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Home My WebLink About2011-01281 - porch ' CITY OF ORONO PERMIT NO.: 2011-01281 . 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUEn: i U17/2011 • 952 249-4600 FAX: 952 249-4616 A�DRESS : 2550 SIXTH AVE N PIN : 28-118-23-41-0005 LEGAL DESC : WILLOW RUN : LOT 004 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : PORCH RESIDENTIAL ACTIVITY : 434-RESIDENTIAL VALUATION : $ 30,000.00 NOTE: ADV.PLAN REVIEW PD ON PERMIT#2011-01279 IN THE AMOLTNT OF$30339 ESCROW PAID ON PERMIT #2011-01449 IN THE AMOUNT OF$700.00 FOUR SESASON PORCH C APPLICANT pERMIT FEE SCHEDULE 466.75 PINEWSKI BUILDERS STATE SURCHARGE(VALUATION) 15.00 13750 CROSSTOWN DR-SUITE 203 ANDOVER,MN 55304 TOTAL 481.75 (763)753-5095 Minnesota State License#: 6859 OWNER RICE,EDWARD&TERESA 2550 SIXTH AVE N LONG LAKE,MN 55356- 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 oniy the work described and does not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances goveming 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 lime" er work has commenced. The applicant is responsible f su�i� equired inspections aze requested in confo ► e e Building Code.This permit may be revoked at an e. . " � / / �7 /70/� � i ( � . �.1� t � .1 �, _ �t ' , �.`�, �... , (.._ C. y'. l. pp icant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. City of Orono � Building Permit Application for New Structures or Additions —_-_ Mailing Address: Permit number: D(��0 �2� , l' //.¢,�,�� PO Box 66 /O, t, O Crystal Bay, MN 55323-0066 Date received: /O" zD–�� Ij �x# '� } Received by: ��s ` „ +�{�� _ ,, , StreetAddress:' \'��,t� ��,�� / 2750 Kelley Parkway Plan review fee: o� D l�–'D l 2..7 q �A�..�.�, 4,� Orono, MN 55356 303.�1 � CG �,,,�sxo, � � __== 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: �� S� " U� ,�/�- Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATIO Name: �in,-,,��f ,��5 State License# Expiration Date: 3 - /- 20/Z. Phone: 5 0 9 S� office �/ - Zo -/�y cell Mailing Address: s c�,�n �� Cit : ;rr ZIP: ,$�30 Contact Person: v i ; Applicant is: ontractor y Homeowner (Circle One) Email and/or Fax: sf�� ,�n1•r.�,sli �1 + /�rr5 � co �n �63 �/�7 y.3�2- PROPERTY OWNER INFORMATION: Name: /�SS ��- Phone(day): � � 70 Address: S c�—6 .�+�`+G City: ��14rIG' ZIP: ,�J' .5.�5^�_ Email and/or Fax ARCHITECT/ ENGINEER INFORMATION: Name: ' Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& Water Supply ❑ New Construction ❑ Single Family with �-Residence �,Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with eck ❑ Relocation detached garage Office/Commercial �.Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water **Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial �-Private Well Minnehaha Creek Watershed District(MCWD) ❑ Othef: (speCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 wwvd.minnehahacreek.or Estimated Construction Valuation (excluding land) $ �Q O�a � STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a.Length(ft.}= Number of bedrooms= ❑Wood/Frame ❑ Masonry b.Width(ft.}= Number of garage stalls: ❑ Metal Attached= � ❑ Pole Bldg. Areas in sauare feet Detached= ❑ ICF 0 On-site Prefab c. Basement= ❑ Off-site Prefab d. 1 St Story = ❑ Other(please specify): e.2"d Story= f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Mot . Enclosed ' A licabte ❑ ❑ Pertnit A plication ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ene Code Calculations and Mechanical Code Re uirements Form ❑ ❑ Surve meetin all re uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ WeUand Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee � ❑ Other APPLICANT 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 inform�4ion 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 altemative 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 infortnation 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 govemmental 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 agreement to ensure completion of the as-built survey and all site irnprovements. � .:. _--"�,.,�--.. .l;;� ,.-�",' ,-- /r � A IicanYs Si nature: � < ��/ � ` Z�� r� 9 �ate: � � / Plan Review Checklist for New Structures / Additions Addr�ss/ PID/ Legal: � �S� � �� Description of work: ��, 3��.1Y ` �rr,+' ► Septic review by: � Date Approved: � U �� Zoning review by: Date Approved: 1.� - l9'• � � Building review by: o Date Approved: I 1— � '�— �l � Grading review by: Date Approved: Zoning File#: Resolution#: Resolution Date: Zonin District Fire De artment Post Office School District Zoning: Lot Area: 3�� SF AC idth: Z�Z! Depth: �P�4� Survey Submitted: es 0 No ��3 ate of Survey: �� Pro osed Setbacks: Front e) Rear(St et) � N Si E W � � N Side � Other Buildings Wetland �_ '� 2.�' 6I � l o� Building Defined Height: Building Peak Height: #of Stories Ok?: � YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement flood crawl START the distance between the slab and the highest space floor and the highest roof peak,the top of WITH roof peak,the top of the cornice of a flat roof, the cornice of a flat roof,the deck line of a the deck line of a mansard roof, or the mansard roof,or the uppermost point on a round uppermost point on a round or other arch-type or other arch- e roof roof SUBTRACT half the distance between the highest window and SUBTRACT half the distance between the highest window hi hest roof eak of a itched roof and hi hest roof eak of a itched roof SUBTRACT the distance between the basement floor/crawl ADD the distance between the slab and the highest space floor and the highest existing grade within existin rade within the foundation the foundation or 10 feet,whichever is less. EQUALS Defined buildin hei ht EQUALS Defined buildin hei ht Lot Coverage: SF a/o Shoreland District MCWD Permit Received Avera e Lakeshore Setback Bluff 0 Yes 0 No N/A 0 Yes No 0 Yes �o � Yes �o � N/A ` Permit Number: Setback: Hardcover Zones Existin Pro osed Variance Re uired CUP Re uired 0-75' � Yes o � Yes No 75-250' Type(s): Type(s): 250-500' � 500-1000' REMARKS (in-house): Updated: 09/11/2009 z:\forms�plan review checklist.docx Fees to be Char ed YES NO Permit . ,, . - � ;; _ . Plan Review =State;SurcMarge . �- ` _. . , _ ,, _ Investigation Fee � `SAC '�;�Vumber4of'�AC Units Sewer Connection .:�IIa#er�or�nect�on -,; �. ._ _ .. . , _ . _ _ - Park Fee . ��te�lnspection __ _ _ . . . _ , Other(specify) "�MiscellaneQus:Fees - -- . , _ . . . _ , .. Calculated By: S uare Foota e $ er S uare Foota e Basement X = $ 1�Floor X = $ 2nd FI00� X = $ Garage X • _ $ n Estimated Construction Value: $ 3C�, �� Orono Inspections Required Work Requiring Separate Permits Required State Permits � Site 0 Plumbing 0 Grading/Filling � Well 0 Hardcover Removal � Mechanical 0 Fire Electrical �ooting 0 Septic 0 Water Connection 0 Poured Wall � Fireplace 0 Sewer Connection � Foundation Survey 0 Masonry 0 Lawn Irrigation � Radon Rock Bed 0 Mfg. �raming 0 Other(specify) Insulation � Built Survey Final � Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: � YES � NO New: � YES 0 NO REMARKS(TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) Updated: 09/11/2009 z:\forms�plan review checklist.docx .� o,� CITY of ORONO � � O �� O Municipal Offices _.�'a - � � �� Street Address: Mailing Address: '�+�� '� G,y,�' 2750 Kelley Parkway P.O. Box 66 ,� Orono,MN 55356 Crystal Bay,MN 55323-0066 ��kESHOg' October 26, 2011 Steve Pinewski Pinewski Builders 13750 Crosstown Drive Andover, MN 55304 Re: 2550 Sixth Ave N 1 Building Permit Application#2011-0128� The City is in receipt of your building permit application which was received by this office on October 20, 2011. Your application is incomplete. The following items must be submitted or revised in order for your application to be considered complete and for the plan review to continue: 1. Certificate of Survey. The survey on file is from 2005 and shows the proposed house. Please provide an updated, scaled certificate of survey meeting the City's survey standards (enclosed) indicating the location of the existing house and proposed addition(s) (and any proposed grading) as well as all existing structures, landscaping and retaining walls on the property. If changes in grade are proposed as a result of the addition(s), existing topography and proposed grading must be shown on the survey. 2. Building Plans. The building plans appear to be incomplete or unclear. Please contact Lyle Oman at 952-249-4600 for specific plan detail requirements. 3. Escrow � Escrow Agreement. Building permits involving grading and/or review by the City's engineer require submittal of an escrow and an escrow agreement. The purpose of the escrow is to guarantee reimbursement to the City for out-of-pocket costs incurred during the review of your plans. Additionally this escrow will guarantee conformance with City Code Chapter 79 relating to erosion control and stormwater. If grading is to occur, the required escrow amount for this project is $2,500. If no grading, the required, the escrow amount for this project is $700. Both versions of the escrow agreement are enclosed. The property owner must sign the escrow agreement and submit a check before the permit will be issued. The above information is required in order for the plan review to continue. Please feel free to contact me at 952.249.4620 or by email at cmattsonCa�ci.orono.mn.us if you have any questions. Sincerely, CITY OF ORONO r ristine Mattson Planning Assistant c Edward &Teresa Rice, 2550 Sixth Ave N, Long Lake, MN 55356 Lyle Oman, Building Official enclosures Telephone(952)249-4600 •Fax(952)249-4616 www.ci.orono.mn.us r'" � • �e`� �j dY1�+�' , " �� e�� cT� �,'-� �� . 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Call for the next inspection 24 hours in advance. �95Z� Z49-4600 Owner/Contracto � : Inspector. White Copyllnspector's File Canary Copy/Site Notice � �I CJ�-- ATE TIME CI O 'ORONO CALLED IN � � INSPECTION NOTICE j� SCHEDULED / / � PERMIT NO.��L � —�/�� COMPLETED ADDRESS OWNER TEL ONE NO. -�1b�1�'�� CONTRACTOR� � � "� �: DESCRIPTION � � ❑ FOOTING ❑ PLUMBING FINA ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � � � - I��• -�'�S��-- lZ .�'. - 0 � W � Q � z W � W � � d U��/�ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W RRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWiTHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑ GTATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (J52� 249-4600 Owner/Contractor o site: Inspector. White Copyllnspector's File Canary CopylSite Notice .� � DATE TIME v CITY OF ORONO CALLED IN INSPECTION NOT CE p SCHEDULED ia -9- i� �0%�D PERMIT NO.ao�J-D�2 O � COMPLETED ADDRESS �SSD �.S^�?G�/C �}"�� OWNER TELEPHONE NO. ��Z Z09 Il �� CONTRACTOR �1�� J �; DESCRIPTION ��°s�a'�-�D�/ � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI O SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � � O a � O � W � Q � Z W � W � � d � �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED n ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice ��-/� DATE TIME V CITY OF ORONO p 12� 1 CALLED IN �a �� INSPECTION NO CE SCHEDULED /a-a�-�� .�t7 PERMIT NO.�� COMPLETED ADDRESS �S�S� d'� 't �� OWNER , EL�PJiONE NO.�� °?_��`��r CONTRACTOR ��- �` 1�� T��C. >; DESCRIPTION �!"`'� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y 0 FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE tNSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPL4INT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNEHICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � � O � � �—�✓L ��S (n��n a ( �C��c� ['1v � � �CC�C� -�-�S v t �►'�''ZT/`/ w � Q � z W � W � � � ❑WORK SATISFACTORY:PROCEED L�ROJECT COMPLEiE W ❑CORRECT WORK 8 PROCEED ❑SSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR W4LL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (J52� 249-46�� OwnerlContractor on si : Inspector. � � White Copyllnspector's File Canary CopylSite Notice r ----. ' . : • . . � • . emo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: 12/18/2012 G/L: 101-22205 Re: Building Permit Escrow Refund Building Permit #2011-01281 pertaining to 2550 Sixth Avenue North is complete. All inspections have been finalized. Please refund the $700 escrow currently held to the property owners, Edward 8 Teresa Rice. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Edward 8�Teresa Rice 2550 Sixth Avenue North Long Lake, MN 55356 w:\street files�.sixth avenue\2550�escrow refund memo 2011-01281.doc � BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2011-0128R AGREEMENT made this�day of 0_', by and between the CITY OF ORONO, a Minnesota municipal corporation (" ity') and Edward &Teresa Rice("Owners"). Recitals 1. A building permit application has been filed for an addition(s) located at 2550 Sixth Avenue North the ("Subject Property"), legally described as Lot 4, Block 1, Willow Run, Hennepin County Minnesota 2. Owners request the City to review this application. 3. The City will commence its review of the application and incur costs associated with said review only if the Owner establishes an escrow to ensure reimbursement to the City of its costs. NOW THEREFORE,THE PARTIES AGREE AS FOLLOWS: 1. DEPOSIT OF ESCROW FUNDS. Contemporaneously with the execution of this Escrow Agreement, the Owners shall deposit $7Q0 with the C�ty. All accrued interest, if any, shall be paid to the City to reimburse the City for its cost in administering the escrow account. 2. PURPOSE OF ESCROW. The purpose of the escrow is to guarantee reimbursement to the City for all out-of-pocket costs the City has incurred (including planning, engineering, in excess of $500, or legal consultant review) or will incur in reviewing the plan. Eligible expenses shall be consistent with expenses the Owners would be responsible for under a building permit application. The escrow will also guarantee reimbursement to the City for all out-of-pocket costs the City has incurred to assure that the work is completed in accordance with the Stormwater Pollution Prevention Plan and the provisions of Orono City Code Chapter 79. The financial security may also be used by the City to eliminate any hazardous conditions associated with the work and to repair any damage to public property or infrastructure that is caused by the work (including planning, engineering, or legal consultant review) associated with building permit #2011-0128�' if compliance with the approved building permit is not accomplished. ' 3. MONTHLY BILLING. As the City receives consultant bills for incurred costs, the City will in turn send a bill to the Owners. Owners shall be responsible for payment to the City within 30 days of the Owners' receipt of bill. 4. DISBURSEMENT FROM ESCROW ACCOUNT. In the event that the Owners do not make payment to the City within the timeframe outlined in #3 above, shall issue a Stop Work Order until the Owners pay all expenses invoiced pursuant to #3. The City may draw from the escrow account without further approval of the Owners to reimburse the City for eligible expenses the City has incurred. 5. CLOSING ESCROW. The Balance on deposit in the escrow, if any, shall be returned to the Owners when the review has been completed and written notification is received from the Owners requesting the funds. 6. CERTIFY UNPAID CHARGES. If the project is abandoned by Owners, or if the eligible expenses incurred by the City exceed the amount in escrow, the City shall have the right to certify the unpaid balance to the su ' operty pursuant to Minn. Stat. §§415.01 and 366.012. CITY• N� OWN_E�t: . BY� � - � , �� LJ. lf�f �) .� nF�aef.fi.x" - .... . _ . , . ..�. - . � s��i��.. 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' _.�..._,_..__.�____...__ ! . � � �....___�__.....�'--_.__... . if.l.i'��:'`t`'i .``y.^FC',��? i - 1 CITY OF ORONO PERMIT NO.: 2011-01449 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 11/17/2011 952 249-4600 FAX: 952 249-4616 REPRINTED ON 11/17/2011 ADDRESS : 2550 SIXTH AVE N PIN : 28-118-23-41-0005 LEGAL DESC : WILLOW RUN : LOT 004 BLOCK 001 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: ESCROW TIED TO BUILDING PERMIT#2011-01281-PAID 1 U17/11 CK#1975 BY EDWARD RICE APPLICANT ESCROW FEE-BUILDING 700.00 RICE,EDWARD&TERESA TOTAL 700.00 2550 SIXTH AVE N LONG LAKE,MN 55356- OWNER RICE,EDWARD&TERESA 2550 SIXTH AVE N LONG LAKE,MN 55356- 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 sepazate pertniu. All provisions of laws and ordinances goveming 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 responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / , �n �� 7/� � �� ' Applicant Permitee Signature Date Issued By Si ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � - _, j i -�; � � + � � .� � � � � � �� ; �E o� + � ; � � � � aa a i � '-5 " `-' m `� i r,. 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