HomeMy WebLinkAboutAffidavit of Property use - SAC ,
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' Metropolitan Council � Environmental Services MCES Affidavit-D
' 390 Robert Street North Last Updated: 12/11/2013
' St. Paul, Minnesota 55101-1805
651.602.1421 �651.602.1030 fax
Sewer Availability Charge(SAC)
2014 AFFIDAVIT OF PROPERTY USE
This Affidavit of Property Use is to verify the demand on this property for SAC purposes for Non-Conforming Credit when there is
no evidence of SAC paid for the existing demand and no documentation can be found for the two types of Non-Conforming
Credit: 1) Grandparent Demand (demand used prior to 1973 when the SAC program began with evidence between 1968-1978);
and 2) Long Continuous Demand (demand for 10 years or more up through 3 years prior to current SAC Determination or permit
issuance .
Property Address: 3382 Shoreline Drive Orono Mn
Customer Community: City of Orono
Parcel Identification Number: 17-117-23-44-0100
Dates of Non-Conforming Credit: 2/27/1995 through 7�11/2011
Type of Non-Conforming Credit: � Grandparent Demand � Long Continuous Demand
I certify that Customer Community staff has researched the above property and have found none of the
items listed below for activity at this address:
- Dated Building Plan(s) associated with a building permit
- Building Inspection record(s) stating the actual use of the property
- Business License(s)
- Building or County Assessment Record(s)
Although no written proof exists, I believe the demand of this property includes (must be specific in what
was there and, if more than one demand include the amount of square feet for each specific use):
This space is part of a buildinq at 3382 Shoeline Drive in Orono. It is 8500 sq ft and was used as a hair
salon known as Jul Ann Hair Fashions from February 1995 to July 2011 when it was changed to a pilates
an we ness s u io.
and was used in this manner during the Non-Conforming Credit dates as stated above.
I hereby certify that I have read and understood this affidavit and that the statements are true to my knowledge and
belief. I further understand that the giving of false information in this affidavit constitutes fraud and is also cause for
the immediate redetermination of any charges. I have no conflict of interest in this matter.
Print Name of Community OfficiaL ��c=�C���E'�'-� �r--'�-�Cr��'
Community Building/SAC Official
Signature of Community Official: ���--�`�'� ��C��'�---�ate: � ��
Print Name of Community Official: L�(LL- ��N (�i2-�Nd ����p,f �Tt�c►n l
Department Head of Building or SAC Official
Signature of Community Official: Date: � — )l� - 1 s
' � l�`'L11�..1`��I���
CI r Y O� ORONQ PERMlT TYPE:
2750 Keliey Parkway- P.O. Box 66 : : � ,;:=.; . ,:::,.
Crystal Bay, Minnesota 55323 Permit Number: _
(612)473-7357 Date Issued: ; -
SITE ADDRESS:
DESCRIPTION:
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C1TY OF ORONO APPLICATION FOR PLIJMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GENERAI, INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Permit cards will be sent by return mail afrer a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT ARD IS
POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing
in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 473-7357. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date
the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 473-7357.
Please check one: New Addition Repair Replace
Residential Commercial
JOB SITE: ��C Rnt����r Fc.hl�,U�vS Zip: 3S3y2-
Owner's Name: Telephone Number:
Mailing Address: _, ��,,?L���S�rr �n� �Df;,x. City: ,�,�r,v Zip: ,���g2
Contractor'sName: i,�,�,�GfC t�v Z�Y o�- t-I TelephoneNumber: ��pv-a52�,
MailingAddress: p�, �� L�_��`��r� ,n<, City: �y Zip: ���,�q�
PLUMBIlVG FIXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT iST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower W asher
Kitchen Sink Water Heater
Disposal Water Softeaer
Dishwasher Wet Bar
Sillcocks Misc (list)
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DATE TIME
CITY OF ORONO CAL�ED IN :� /S'J-
INSPECTION NOT CE SCHEDULED ;�
PERMIT NO. �c�.-��f COMPLETED I� �
ADDRES ���'y- ,� , o � ��
OWNER c���,�._..,-, : _CONTR.,�[_i�/!/?�A J
TELEPHONE NO.__ 7C% - (; `-��2 Z
� DESCRIPTION �� O67`.
� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIL�ING
` � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Z03 INSULATION 24J25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
�Q OS FINAL t4 SEWER HOOK-UP O6 PROGRESS
07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-F 15 SEPTIC INSTqLL.
22 FOLLOW-UP
? UM81NG RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUM8ING FINAL 36 FOUNDATION/REMOVAL
� OWNERfCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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4i WORK SATISFACTORY:PROCEED � PROJECT COMPLETE
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W u ISSUE CEqTIFICATE OF OCCUPANCY
OO Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING
Cl CORRECT UNSAFE CONDITION WITHIN HOURS. PERMANENT
INSPECTOR WILL RETURN = PHOTO TAKEN
C i STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALI.TO ARRANGE ACCESS.
Call for xt i spection 24 hours in advance.473-7357
Owner/Contr c n it .;
Inspector. —
White Copylinspector's File Canery Copy/Site Notice
ATE TIME
CITY OF ORONO CALLED IN �.Z
INSPECTION NOTI SCHEDULED =�1��� �z^
PERMIT NO. ���� COMPLETED J �
ADDRESS �` �' �..��� �
OWNER'�2���L //�s�����.�`ONTR.
TELEPHONE N0. 'Cil7/- �-z-z 5
� DESCRIPTION �'�-.����,�-f:a�, ��o� ��
� 01 FOOTING 71 MECHANI I 18 EXCAV/GRADING/FII�ING
" Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP SITE INSPECTI
Q OS FINAL 14 SEWER H�OK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAWT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING AI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERlCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� 'WORK SATISFACTORY:PROCEED PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED Q ISSUE CERTIFICATE OF OCCUPANCY
O � CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING pERMANENT
i-:CORRECTUNSAFECONDITION WITHIN HOURS. _ pHOTOTAKEN
INSPECTOR WILL RETURN
;f STOP ORDER POSTED.CA�L INSPECTOR CITATION ISSUED
O tNSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for ne inspection 24 hours in advance.473-7357
OwnedContra t on i :
Inspector.
White Copyfinspector's File Canary CopylSite Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE �� �-� SCHEDULED !-z.�--�� ��
. PERMIT NO. COMPLETED !t i Q
ADDRESS -33�'� ��i2EC-irv�: l.�(L
OWNER �����NS " ?���C CONTR.
7ELEPHONE N0. �l� t'�z��
� DESCRIPTION 6L� ��� r��
� Ot FOOTINCi 11 MECHANICAL RI 18 D(CAV/ORADINO/FILUNO
r y 02 FRAMINQ �3 MECHANICAI FINAL 19 IAI�SHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 77 SITE INSPECTION
� OS FINAL 14 SEWER HO�K-UO 06 PROGRESS
2
� 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT
J
W 07 DEMO—FINAL 15 SEPTiC INSTALL. 22 FOLLOW-UP
Z 09 PLUMBING RI 23 SEP71C FINAL 35 HARD COVER REMOVAL
� 10 PLUMBINCi FINAI 36 FOUNDATION HEMOVAL
Z OWNEii/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d RK SATISFACTORY:PROCEED PROJECT COMPLETE
� L CORRECT WORK 8 PROCEED - ISSUE CERTIFICATE OF OCCUPANCY
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O i", CORRECT WORK,CALL FOR REfNSPECTION TEMPORARY
0 BEFORE COVERING
PERMANENT
iJ CORRECT UMSAFE CONDITION WITHIN HOURS. r pH0T0 TAKEN
INSPECTOR WILL REfURN
i�STOP OROER POSTED.CALL INSPECTOR
-CITATION ISSUED
❑INSPEGTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the next ins tion 24 hours in advance.473-7357
OwnerlConiract e:
Inspector.
White Copyllnspector's File Canary CopyfSfte Notice
CITY OF ORONO SALE OF WATER METER
Box 66 (2750 Kelley Pazkway)
Crystal Bay,MN 55323
GENERAL INFORMATION
1. Water meters must be picked up and paid for at City Hall.
2. Water meters must be set and sealed by Orono Water Department (249-4640) upon
completion of ineter installadon.
JOB SITE ADDRESS: _ 3 3 g `{ � �1 U)'�'��l a b��. � a r�� �S S�3�i/
Occupancy Type: Residential i _Commercial
Owner's Name: ���� �,�n� Phone Number:
Mailing Address: ��$� �`�Gr/,�q r l�r, City:f�/�rr0 Zip•-s�`'� �
Contractor's Name: J��;, �j� �Q r �lu��rj Phone Number:
Mailing Address: City: 7�•
METER INFORMATION
(5/8" meters= $130.00; 3/4" meters=$180.00; 1" meters=$240.00)
Serial Number: ��1 �3�� g Remote Number: q��(t�/�
Size: 3�y Brand: F�-�-O�fh�}IG TYPe� �0.4�1/
Meter Fee: � � �.��
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Signature of Applicant: Date: / C�� �
cc: addresss file,Utiliry bill' Dept,cash register
X:IAPPS\W PWIN60\W PDOCS�FORMSIWATERMETER
•y � �
State of Minnesota License No: 2011-03
County of Hennepin
City of Orono Fee: $250.00
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Upon investigation and satisfactory evidence of the qualification of the licensee, this license is granted and
pursuant to application and payment of fee thereof, and is subject to all the provisions and conditions of the
regulations and ordinances of the City of Orono and City Code Chapter 31 pertaining to such; and subject to
revocation according to taw for violation thereof. This license is not transferable except by consent of the
issuing authority.
Licensee Name: All Bodies Pilates and Wellness
Trade Name or DBA: All Bodies Pilates and Wellness
Applicant: Andrea Odenwald
Address: 3384 Shoreline Drive
Commencing: July 12, 2011
Terminating: December 31, 2011
Approved Massage Andrea Odenwald
Therapists:
Issued by authority of the City Council of the City of Orono, Minnesota July 11, 2011
� d�►T� i 4.�1J�--=
Attest:
Lili Tod McMillan, Mayor
_ �/��
Linda S. Vee, City Clerk
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