestos Hazard Emergency Response Act (AHBRA) was used as a guidance document for
bulk sampling procedures, sample analysis, and locatiop selection. An AHERA asbestos trained
building inspector participated in the building inspection.
BULK SAMPLING METHODS
Asbestos bulk sampling was performed, sampling included collection of material samples and
analysis of bulk samples for asbestos percentages utilizing polarized light microscopy(PLM).
A walk-through survey of the building was first conducted to identify homogeneous areas and
develop a bulk sampling and inspection strategy. For each homogeneous area sampled,two criteria
were used to determine sample locations:
1)The sample site must be representative of the homogeneous area,
2) A random element to prevent bias from entering the results was exercised in sample site
selection.
Sampling protocol was as follows. Amended water consisting of water and a surfactant (soap
solution) was misted on the sample site before, during aild after the sampling process. This served
to minimize dispersion of the sampled material. Sampling instruments were used to section a
representative sample of material away from building component. Sealed, plastic packs were used
to contain the sample and marked with the sample setial number. Sampling instruments were
cleaned after collecting each sample to prevent cross contamination of subsequent samples.
Inspectors utilized half-face respirators when appropriate, and gloves for adequate personal
protection during sampling activities.
Results for bulk samples collected during the survey are provided in the Asbestos Laboratory
reports attached by: EMSL Analytical, Inc. Bulk samples were analyzed by: EMSL Analytical,
Inc. 14375 23`a Avenue North, Minneapolis, Minnesota, utilizing polarized light microscopy
recommended by method EPA/600/R-93/1 16 in accordance with federal, state and local laws and
regulations. EMSL Analytical, Inc. National Voluntary Laboratory Accreditation Program
(N V LAP)number is 200019-0.
Attached are sample sheets describing; asbestos locations and the Demolition permit for the
Minnesota Pollution Control Agency. Complete laboratory analysis charts are also included in this
report.
If the homeowner was to remove the asbestos, they should wear personal protective equipment;
include a N-100 respirator and disposable clothing. The materials kept wet, and, check with the
landfill used for disposal to see if they allow asbestos containing materials.
Two landfills that take asbestos materials include: Rolling Hills Landfill in Buffalo and the Elk
River landfill in Elk River. Landfills that take demolition debris are Dem-Con landfill in Shakopee.
For more landfills accepting asbestos follow the link below.
https://www.pca.state.mn.us/sites/default/fi les/w-sw6-OO.pdf
If anyone is hired to remove the asbestos,they must be a Licensed Minnesota Department of Health
Asbestos Contractor. A current list of asbestos abatement contractors can be obtained from the
(MDH) Minnesota Department of Health-Asbestos unit at 651-215-0900. Or at the following MDH
website.
http://www.health.state.mn.us/divs/eh/asbestos/find_contractor/asbestos_contractor report.cfr?regio
n code=ME
A homeowner can legally remove the asbestos from their own home. However, safety
precautions need to be taken.
The Minnesota Department of Health has put together a how to list for safely removing asbestos
from your home. The website covers the following topics: Can I remove asbestos flooring
myself? What tools do I need? How do I prepare the work area? How do I remove it? How do I
clean-up? And how do I dispose of the waste? It also includes guidance photos that illustrate
how to remove asbestos.
All of this information can be found online by going to the Minnesota Department of Health
website and searching for asbestos. It can also be found by following the link below:
http://www.health.state.mn.us/divs/eh/asbestos/floortile/index.html#res
Some more good information on asbestos for the homeowner can be found at the following
internet address: http://www.health.state.mn.us/divs/eh/asbestos/homeowner/index.html
(click on the above link while holding down to ctrl key to go to the links)
The fluorescent lights, ballasts, appliances, batteries, and thermostats can be taken to the Hennepin
County hazardous waste disposal site at 8100 Jefferson highway, Brooklyn Park, or 1400 West 96tn
Street in Bloomington. Hennepin country recycle phone number is 612-348-3777 or go to
www.hennepin.us
If you have any questions or concerns regarding the information in this report, please contact
Hickey Consultants at your convenience.
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Minnesota Department of Health Asbestos Inspector License Number A12420
Attachments/Enclosures:
• Asbestos Inspection Survey Results
• Minnesota Pollution Control Agency Notification of Intent to Perform a Demolition
• Minnesota Pollution Control Agency Pre-Renovation or Demolition Requirements
• Hennepin County Recycling Drop-off Facility Locations
• Minnesota Department of Natural Resources Fire Burn Application
• Photo Log
• Sample EMSL Lab Results
• Floor Plan Maps
• Asbestos Inspector Certificate
Inspection Data Sheet
Contains
Room/Area Material Asbestos Estimated Physical Friable Sample Percent
Location Descri tion >1% Amount Units Condition es/no Number Asbestos Comments
RM 1-O 1- None Detected
RM1- Rooting Shingles
shingles and tar RM 1-O 1-Tar None Detected
Exterior of Home a er No Sqft Good No Paper
TRl-Transite like 25%
Exterior of Home sidin Yes 984 S ft Good No TR1-02 Ch sotile
TR2-Fiber Board
Exterior of Home Soffit No S ft Good Yes TR2-03 None Detected
WGl-Window
Glazing on inside
&outside of
Exterior of Home windows No S ft Dama ed Yes WG1-OS None Detected
WCl-Window
Caulk around
window frames and
Exterior of Home base of house No S ft Dama ed No WCl-06 None Detected
TPl-Tar paper TPl-07a-Tar None Detected
under transite paper
Exterior of Home sidin no S ft Good No
TP 1- Transite Same as
siding over Tar sample TP1-07b- 25°Io
Exterior of Home a er Yes TR1-02 S ft Good No Transite Chr sotile
TR3-08- None Detected
TR3-Newer Fiberboard
cement board TR3-08- None Detected
Exterior of House sidin No S ft Good No Adhesive
Inspection Data Sheet
Contains
Room/Area Material Asbestos Estimated Physical Friable Sample Percent
Location Descri tion >1% Amount Units Condition es/no Number Asbestos Comments
FT 1-04- None Detected
Linoleum
FTl-Beige FT1-04- None Detected
Kitchen Linoleum Floarin No Sqft Good No Adhesive
FT2- Black Mastic
under linoleum
Kitchen floorin NO S ft Good Yes FT2-10 None Detected
No Asbestos
Living Room Observed
No Asbestos
2°a Floor Observed
PIl-White tape on 55%
Basement Metal Ducts Yes 1 1.6 S ft Good Yes PI 1-09 Ch sotile
CM]-Gray
Caulking material 12°Io
Basement-back room on metal ducts Yes 033 S ft Damaged Yes CM1-1 1 Chr sotile
Ground Floor FTl-Beige
Bathroom Linoleum Floorin FT1 None Detected
Material Descriptions
Contains Asbestos
Name Descri tion >1%
None Detected
RM 1 Shin les and tar a er
25% Chrysotile
TR1 Transite like sidin
None Detected
TR2 Fiber board soffit
None Detected
WG 1 Window lazin on inside and outside of windows
Window caulk around window frames and base of None Detected
WC1 house
None detected
TP 1 a Tar a er under transite like sidin , and sidin
25% Chrysotile
TPl b Transite sidin over Tar a er
None Detected
TR3 Newer cement board sidin
None Detected
FTl Bei e linoleum floorin
55°Io Chrysotile
PI1 White ta e on metal ducts
12% Chrysotile
CM l Gra Caulkin material on metal ducts
None Detected
FT2 Black Mastic under linoleum floorin
Inspection Data Hazardous Materials Summary
Room/Area Location Materials to be Removed Prior to Demolition Comments
Freon
Exterior of House Air Conditioner Concerns
Exterior of House disconnect electricit , as,cit water
Radiation
Interior of House Smoke Alarms Concerns,
Mercury
Interiar of House Florescent li hts(several in the basement.) Concerns
Mercury
1 s'Floor Thermostat in hallwa Concerns
Kitchen Refri erator, dishwasher,microwave
water heater, water softener, furnace, washer,dryer,
Basement dehumidifier, s ra aint cans,florescent li ht bulbs
� Minnesota Pollution Contral Agency ���tivw.pca.state.mn.us
�
Pre-renovation or demolition requirements
Scope of this guidance
In Minnesata,}taiardous a•rd other probl�r7�wastes must be rerna��ci frorn a structure betor�it is
renovated or demolished.The removed wastes must be managed properly through recycling or
disposal.�his fact sheet provides guidance in identifying haza�dous and problem rvastes and
determin�ng their proper d�sposal,but does not supersede any state nr iederai regulatory requirements
applicable to a rennvation ar cemolition project.
The Minnesota Pollutian Control Agency's(MPtA)pre-renovation or demolition requirements apply to
all st�uctures in Minnesota,including residential,agricultural,governmenta:,commercial,and industrial
st+uctures_Note that therp is nn exempti��from these requiremen!s in Minnesota for farm buildings.
In addition to the Minnesota requirements,certain buildings built before 1978 may also be su�ject to
federal requf�ements under the Repair,Renovation,and pa�nting Rule�RRP}of the U.S.Environmental
Protect�on 11�ency(EPAj. for rnc+re info�mat�on on the RRP,v�s�t the EPA at httta:l/www.epa.�ov,
Burning structures
In Minnesota,at�5 dle�al(or anyone to�n;entionally burn eny Strutiu�e,includin�a farm building.The
nnly exception to this prohibit�on is tor legitimate firefighter Vair�ing.A leg�limate tirefighter training
burn must incaude a prepared curnculum,spetific training abjectives,and documented post-training
assessment,Bumfng a structure for disposal is not legitimate training.All oi the pre-demnlition
requirements,including an asbestos survey and abatement,must be followed and a specific fire tra�ning
burn permit obtained from the M:nnesota Department of Natural Resources(DNR)prior to a legitimate
firefighter training burn. For rnore information,con,act the DNR as listed at the end of this fact sheet.
Notification
If you are go�ng to renovatc,demol�sh,or burn for Icgitimate fire tra�Ring any strurtu�e regulated under
the Federal National hm�ssion Stand2rd(or H8�3rdous Air N011u[ant5{NFSHAP)for asbestos,not�(y the
MPCA a1 least ten warking days pnor ta thF start oi thc!work.Th;s NESHAP is found at 40 Code of
Federal fieguiations,Part bl,Subpart M_In general,aA structures in Minnesflta are regulated under this
NESHAP except for residences having four dwelling units or less.
No[e-Residential un"ts may remain NESHAP-regulated under the following conditions:if they were
converted from prior regulated uses rega�dless of the number of units:the demolition of multiple
st�uctures owned by the same party;or the demoliUon of any number oF houses as part o(an urban
renewal praject,a highway constructfon pro�ect;or a project to develop a shopping mall,indusirial
facility,or other cnmrnercial development.
Remember that whether subjec[to the NE5HAP or not,asbestos work in structures may still be
regulated under Mlnnesota Department nf Health(MDH)req»irements.For mare information,conract
the MDH as listed at the end of this fact sheet.
. For a renovation and for MDH-regulated work,notiFy the MPCA and MOH by submitting MPCA form
nw-sw4-Q6,Not�ficaUon of Asbestos Work at htta://www,nca.state.mn.us/publ�caUons/w-zw4-06,pdf,
. f or a demolition or legitimate training burn,notify the MPCA by submitting MPCA form ttw-sw4-21,
Notification of Int�nt to Perform a Demo��tion,at
htte://www.oca,state.mn.usloub�ications/w-sw4-21.odf:
!�IiniiF,uE.Y F';�I uliUn�C�ntrO�Ahe��Cy � f1�[r�":licr i::i,; , ..-st.=:-i1;
F� : 7�-F.+:i�i�'� � Rt�-h�1-�Eh�9 ' IIY���1-?8?-43�?:n li;.�,1-3R�.1 Ava�rab.+:ntlHen,at��.Pt�:�rm�+ts
Common wastes that must be removed before demolition
Type oi waste More information
Appiiances;such at air condit�on�fa ar•d furnacrs. Ses MPCA hazardouswastcfact shect 1►w hw3 02,
Recvdm�Apphanccs.�t
httQ�Uwww.pca.state.mn.usioubiicationsJw hw3 01.c►df.
Asbestos;such as p�pc lagging and furnacr flur.c. Sc�c MPCA webpagc p4f32,
'1(ony osbestos-ronto�mnq moterrot/ACMJ is 1�ff�n pbce rn ��stos Proaram,at
the por���n U�strU�[ure to be demohshed,then alf resuJdrrg klttp://www.pca.5tate.mn.US/tChv]f7.
debris must be m�onoged ornd disposed as ACM.
Electronics;suth as smokc alarms and homc Scc MPC:A hazardous waste fact shrM thv hw4 1S.
entertainmem systems. M�na¢in�Eledronic Wastes.at
http://www.pca.state.mn.0 s/publications/w-hw4-15.a�df.
Environmental and safety system controls;such as Sec MPCA hazardous waste fact sheet trw hw4�2,
thcrmostau and rnanometers. Manasinit Universal Wastes,at
http://www.pca.state,mn.u s/pubGcations/w-hw4-62.odf.
Haiardous waste;such as lawn chemicals and paints. See MPCA hazardous waste tact sheet itw-hw3-12,
Manap,in�[Waste trom Residential Prooerties,at
htto;//wvgw.a�a.state,mn.0 s/uuWications/w-hw3-12.adf.
Lead-containing kems;such as pipes and roof See MPCA hazardoui waste fact sheet tlw�hw4 23,
flashine lead Paint Oisoosal,at
•tcad pernt moy rcmc�n on thc struc[ure. httD;IIWNtW.eta.state.mn.us/DublicaUons/w-hw4-23,�df.
lfghting componcets;xuch as fluoresccnt/HID lamps Scc MPCA hazardous waste fact sheet t�w hw4 62,
and ba�lasts. ManaQi U�iversal Wastes,at
�tttD://www.oca.state.mn.0 s/o ubGcation s/w-hw4-62.odf.
ORs;such as fuel oil and hydrauGc fluids. See MPCA hazardous waste fact sheet aw•hw4•30,
Used Qii�d Related Wastes,at
h ttu://wvYw.oca.state.mn.0 sluubl�ptionslw-hw4-3fl.odf.
Reirigerants and halons;such as chillers and halon See MPCA webpage ttb2,
t�re extinguishing equipment. Chlorofluorocarbot�s(CFLs}.at
httn_//www.oca,state,mn.0 s/vh iz4b$.
Solid wastes;sucfi as furniture and window
treatments.
Subme�sible well pumps,which may conta�n Search(or MOH publication q141-0434,'Sealing Unused
polychlorinated biphPnylt(PCBs)or mer�ury. Wplls',at httD://www,h�dkh.state.m .us/.
A�y other wastes not acceptable at a disposal
facility;s,ich as radioactive or iniect�ous wastes.
Wastes that do not need to be removed before demolition
You do not need to test pain:for lead or remove suspected or known lead paint from a strutture if you
are going to demolish the stru�turc or if it will be bumed ior a Iegitimate fireFighter training bum.
You also do not need to test caulking or paints for polychlorinated biphenyls�PCBs}ar remove
suspected or known PCB caulKing or paint if you are going to demolish the structure.If the structure will
he burned for firefighter trai�ing,however,the caulking and ather sealants must be tested for PCBs and
any PCB-containi�g caulking removed prior co the bum.
Pagr 2 oi 3 Detember 2013 ( w swd D7
For more inforrnation on PCBs in caulking or paints,see MPtA hatardous waste fact sheet Itw-hw4-48k,
ManaAinQ Seatants and Coatin�s ContaininA PCBs,at
htt : www.pca.state.mn us�publications/w-hwa-4gk.pdf.
Timef�ames fo� removal
Remove all �he wastes above and any other wastes which would be required to be removed at least two
days before the intended renovatian or demo��tion date.
However, if due to accident�l or emergency circumstances that werc beyond the control of the
structure owner it is unsaf� �r unfeasible ta remove all of these wastes prior to the renavation o�
demolition worlc,then you may complete ihe work, but must identify and remove a11 of these wastes
from the debris prior to disposal. Note that identifying and removing hazardous and p�oblem wastes
from debris is irequently much more difficult �nd expensive than removing them before demalitian.
Exampl�s of accidental or emergency circumstances when this cieferral could be allowed may include:
• declaration by a government entity that the structure is unsafe io enter:
• damage or partia! destruct�on of the structure by acc�denta!f�re;
• d�scovery after demolition or renavation has alfeady sta�ted of previously unknown hazardous or
problem wastes which could not reasonably have been identified beforehand.
More information
Guidance and requirements in this fact sheet were cornpiled from Minn. R.Chapters 7035 and 7045,and
inco�porate regulatary f�terpretation detisions made by the MPCA on luty 3, 2013. Visit the Offite af the
Revisor of Stacutes at httc�s:!/www.�eviSQr.m�,QovJpubs to review the Minnesota Rules directly.
Thc MPCA has staff availaWe to answcr your waste rrtanagernent questions. For more information,
contact your nearest MPCA solid waste staff. For informat�on about waste and toxitity reduction,
contact the M�nnesota Technical Assistance Prog►am (MnTAP).
Minnesota Pollution Contrul A►gency Minnesota Technical Assistance P�ogram
Toll free (all otiices)........... �•800-657-3864 Toll free...................................1•800-247-QO15
E3rai�erd.................................218-828-2492 Metro........................................_b12-624-1300
Detrort Lakes..........................218-&47-1519 Website..............httq://www.mntap.umn,edu
Duluth....................................218-723-d660 Minnesota Department of Natural Resources
Mankato ................................507-389-5977 roll free
...................................1-888-646-6�6�
Marshall.................................507-537-71d6 Metro ........................f>51-296-6157
Rochestcr...............................507�285•7343
Website htia://www.dnr.state.mn.us/
St. Paul...................................651-296-6300 Minnesota Department of Health
Willmar..................................320-214•3786
WebSite .........http:jlwww.pca.state.m�.us Toll iree...................................1-888 345-Q813
Metro.........................................551-201-4620
Small Business Environmental Assistance Website........http:/lwww.health.state.rnn.�s/
Toll free.............................. 1-80U-657•3938
Metro.....................................651-282-6143
website httc;//www.xa.sta�te.mn.uslsbeaD/
Hennepin County Drop-off Fa�ilities
Brooklyn Park Bioomington
Brooklyn Park Transfer Station and South Hennepin Recycling and
Recycling Center Problem Waste Drop-off Center
Fuf!and self service areAs Full servite only
g 1���Jeff����n H�ahv,rd�v f���0 W a�th St.
f��r«�klyn I'ark,MN �5�►�5 , f3 _>orni��gtor7,iVIN 55�(31
� R�cnfleld --
� Brooklyri Park �
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a ' �
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Meple � 94TH ST
(3rove TRANSFER STATION
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ELM CREEK BIVD N BFlOOKLYN BLYD 9GTH ST ��' WASTE
DROP-OFF
CENTER
To St Cbud
98TH ST
_ � ; ����
.�:. � 0 ; �,05
Minneapolis � 8lopmingion
Facility hours What to bring:
T�,���-�dy�,�hur5d�y,�ri�ay .....1Qa.m.-6p.rn. • Prcn;t c-�t r��,ic�r�r�c �,•, tii�;h��a
Wednesda driv�r's licE n�e or urility bill
y...................10�.rti.-8�.m.
• Fayr�ent, if ap��ic�bie
Saturday........ ...... .. ... ..8 a.m.-5 p.m, c�:st�,; ,.,��k ��� t���.iit �.�;�v
Closed Sundays,MOn�iay5 dnd hQl�days For the most cur�ent facility
O�n to r�sicierlis otHenneFain,Anok�,Carv�r, information�o tt: wwwhen�epin.us/
f3akota,�tarry5ey and V1�ashington Gcaunties dropoffs c�t call 61�-348-3777.
Attentqn If you want help translating this inlormation,
WII612 348 37T7
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rsta ir�formaubn,I'�rna 612 348 3777
o9ow Haddii aad docmeyso in lag�a kaalmeeyo Hen�epin County
tarj�rtwdd�maNuumaadkani oa I�ccg la'aan PUbllc WOrkS
wat 612-3Afi-3 7�T
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Ceeb toom Yog koj xav tau kev pab txha�s cav xav na rau www.hrnnFprn.ui�drqpoffs
ko�daw6,hu 6i2 34$3?�� esvironment�henneAin.us
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n�,orv� Minnesota Dep�rtment of Naturai Resources
How to Conduct a Fire Department Training Burn in Minnesota
live fire training in a training center burn building, or in a suitable, acquired building
awaiting demolition, is an excellent means of training firefighters. In the State ot
Minnesota, fire departments may be issued Fire Training Burn Permits, through the
Minnesota Department of Natural Resources, �ivisi�n of Forestry. to conduct live
training burns o! residential structures awa�t�ng demolition. The burn must be a
bonafide training burn, not a demolition bum w�th the fire department standing by.
In addition, a f�re department member rnust attend the site unti! the fire is
ext�nguished and ensure proper disposal of the ash.
The fo/lowing is an outline of steps that shall be fol/owed to conduct a live
s�ruciure iraini�g burn:
1) Tra�rong bums: Must use only fuel rnaterials as outl�ned �n the current edition of
National Fire Protection Association 1403, Standard on Live Fire Training
Evolutions, and obtain the applicable live burn documents �n accordance with
the cuRent edition of the Board of F�refighter Training and Education's live burn
pla�. http://www.mbfte.orgtformslliveburnpacket.pdf
2) Have a Minnesota Department of Health certified inspector conduct an asbestos
inspection of the structure to be burned. To obtain a cuRent list of certified
asbe�stos +nspectors, call the MDH Asbestos Unit ai 551-201�4620 or on the web
at; www.health.state.mn.usldivslehlasbestoslfind_contractorlindex.cfm .
3) Review the as�stos inspe�tion report provided by the inspector.
� If the�e are ANY asbestos-containing rr�ten�ls (ACM) in the structure,
contract with a licensed asbestos abatement company to abate the ACM. See
the MDH information above to find a licensed asbestos removal contractor
Note: Homeowners may abate the asbestos themselves; however, all o� the ACM
must be removed completely with na residue or debris remaining. Fire
Oepartment personnel cannot abate ACM.
Go to; www health state_mn_us�d�vSleh?asbestos/homeownerlindex.html for
asbestos removal by the homeowner.
4) Obtain a "Notification of lntent to Pertorm a Demolition form� {w-sw4-21), other
forms and fact sheets by call�ng the MPCA at fi51-296-fi3U0 or go to;
wtivw pca state mn us�programstasbestos_p html
� Mail or fax 651-297-1d38 the Notification to ihe MPCA. The form must be
completely filled out or it will be re�ected.
� The MPCA will contact the F�re Department only if there are problems with the
completed Notification. No confirmation letter is sent.
� The Notification must be feceived or postmarked at least 10 working
5) Remove all hazardous materials from the structure to be burned. To obtain a list
of examples of hazardous materials, call the MPCA at 651-296-6300 or go to;
www pca state mn us;�ndex php�view-�ocument html�gid=4954
6) Obtain a copy of the "DNR F�re Training Permit Applicationp. Call you�local DNR
Forestry Area Office or go to; www.mndnr.�v�grantslr�ratfirelresourCes.html
G �omplete the DNR Fire Training Perrnit Application_
�� Be sure to identify a time penod (up to 21 days)�wt�en the training may occur.
The"Permit to Bum' may be issued for this time period.
u Submit the Application to your local DNR Forestry Area or field Office at least
10 working days (or 14 calendar days) priar to the training bum for review
Approved applications, alang with a "Permit to Burn", will be returned to the
fire department. Do not send application to the DNR Central Office in St.
Paul or to Regional offices. Permits are issued f�om Forestry Area
Offices only. http ��,�w�r,1v dnr state mn usicontact`locator html
7) Conduct a final waik-through of the structure erior to the training bum to ensure all
prohibited materials have been removed.
0 No additional materials can be hauled into the structure, other that clean hay,
straw, or wood used to igrnte the structure. Liquid petroleum products can�ot
be used to ignite the structure.
Contacts and lntormation:
� DNR Forestry offices for questions regardrng the Appl�eation DNR Fire
Training Permit Application or the burning permit
www dnr state mn us!contacUforestry html.
� MPCA for questions regarding the asbestos survey, asbestos abatement, or
the Notification Information at;
www pca.siate mn us�programslasbestos�.html
G Contact the MDH Asbestos Unit at;
www.health.state.mn.usldivs/eh/asbestos/find contractor/index.cfm to bbtain a
current list of certified asbestos inspectors and asbestos removal contractors.
G State Law related to training bums.
http tJwww rev�sor.leg state.mn uslstats/8$/17.html
July 15, 2U15
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EMSL Lab Results
EMSL AnalytiCal, Inc. EMSLOrder: 3517Q2897
Customsr ID: HICK55
_ t4S75 2�ro Avonua Nonn hMnnaapolis.Mn Si417
T�::r:,. 175:�1 d49-1922::?ti 3;449 A�?A
Customer PO:
�ll'.J�'YYYrN'.EMSL.G�0111!minr�ea;ro�slab(���errsi•cu��� Project ID:
Attention: Douglas E.Hickey Phone: (763)479-3214
Hickey Consuttants Fax: (763)479�3214
4301 Spruce Way Recaiv�d Data: Oa128r2017 1:40 PM
Mapie Plain,MN 55359 Analysis Date: 05103;2017
Collected Date:
Project: SW042817
Test Report:Asbestos Analysls of Bulk M�terlals vla EPA 600/R-93/1f 6 Method using Polarized
Lfght Mlcroscopy
[�JWI�A6bB5t(t§ �.Qje
Sample DescHplbn Appeerance •.b FiUrous 74 Non Fibrous %Tjrpe
HA1'I il' 5n�ng'Q ROOFING Gray�Bla:� 15`�+Glass A5^.:,Non-ftypus{p�l,p•i Na,eDeee,.-cey
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TR1-p2 TRANSRE UKE Giay�TantW�ite 75'�:Non 1txa,s 1,Otbe�i 25��,Ch��•se[de
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OrderID: 35 289'f Asbestos Chain of Custody EMSI-Aw►tYnCAi,INC
� EM8L Order Numbe�r � 14375 23'�AvE NoRTr+
Mwn�AP0�13.MN 55�47
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Map of First Floor of 1750 Shadywood RoadAsbestos Survey.Ye11ow=Asbesots Containing.
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E8CROW AGREHMENT
AGREEMENT made th�s�day of ��-,20�?,by and batween the C1TY OF ORONO, a Minnesota
municipal corporation("City"}and C"-,rz�cz..�-,; N �.�.,n �Y�F s H-a-,� (•pwner(s)").
REC LS
A. The unders(gned!s i are#he Owr�er(s)of the SubJe�t Properiy and hereby agrees to and cohsent to the
terms and oondlt(ons of this Escrow Agreement
B. Ownerhas: (check one)' _
� Flied a zoning applicatlon# l(0 •387g'
P� Filed an application for a 8uildinglzenifl�Pem�tt# 2d17-ODIQ'�� 'Q�1(� 1��,(�']-W?.r, rj
a Agreed to comply with Orono City Code Sectioh 78-1432 regardtng ac�essory st�uctures.
o Filed an Individuaf Sewer Treatment System(1$TS)permit applica�on.
o Requested to do work within public Right-of-WB�y ,
o Filed a request for a Temporary Certificate of+Occupancy
o Other
("Application")on land situafed in the City and locat�d at
(the°Subjeot Property"); and
C. The City is willing to review or monitor the Applica�cn only if the Owner agrees to reimbu�se the City
for the actual costs expended by the City on behalf bf,or on account of,the Owner.
NOW THEREFORE,THE PARTIES AGREE AS FOLLOW3: �
1. DEPOSIT REQUiRED. Contemporaneously with e executfon of this Escrow Agreement,the Owner
shap deposlt$�(�Escrow") with the Ci neaessary to secure coverage of the total costs
assoc�ated with review, approvai, and monftoring the Application. Any Escrow shall be hetd in a
speci�l escrow account and shall be credited to the wner.
2. PURPOSE QF E�CROW. ,
■ Zonina. The purpose of the Escrow is to guarpntee reimbursement to the City for expenditures
including but not be limited#o staff time,at the�ates estabtished by the City Council, )n exoess of
that covered by the standard appiication fees, eng(neering consultant and legal oonsultant
expenses incurred by the City in revlewing and approving the Applics�tion and all other city staff
administra�ve and consultant seryices pertormed in the processtng of said�evlsw ahd approval,
• 8uildlna/�onfng. The purpose of the escrow is to guaraMee completion ofthe site plan as approved
and the provision of the as-butlt survey as requi�ed by the Building officlai.
« Acs�ssoro Stnacture. The purpose of the Escrow is to guarantee re(tnbursement to the City for
expenditures including but not Iimtted to staff Ume, at the rates established by the City
Administt�tor, engineering and legal consuitant expenses incuRed by the City in removing an
accessory bullding if the Owner faiis#o perform tAe obiiga�ons in Orono City Code Section 78-1432
and ali aiher City staff administrative ar�d consut4ant services performed in removing the accessory
building, including land stabilization.
■ I„�S. The purpose of the Escrow 1s to guara tee relmbu�sement to the City for experiditures
inciuding but not be limited to staff time,at the tes estabUshed by the City Council�in excess of
that covered by the standard application fe , engineering consultant and legal ccnsuNant
expenses incurred by the City if Owner for ny reason is unable or unwltling to honor the
requlrements of Chapter 58 ofi the D�ono City�Code, and all other city staff adm(nistrative and
censultant services pe�formed!n relating to the Applicat�on, The City may also reimburse itseif br
ati enginee�ing and legaf expenses assoclated with the construcHon, removal, alteration, or repair
of the 13TS if the Owner fails to do so.
• Temaorarv Cert�icate of Occuoancv. The purp�se of the Escrow is to guarantee compie�on of
exterior �nprovements (driveway, yress, etc.) that cannot be accomplished due to weathec
conditions.
lanuary 2017 1
. �
�. �L.Y BILLtNG. The City wit! monthly fiorward to the pyvner a statement end bifi for the
���d�res fncuRed by the Ctty far skaff and cflnsultaM setvices. Such statements shap be due and
payable w�fiin 15 days far receipt by the pwaeer. No stat�ment will be sent if there afe na expenses
lnctrrned in the perlod since the most recerrt atatement i'i�e CKj,shalt�t�m�a!I�me, servk:es, and
materiats b111ed�o any dwner and said�m�j tervices, and matedais shaif be!n at�corc�anc�with the
rules,r�egulations, and fees as prornulgated and adopfed by the City Council. ��
4• PJ�BURSEMENT FRt�M�3CROW ACCeuN'r,
tn the event the OKmer dces not make paymen#the
City as required under paraQ�ph 3,the City mey draw from the Eacrow wlthou#fuKher approVal of the
Owner� refmbur�e the Ctty for eitgihle expenses#he has incurned.
notliy the Owner of the draws the Ctty has made and tF�e nature of ttie�Cj�-shail periqdic�fly
reimburset�nt is being made, �n8� �r which the
6. REIMBURSEMENT O�Ecr_�tpy�y, The pwner shafl re(mbur�e the Escrow fund for any defir�ts caused
if the amount actualiy expended by,or biiled to,the C�y excesds the escrowr fund baiance. .
6. L�1GHT_d__E�IT t�y,
• �g. This section is nat appiicab�.
' ' Bu�. This section Is not sppitcable,
� AOCB6SOTV �rhyrra
—�.____._�'_.�,.i.,. The Uwner hereby grants the Cfty, ks ageni�, empioyees� offlcers and
contractors#he r1ghE to�tsr the prolsertY toi remove fhe aooessory buil�iing(s)should the Owner
not�pmple#e tile remo�at obllgatlons tn Qrn C#ty Code Sec�ion 7&1432.
' �. The O�rner here
ta en�r the bY 9�'nts the Cit�r,its ents,emploYees,offlc�rs and contr�cmrs the right
property ta perform atl work d Inspec�ons deemed appropria�e py �hQ City In
oonju�on wifh reptacemen# of the seA� Y�� �ciudlr� but �t timit�ed ta conat�ucting o�
c�mpietin� any and glt o#the agr+eed upon i provements shauid t(�e d
improvements by tlie date a9reed upon. Owner not camptete th�e
� Tematytstv Cert#fic�te ef c]rr���� Thi�se�tion is not applkable.
T, NQ INTE�{�gT pp�p. A!f accr�ed i�teres#, if eny,�shaN be paid to�e City to�eimburee the Clty for its
cast�n administe�ing�e Escrow accwunt.
8. CLOStNt�ES�ROW. When the review has baen campleted or the project has beet�compfeted, the
bai�nce of��wN V ,If any�shali be retumed to�check dne�:
�Owner a Appiicant o Other
Nati�: � �,, ��
Sd+�et Address!PO Box, � iG► l r�e
+City/Statel ZIP: ,- ;�
9. C�RTI�IED UNPa CHaRQEa E���qp�}ica�on Is ab�ndoned by Owner,or if the elEg(ble expensas
�'t�umed by the Cih►exceed tt�e�mc�unt in Escrow�ttie City shalt have the right ta oerfify the unpaid
balanche to the iSubject Prpper{y pursuantto Minn.Stat�§4i5,U1 and 3gg.p1�.
IN WiTNEBS WHER�O�,the unders�gned have exec�ted this Ag�eem�t as of the daY�and year flrst above writt�n.
CITY QF ORONO� OWNEIR(s):
8Y: ����`.�_ w__��'
BY:
�
lanuary 2di� 2
�� � ��
l./ `�' DATE TIME
L�
CITY OF ORONO CALLED IN � �
INSPECTION NOTICE_ l q�i_SCHEDULED �`�
PERMIT NO.,�-a r�I 7"'�CG =�COMPLETED �� �
ADDRESS � tS �C�cc�l.. C,�l.�xiCy I�CJ
OWNER TELEPH NO. �� Z s ��6� C��I
CONTRACTOR , �Y�� �'��'� �-�
� DESCRIPTION � ' `� I��L.����
tL ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL , /N I,�L�
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/�ILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
� ❑ DEMO-SITE ❑ S PTIC INSTALL
2 OWNERICONTiiACTOR TO MEEf YOU: ES_NO
� COMMENTS: ,
� ^ ��P,G• /��.s �je �� Gr�S�a�r `l�.c��cP
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W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� ❑CORRECT WORK�PROCEED ❑ISSUE CERT�FICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY
V BEFORECONERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WFLI REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-460�
OwnerlContractor on site:
Inspector: C��i �
(/
Whits Copyllnspector's File Cenary CopylSife Notics
Cr DATE TIME
CITY ORONO cnLLED IN
,INSPECTION NOT CE 9CHEDULED S-�I $ �3t�
PERMIT NO. ' OOMPL e�
ADDRESS Q
OWN�R TELEPHONE NO.�77��-3�
CONTRACTOR �� �`'�
� DESCRIPTION �t��� v�v�� K-
� ❑ FOOTING ❑ PLUMBING RINAL ❑ EXCAV/GRADING/FIWNG
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVEfLANDS
O ❑ FRAMING ❑ MECHANICp1 FINAL ❑ TREE REMOVAL
Z � INSULATION ❑ WOOD BURNER/FIREPLACE � SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP p PROGRESS
� ❑ FINAL ❑ SEWER HOCK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERfCONTRACTOR TO MEET YOU:_YES,_NO
c�.� COMMENTS:
W .
� ' e �tG• �!- �i� '- .�S G�K Ktc�t�
� - S et.��✓ a u.�a�e�� a/•s«.�•re��t,�
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� �IAIBRiE6ATISFACTORY:PROCEED ❑PRWECT COMPLEfE
W O CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTIO TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR ' ❑CITATION ISSUED
i
❑INSPECTION REWIRED.CALL TO ARRANG�ACCESS.
Call forthe next inspection�4 hours in advance. (g52) 249-46��
Owner/Contractor on site:
Inspector. �
White Copyflnspector's File Canary CopylSfte Notice
v ca�a�
� CERTIFICATE OF SURVEY FOR
� GRETCHEN SHAW
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��, � �� � ` OF LOT 16, SHADYWOOD R
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O Q � i '� PROPOSED � �o � '"": i7. � � � .-''LINE (O.H.W.)
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� � •. (wa�) s4i.s.....� (s�aa1 99.99 941.4 - g '� ,42.3�1 �-~ `1
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�o,o,� �� GARAGE HOUSE � � � � \ LEGAL DESCRIPTION OF PREMISES :
I � �a,. �eu.o \
�t ' (aw.$) :, ... DECK \a � �
, �+�•• e,o�j �E1760 � `� �, � Lot 16, SHADYWOOD
�, \ •°J •-'..•�V 89°53'30" W ' • 130.9a�''. (�so.4 , 1 \ � m� �
40
66 Y� \\ \ �s4i.» ` 1 �sss.�� 1 '�
� \ � � \ � � • : denotes iron marker found
f—�AC � (e�e.$) �y�o.$) (�i.e> �wzi (ea�.� �ew.e) t ` \ � �
Roqowq°p �, (93E9) \ `�7' c�•22� (�� � �` 1` �` �\` (908.3): denotes existing spot elevation, mean sea level datum
l (939.4) ` , g10.8 : denotes proposed spot elevation, mean sea level datum
� �' (vaz`>
� --9�7 -- --: denotes existing contour line, mean sea level datum �
PROPOSED ELEVATIONS : (per architect, verify) �
—�—: denotes proposed contour line, mean sea level datum
1) Garage = 941.8
Bearings shown are based upon an assumed datum.
2) Top of foundation = 942.t
3) Main floor = 942.5 This survey intends to show the boundaries of the above described
property, and the location of an existing house, spot elevations,
4) Basement = 932.5 topography, trees, lakesides of adjoining houses, and all visible
"hardcover" thereon. It does not purport to show any other
improvements or encroachments. t� � ���_ L3e'
DATE DESCPoPTION I hereby certify that this plan, specification, or re ort SCALE , /��
��,e STRUCTU2AL IWiDCOVER ON/1780 LOT SFiOWN G R 0 N B E R G 8c A S S 0 C I A T E S I N C. P
e-ta-t6 PROPOSED MqUSE,DPoVEMAY MD wwc sarm was prepared by me, or under my direct supervision, � 20 f�"
n_ r
f and that I am a duiy Licensed Land Surveyor under
io-zo-�e the laws of the State of Minnesota.
,z-,.-,e PROPOSED FLEVAiqNS�DOED,FEVISED DPoVEWAY CONSULTING ENGINEERS, LAND SURVEYORS, & SITE PLANNERS o"T�
z-�-n Pao�n��vo owvew�r r�vsm 7-21-16
�e--n �ovogo w�uc,PAT10,MO STpE 57EP5 FEVISED 445 NORTH WILLOW DRIVE, LONG LAKE, MN. 55356 / /_
952-473-4141 i!i�.!!• �����L ,aB ra.
Mark S. Gronberg Minnesota License Number 12755 ��—��