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Home My WebLink About2013-01176 - addn/remodel/repair . CITY OF ORONO * 2 0 1 3 - 0 1 1 7 6 * - 2750 KELLEY PARKWAY DATE ISSUED: 12/12/2013 ORONO, MN 55356- (952) 249-4600 FAX: 952 249-4616 ADDRESS : 3185 SIXTH AVE N PIN : 28-118-23-32-0006 LEGAL DESC : UNPLATTED 28 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 53,900.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) ADDITION APPLICANT PERMIT FEE SCHEDULE 711.75 STATE SURCHARGE(VALUATION) 26.95 MJS REPAIR AND REMODELING INC. TOTAL 738J0 2327 LAFAYETTE RD WAYZATA, MN 55391- Payment(s) (952)270-5320 CHECK 1443 738.70 Minnesota State License#: BC626845 OWNER BRANTINGHAM,HENRY&NANCY 3185 SIXTH AVE N � LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued sha(I 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 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 c se �z/z�� /Zi /z-�l� A licant Pe ' e Signatur Date Iss By Signature Date � � � `' ` �' � � u,,2 �Z-�- ( 3 City of Orono C,l�r � _._ �- .�`� �� Building Permit Application � 3 g , -� � � � for New Structures or Additions _---_-� Mailing Address: ^,. PO Box 66 Permit number: ��— � I I 7 �O`v� Crystal Bay, MN 55323-0066 Date received: ( " — �3 Street Address:' Received by: ,s yF ,� 2750 Kelley Parkway Plan review fee: �p2. �� c? Orono, MN 55356 `q'rFSHO�� Main: 952-259-4600 Total Fee: °��'3'0��7J� Fax: 952-249-4616 www.ci.orono.rnn.us �jl;� ,ti:� � �� ut� This application form must be completed in full and all required information must be mitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: '.�t�'S� (�G�'�L'�� c�a� �• : f��-'�� ,M.r� S3 3S� Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes �No If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �35 �EP�ik-- r��'.� ��McyF�u�,lF� ��t.�C.a State License# �jC �;�$y-s Expiration Date: 3 � "� Phone: (cell) C'.�5-� �7c; S 3 z.rJ (office) ,�✓jr1 Mailing Address: L3L7 c��'a�ETT� ,� City: �,/,gy�z,�r,4 ZIP: ��-3��/ Contact Person: MrK� STocX�.�6E� Applicant is: Contractor�/ Homeowner (Circle One) Email and/or�Fa�x: �� P�e. A�D 2E,^^�.�E�,r,�6i�L � C�� , c_o�� PROPERTY OWNER INFORMATION: Name: E:�;�ti �. .4+� ' ,�l�N' " �w� Phone (day): " - �,,r y Address: _3ig� �•7�r ,ea �, � Cit : � ��;�t.�Q ZIP: SS� Email and/or Fax {�g,Q�!-n,��.}q r� /rJ �;r�t« 1 c�y� j �CL•Yl` � ' /' ��. . c�m ARCHITECT/ENGINEER INFORM"� ��, Name: nA-� r � �. Phone (day): . ' � t � � Address: , VW � �` Cit : — i ' ZIP: � � � �� Y L�� ,�� .�s..�� Email andbr Fax: � jJ�� j�� \ . �� PROJECT INFORMA'� �I�;.��"� '�.ti;�` i� �I�S j��N�� r"�r�i�2i3r��Trf� �`',5,,k� 1. Type of Project ture Type 4.Sewage Disposal 8� Water Supply ❑ New Construction nce �ddition /Accessory Bldg. �Public Sewer 'U Accessory Building ❑ Relocation mmercial ❑ Private Sewer ❑ Other: (specify) � ❑ Public Water ""Any earth movement may requi, .,;� (specify) MCWD review& permits. �private Well Minnehaha Creek Watershed District(MC 18202 Minnetonka Blvd Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) � �.3 �� r Packet Last Updated: 04/19/2013 Page 22 of 23 1 . " :� STRUCTURE INFORMATION: 1. Structure Dimension� 1. Structure Dimensions (continued) 2.Type of Construction ��Kl a. Length (ft.)= � Number of bedrooms= �Wood/Frame b. Width (ft.)= _�� Number of garage stalls: �Masonry Areas in spuare feet Attached = ❑ Metal ❑ Pole Bldg. c. Basement= � Detached = ❑ ICF d. 1 S`Story = �W ❑ On-site Prefab @. Z�d StOf)�_ . , � ,� ❑ Off-site Prefab f. '/z Story = ❑ Other(please specify): g. Total Area= �3 2 REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ Permit A lication ,8' � Pro osed Buildin Plans ,0" ❑ Mt�l State Ener Code Calculations and Mechanical Code Re uirements Form ❑ Surve meetin all re uirements ❑ 13 Stormwater Pollution Prevention Plan ❑ Hardcover Calculation s O .0 Se tic S stem Site Evaluation Re ort ❑ E Access Permit ❑ � Wetland Buffer Im rovement Plan ❑ � En ineered Plans for Retainin Walls 4 feet or above ❑ ,� Minnehaha Creek Watershed District Permit s ❑ ❑ Plan Review Fee ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; � Agrees to pay the City of Orono for engineerirag consultant revievv costs in excess of$500; • Certifies that the information supplied is true and correct to the best of hislher 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. ApplicanYs Signature: Date: _3 Owner's Signature: � " �'` Date: � � Packet Last Updated: 04/19/2013 \ Page 23 of 23 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address/Permit Number: � �r � C.� �/ �� (� Description of work: � �� '� "� "' � .., . Septic review by: :�� Date Approved: � '� Zoning review by: Date Approved: �2� "-IJ� Building review by: Date Approved: � (' ' ?�I Grading review by: �� Date Approved: � / Zoning District: '�l` " �� Zoning File#: Reso#: Reso Date: Zoning: Lot Area: —1 � .]� SF/AC Width: Lot Coverage:��:�` .uD��- SF �` % Survey Submitted: �s 0 No Date of Survey: �b'2-�' � � Revised date(?): Pro osed Setbacks: Front�) Rear(Street) ( N S E W�) ( N S E W ) Other Buiidings Wetland Side Si e �p� � � z�.�� pefined Height: �� Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet)= 50% _ #of Stories Ok? � YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: The distance between the lowest FOR A BUILDING ON A SLAB FOUNDATION: START WITH proposed floor(of the basement or crewl space)and the highest point of the roof. START WITH The distance between the top of slab and If you have a... the highest point of the roof. � If you have a... • GABLE OR HIP ED ROOF(no . GABLE OR HIPPED ROOF(no windows): tract half the windows): Subtract half the distance distan lween the highest point between the highest point of the roof of t f to the low point of the to the low point of the corcesponding SUBTRACTION ponding gable or hipped roof SUBTRACTION gable or hipped roof (BASED ON ROOF . GABLE OR HIPPED ROOF(with (BASED ON . GABLE OR HIPPED ROOF(with TYPE) windows): Subtract half the ROOF TYPE) windows): Subtraot half the distance distance between the top of the between the top of the highest highest window and the highest window and the highest point of the � point of the roof . ALL OTHER ROOF TYPES(flat, . ALL OTHER ROOF TYPES(flat, mansard,etc:No subtraction. mansard,etc):No subtraction. ADDITION Add the distance beriveen the top of slab TRACTION Subtract the distance beriveen the (BASED ON and the highest existing grade adjacent to (BASED ON EXISTING �SemenUcrawl apace floor and the EXISTING the foundation. GRADES) highest existing grade adjacent to the GRADES foundation OR 10 feet(whichever is less). EQUALS Deflned bullding height EQUALS DeBned bullding height Shoreland District MCWD Permit Receive Avera e Lakeshore Setback Met? Bluff / � Yes 0 No N/A 0 Yes No p'Yes � No � Yes 0 No N/A i Permit Number: � Setback: Stormwater Quality Existing Proposed Variance Required CUP Required Overla District Tier Hardcover Hardcover 0 Yes �No 0 Yes No � �e�� r �� TYPe�S)� TYPe�S)� Updated: January 2013 �f�j�S 7,jZ�j ��'. v:\forms�plan review checklist 2013.docx REMARKS (in-house): Fees to be Cha ed ' YES - NO ° ' '� � k �'�aaq��',��q � �f P y r�3 ^r ,� t* a au+r`�e� �2�`-.� }s� 2d:` ,�" q�:�' "� `9��":;�a'�'t��,.,�v�,,�'�^'x,�`,^z�'::',l'�� »?�'rusc,.�;2�-�� 5"� t �r .d 1 ��e,�,;�.,. � : Plan Review ,y�� ,�ri � � ��,� � � r �,5,,, ��,� �� ti�`A'`�. ia.'�� '`'S.'?�.�� l�fi.^�� .,. -�`i�� k"�`4,-,��,+ „+�".`�r�.& � Investigation Fee . ,��, �� n �. � �� „ r�, �_ ; , :� , +t'e^�� u,._,�,r.�� ,.!��x.�.�,.s'��il��... ,.r.3`-�ia ��;'ra.f,,+�,��`.:;T �'��` ` �,s Other(specify) S uare Foota e $ er S uare Foota e Basement X = $ 1�`Floor X = $ 2nd Floo� X = $ Garage X = $ Estimated Construction Value: $ S?J,90� Orono Inspections Required Work Requiring Separate Permits Required State Permits � Site Plumbing O Grading/Filling 0 Well G Hardcover Removal Mechanical 0 Fire � Electrical ,� Footing G Septic 0 Water Connection 0 Poured Wall 0 Fireplace � Sewer Connection � Foundation Survey 0 Masonry 0 Lawn Irrigation � Radon Rock Bed 0 Mfg. � ,Fl Framing � Other(specify) �nsulation � As-Built Survey �Final 0 Wetland Buffer O Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: � YES � NO New: G YES G NO OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED Updated: January 2013 v:\forms�plan review chedclist 2013.docx �%� � br � . City of Orono ,,ro:1 J Hardcover Caiculation Worksheet �,�1 + Property Address: �/B 5 T/X T/� �!LE. �/. �BR��T/�r/G/,J�/y1 � =� `S�^�� Prepared by: ��;BF�F� .� AJ"1'oCl�t'rcI , r.�.�c. Date: l � 3 , v- 9-r St��;m�,�ater Quality Overlay District Tier: (Circle one) Tier 1 Tier Tier 3 Tier 4 Tier 5 Step 1: EXISTiNG HARDCOVER In tlie following table identify all items af existing hardcover on the property, keyed by fetter to Certificate of S��ivey(survey must accompany this form). Use as many lines as necessaiy to accurately depict existing hardcover status of the preperty. For Tier 1 properties, identify any features by letter which are split a:the 75' setback line and caiculate hardcover square footage separately for each portion. Key to Hardcover item (Describe) � Length x Width g tuare Feet Survey t � '�:a-:�a ' `Gzraoe � 24'x 30' 720 S F. A /�o .T /S2 5 S.F. 6 G 6 / S.F. �.r r,e� ,� o�e�v 3 .5 S.F. D j c' ,� E' 1'r 6 S.F. E D�cK �wFST� I __ ' o S.F. F � �� c 2 0 o S.F. G � ��f F.p .t�/ .3 /� S.F. H Ft,ac r a �a� �v Cxc Z S.F. I ; i � S.F. J !�. S / S.F. K ; �� r 7 .S x �'nr' ,rJ } i`0 S.F. : � ' L ii � 7, s �c �o r �` S.F. ; P�� ' R �t/ S.F. ' N �GiVC/� C�T - C/t-T '.t N CE I S.F. ; ' O i : . iz E GtJ c S.F. ' P j R� C Bo.P�J r / S.F. � ; i, .. S.F. R � i� Bo�'v F� � S.F. g 3 ., ., / o S.F. ' T ; .CE�K o.��E' ' S S.F. U T.:�� S.F. ; U � „ ,,.: � S.F. W G��'G' Bo�tar� S.F. ' X 7 �� ♦m E S.F. Y , .��t.r1E ,�4aK� � f A��' S.F. Z S.F. � i 1)_Totai Existin�Hardcover S.F. ,._,._ - - -- - — Excludable Hardcover See Cit Code Sec 78-1684 : � , S.F. � _ , _._.�_ .�__..._. . _ __ _.._ _.r.___^____�.__.___...__ ------ ._.�____� , �.__ ---_�___�_._._�_____. �.____.___�._ ^_� _.__... .._ _..__...__.�. � S.F. - I------ __.-�--_..,_..—__-�---- ---. _._.�.___ , S.r. i , , , � _._— .�__ �.__._._ ____-_-, �___ ___ ,------------- _-------- � T_._._._ S.F. j j_ ._.__._.__------_-- - — _—_ �..�— � i2j Totai Excludable Hardcover !�� D S.F. '�, �_(3) Net Existing Hardcover Subtract line{2)from line(1)] ��S�? S.F. '� f_{4� Total_LotArea CFxc<<..d,n.:G co. Ra. � �.ci✓r Q� v��'s) �i 3ZZ S.F. �� L Existing Hardcaver Percentage [(3)+(4) ] 9, p G % I� � (Praposed Hardcover next pa�e) lanuary b;Z013 �I�� Z��- = �l� - � r , City of Orono � �o-�o Hardcover Calculation Worksheet '� ,� �^ ; ' Property Address: �/��r ,T'/X Tf/ iy t/E. /C/ ��/I,�,vT�.vG N�J�t � _ - Prepared by; G��E��. � AJ�,�U C/A TESd �,��, Date: ��_l9_i3 Stormwater Quality Overiay District Tier: (Circle one) Tier 1 ier Tier 3 Tier 4 Tier 5 Step 2: PROPOSED HARDCOVER in the following table, identify ali items of proposed hardcover on the property, keyed by letter to Certificate of Survey (survey must accompany this form). Include all existing hardcover items that are intended to remain, as wel!as all proposed hardcover items that will be added. Use as many IineS as necessary to accurately depict proposed hardcover status of the property. For Tier 1 properties, identify any features by letter which are split at the 75' setback line and calculate hardcover square footage se aratei for each ortion. Ke to Surve Hardcover Item (Describe) Length x Width Total S uare Feet i�xam le Gara e 24'x 30' 720 S.F. A S.F. B S.F. � S.F. i D S.F. E S.F. F S.F. G S.F. H S.F. � S.F. i � S.F. K S.F. � S.F. M S.F. N S.F. I O S.F. P S.F. Q S.F. R S.F. S S.F. T S.F. � S.F. U S.F. W S.F. X S.F. Y S.F. Z /�/IG G!' iT! ,�6� S.F. 1 Total Pro osed Hardcover 70,5 �,�c.�1'T',�'is/�' f ,Z 66' I P,aE''C�l'FO �.�2, S.F. � Excludable Hardcover See Cit Code Sec 78-1684 : S.F. S.F. S.F. S.F. S.F. 2 Total Excludable Hardcover � S.F. 3 Net Pro osed Hardcover Subtract line 2 from line 1 � S.F. 4 Total Lot Area C F f R i -a - S.F. Proposed Hardcover Percentage [(3}-!�(4)] l p, 2 7 % January 8,2013 ' Cfiristine Mattson From: Brett Eidem [BEidem@minnehahacreek.org] Sent: Monday, December 02, 2013 11:46 AM To: Henry Brantingham Cc: Jesse Struve; Nancy Brantingham; Christine Mattson Subject: RE: survey Henry, After our discussion and reviewing your plan, it does not appear that your project will trigger any district rules: therefore,you will not need a MCWD permit.The disturbance size is well under 5,000 sq ft, and with the excavated soil being used on site and confirmed to be less than 50 cubic yards,there will not be a district permit required.Also,the proposed silt fence for perimeter control looks to be sufficient for the project. If you have any other questions,feel free to give me a call. Thanks, Brett Eidem District Representative Minnehaha Creek Watershed District 15320 Minnetonka Boulevard Minnetonka, MN 55435 Direct: (952) 641-4517 Main Office: (952)471-0590 Fax: 952-471-0682 www.minnehahacreek.or� �, � �� MINN�N�ANA CREEK wwrEa�FsEl7 Dtsta��T New office address July 1: 15320 Minnetonka Blvd., Minnetonka, MN 55345 From: Henry Brantingham [mailto:hbrantingham@gmail.com] Sent: Wednesday, November 27, 2013 1:31 PM To: Brett Eidem Cc: )esse Struve (Orono); Nancy Brantingham; Mike Stockinger Subject: Fwd: survey Hi, Brett: i , Minnesote Department of Labor and Industry Licensing and Certification Services " • Construction Codes and Licensing Division Phone: 651.284.5034 443 Latayette Road N Email: DLI.License@state.mn.us Saint Paui,MN 55155 Website: www.dli.mn.gov/ccld.asp NOTICES NOT TRANSFERABLE MJS REPAIR AND REMODELING INC CHANGE YOUR BU3INESS STRUCTURE 2327 LAFAYETTE RD SUBMIT A NEW APPLICATION FOR NEW ENTITI( WAYZATA, MN 55391 RENEW OR REPLACE INSURANCE POLICY SUBMIT NEW CERTIFICATE OF INSURANCE NOTIFY THE DEPARTMENT OF A CHANGE IN YOUR BUSINESS. Failure to do so,subjects you to administrative penaities of up to$10,000. 15-Day Notice Requirement—Forms available online at www.dli.mn.t�ov/CCLD/LicUadate.asa • Change in business'physical address,mailing address,phone number,or email address • Change in control,owners,officers,directors,members,partners • Change in business'legal name and/or assumed name • Loss of or change in QUALIFYING BUILDER • Change in general liability insurance o�workers'compensation insurance coverage Immediate Noiice Requirement—Notification to DLI in writing • Judgment Debtor. A licensed contractor has 15 days to provide written notice of the finding that it is found to be a judgment debtor based upon conduct requiring licensure. • Bankruntcv Petition Filed. A licensed contractor has 15 days to provide written not�ce that it filed a petition for bankruptcy. • Conviction Notice. A licensed contractor has 10 days to provide written notice that it has been found guilty of a fefony,gross misdemeanor, misdemeanor or any comparable offense related to the license, including convictions of fraud, misrepresentation,misuse of funds,theft, criminal sexual conduct,assault, burglary,conversion of funds, or theft of proceeds in this or any other state or any other United States jurisdiction. YOUR CERTIFICATE IS BELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS. ' MINNE80TADEPARTi.1ENTOR RESIDENTIAL BLDG CONTRACTOR � LABOR 8e INDUSTRY Construc8on Codes and Licertsiny Division Licensing and Certification Services 443 Lafayette Road N St.Paul,MN 55155 Webske: www.dli.mn.aov/ccld.asp Email: dli.licenseC�state.mn.us Phone: 651284.5034 This is to certify that the certificate holder is Gcensed as a RESIDENTIAL BUILDING CONTRACTOR in the state of Minnesota and is in compliance with Minnesota Statutes 326B.805,and may build residential real estate,contract or offer to contract with an owner to build residen6al real estate,and contract or offer to contract with an owner to improve existing residential real estate;provided the responsible individual is at all rimes a QUALIFYING BUILDER and the certificate holder maintains compliance with the required general liability insurance,and workers'compensation laws. License : RESIDENTIAL BLDG CONTRACTOR Lic Number : BC626845 MJS REPAIR AND REMODELING INC Effective Date : 04/19/2013 2327 LAFAYETTE RD Expiration Date : 03/31/2015 WAYZATA, MN 55391 VERIFY UP-TO-DATE STATUS,BOND,AND INSURANCE INFO AT www.dli.mn.�ov/ccld/LicVerifv.aso (ENTER NUMBER). � , ,- j. � ' � � City of Orono �:o,vo Hardcover Calculation Worksheet .��, Property Address: ,;'�A . �/8S T/X T/� ilL¢'. N �BR.��✓T/it/G/,/�M,L _ Prepared by: C�o�B F�G 1 A1'1'o Cl.�rFl,,i�vc. Date: l0-Z 9-�3 StGrmwater Quality Overlay District Tier: (Circle one) Tier 1 er Tier 3 Tisr 4 Tier 5 Step 1: EXISTING HARDC�VER In the following table identify all iterns af existing hardcove�� on the property,keyed by letter to Ceitificate of SUivey(survey must accampany this form). Use as many lines as necessary to accurately depict existing hardcover status of the properry. For Tier 1 prc�erties, identify any features by letter which are split ai the 75' setback line and calculate hardcover square footage separately for each portion. Key to Hardcover Item (Describe) Length x Width Total Survey S uare Feet ' F�a-�.o'a; ' Gara e 24'x 30' 720 S.F. A /�o .1' /SZ 5 S.F. B G S.F. C e�r,e� o,e�v S.F. D c F' fr S.F. E � T _. p S.F. F a c 2 0 o S.F. G �.� E-,�C c.� 3 �� S.F. H � Ft r o �a9 ry c,� Z S.F. I � i S.F. J /�. S ! S.F. K I i• i� .S x ��' ,D S.F. L I �i �• s x Fo r S.F. � M � ,e S.F. ; N ��vc,e Fr - E'�-r .v �E S.F. O � S.F. P 1 �ei�C Bv�ev - S.F. Q i. .. S.F. R ' �� ePv�v F S.F. g .� .� /o S.F. T itK .��F S.F. U � S.F. U .., � I S.F. W , Gt� D o S.F. � X �r ri S.F. ! Y �r�cdE �oKQ • �' S.F. ' Z S.F. f_�1�__Total Existing Hardcover S.F. � Excludable Hardcover See Ci Code Sec 78 1884 : _ ; S.F. _�___.. .___ _--- - -_____ � �.________.______�. _ .___..__. _ _._.._._—_...._____�_____. __ S.F. - �.__._.�___ _ S.F. -- - _ -- __.__ _.___._. __...�.__._._}_ �...._ , S.F. � ___--fi--.__________.___� .._. ..._____ � �._...Y....�._.._.._._. _..__.._ _ _------ -�-- - ----------�-- S.F. 2�Total Excludable Hardcover �� D S.F. {3} Net Exish'ng Hardcover Subtract line(2 from line 1) ?'e►S9 S.F. (4� Total LotArea __ CFxc�uo,�.,F co, Ro, �' .r�Gi r �u�Ay) �� 32� S.F. Existing Hardcover Percentage [(3)+(4) ] 9, 9 a % + (Proposed Hardcover next page) �anuary 8,ZDi3 � � , - i , . � • , City of Orono �o�vo Hardcover Calculation Worksheet i _ y _ ' Property Address; �i8� �-.�xT / `',` � f i9 l�E._.�C/ �.f�R,��vTi.vG�lA�t � ""`� Prepared by: Date: .,:.��` GRr/�r/,c9E/QC � A,J'fp C/A TES�, /�t/�', �p�l q.,�3 Stormwater Quality Overlay District Tier: (Circie one) Tier 1 ier Tier 3 Tier 4 Tier 5 Step 2: PROPOSED HARDCOVER in the following tabte, identify all items of proposed hardcover on the property, keyed by letter to Certificate of Sunrey(survey must accompany this form). Include ali existing hardcover items that are intended to remain, as well as ali proposed hardcover items that wiil be added. Use as many IineS as necessary to accurately depict propased hardcover status of the property. For Tier 1 properties, identify any features by letter which are split at the 75' setback line and calculate hardcover square footage se aratei for each ortion. Key to Hardcover Item (Describe) Length x Width Totai Surve S uare Feet Exam le Gara e 24'x 30' 720 S.F. A S.F. B S.F. � S.F. � S.F. E S.F. F S.F. G S.F. H S.F. � S.F. � S.F. K S.F. � S.F. M S.F. � S.F. 0 S.F. P S.F. Q S.F, R S.F. S S.F. T S.F. � S.F. V S.F. W S.F. X S.F. Y S.F. Z Rd G T 26 S.F. 1 Total Pro osed Hardcover 70,5 �c�J'T/ f 6 4 G'PF 32 S.F. Excludable Hardcover See Cit Code Sec 78-1684 : S.F. S.F. S.F. S.F. S.F. 2 Total Excludabie Hardcover S.F. 3 Net Pro osed Hardcover Subtract line 2 from line 1 7 S.F. 4 Total Lot Area C F R � -Q - S.F. Proposed Hardcover Percentage [(3)+(4)] l p, 27 % January 8,2013 DATA PRIVACY ADVISORY In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen warning", 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 Minnesota State Statute 13.04 (see following page) to review private data on yourself. 6. Your full name is required to process this application or permit. r��- ��t� �TzY�cr�� First Middle Last �3�� r� �� Address (��?_�'T14- M� ��q ( 9'S-��7� <S3o�c7 City State Zip Phone I understand my rights as stated e. Sign re Packet Last Updated: 04/19/2013 Page 20 of 23 . . . . � ��o C ITY OF ORONO � � Street Address: Mailing Address: Telephone(952)249-4600 'S�, � 2750 Kelley Parkway P.O.Box 66 Fax (952)249-4616 !,q t�,G Orono,MN 55356 Crystal Bay,MN 55323 www.ci.orono.mn.us kESH04� November 21,2013 Henry&Nancy Brantingham 3185 Sixth Avenue N Long Lake, MN 55356 Re: Building Permit Application#2013-01176 On November 4, 2013 the City received a building permit application for an addition to the principal structure. Your application is incomplete. The fnllowing 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.One copy of a survey was submitted but it was missing topography. Please provide two copies of an updated, full size certificate of survey which meets all of the City's survey standards (enclosed) specifically indicating the existing and proposed grading. A copy of the engineers comments are attached. 2. Escrow & Escrow Agreement. 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 witli City Code Chapter 79 relating to erosion control and stormwater. The required escrow amount for this project is $2,500. The escrow agreement is enclosed. The property owner must sign the escrow agreement and submit a check for$2,500. Your project may trigger the Minnehaha Creek Watershed District's(MCWD) permitting requirements; please contact the MCWD regarding your project. Please note, the City of Orono will not issue a building permit without a copy of MCWD permits or documentation from the MCWD stating the proposed project does not trigger any of their permitting requirements. 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 cmattson@ci.orono.mn.us if you have any questions on the above requirements. Sincerely, � �� CITY OF ORONO Christine Mattson Planning Assistant c Henry&Nancy Brantingham via email Mark Gronberg,via email Lyle Oman, Building Official enclosures �� . �' �� Minnesota State Energy Code Calculations and Mechanical Code Requirements Form Additional copies can be found by going to: http.//www.dli.mn.gov/CCLD/PDF/sbc 1322 cert.pdf V�1101.8 tertifica�r �� c .,� �� _ / e�.aa�:�.��.�c��- oa�e: �( �S�!3 �rte Aaa�ess: �t�� iv Cor�tracto r Piamc: �� i/Z "�- ��E.0 o�� Jlf C Li�cc nsc N umber. �{S t�:�c:wr ry�,r�+ �r+�r r� Lw..rlicnr s� Inse�/.�tiivvs R Y�krc e �r Root �1 '' u:.Ji.o; 4 � - l.anbusOon nar Wai � � - Waler N�eaU�� Stab-vn-�s�ad� ��TI�ICm ��S�bti� oor IMIAS yb�hi�flP l'►f(1fIMktNfliPf� tt�m�oist 7- -3' �nw, oi or LpCi�lrivalr /'?�' �OUt�7tIW1 MF�l -d��l.� C: -ICJ .f�M ^r �'' II /J-lviV h71' �1i!!.l i/�ii�IIW�?t M MPI`�KMA/l� F+�7t'6fY� AP►1MM* �t��C}�Xd�.IANI � t� I�dt�Ml Clll� T I R� ' rlFUE ctu�v�,r C w Meat Lasx� wPan ti �,�J �:K ;;G T R.� ' SEFR Pktnrrf�rctrrvrw I'Moti.�f Coo� Lo�ad Mcvt Garrr rv Q � Cl.j T Locati�oarr ��ix�ro�s To!' Vcn�+i Med�a�ical Verrbiiation RECEIVED Packet Last Llpdated: 04/19/2013 1r r, n Page19of23 N�Y U� Zu73 CITY OF ORONO �" � DATE TIME Y CITY OF ORONO CALLED IN /c��-3 �_ INSPECTION N TICE SCHEDULED PERMIT NO l�7 COMPLET�ED � AD�RESS ` � OWNER �n � TELE,RHONE NO.l�✓��d�✓��Y CONTRACTOR��"� . �; DESCRIPTION � � �FOOTING ❑ PLUMBING FI L ❑ EXCAV/GRADING/FIWNG Q ❑ POURED WALL ❑ MECHANIC RI ❑ LAKESHORE/WETLANDS Q ❑ FRAMING ❑ MECHANI L FIN ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOpD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPUUNT � O DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL O SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI � SEPTIC FINAL ❑ FOUNDA710N/REMOVAL � ONfNERICONTiUCTOR TO MEET YOU:�YES_NO c� COMMENTS: W � _ -- Jc��s - oK j �- �p�'wt.J � l�l�l.t� .l�r d�GH _' O � � .S�o�L � c /��. � o — t'e,�, aQo�e..l�Q /rl�a �Xi.S'7�.�s �7�s � � . � Q " I'yj� r"��'*�n� C�C4vt�e�� S 7'6� /`��•�' '7� 2 Q i o 4�te�'—" . W — �/�D'T�C� Co.1C/�� F– 9rOk� �Mwl f✓M2.�1c °� Q/� �— .��4✓ Er��~S j 0 W� ❑WORKSATISFACTORY:PROCEED ❑PROJECT COMPLEfE w �ORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. ❑pHOTOTAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance.�95� 249-4600 OwnerlCoMractor on site:_, �C.� GJ �J �� Inspector.��'^^� White Copyllnspector's Flle Canary CopylSke Notke � � TIME V CITY OF OR N' CALLED IN � v'� � INSPECTION OTICE SCHEDULED - - � d- ' O PERMIT NO.� '� � �COMPLETED ADDRESS �g OWNER TEL�EPHONE O. O'Sc3�O CONTRACTOR S � �, � � DESCRIPTION —�l�1'� Dl�l � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FIWNG Q ❑ POURED WALL � MECHANICAL RI ❑ LAKESHORFJWETLANDS y �FRAMING ❑ MECHANICAL FINAL � ❑ TREE REMOVAL Z ❑ INSULATION . ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB O WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ Cp►�p�q�ry� � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTiC FINAL ❑ FOUNbA710N/REMOVAL 2 OWNERICONTRACTOR TO MEET Y�OU:_YE t NO � COMMEN�� f�4�� .S�sp,�or f �o4�i/� � .� L On w�rt c.t? � � � o Blec,E -i ►'��/ S/�c�'.r�� :.�/,� o.t �..lo.r� �.t�0 � !'�f.e:�-1?.li� ��i�cw�s ��d�rb�.f J- /ta�l C�1 � yO.�. � 1' � ! . . � � r i�K � L Q � IG �@+ � �' 2 1��i .ow�. d �i� .lc (a��t 6� W � = �1��I_-_oK � a � O WORK SATISFACTORIh PROCEED ❑PROJECT COMPLETE W ❑CORRECT VYORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O�CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V EFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. C ' sPection 2a qours in advance. (952) 249-4600 ctor on site: A Inspector: � VYhite Cop nspecMr's File Canary CopylSfte Notiee 3 TE TIME V CITY OF OR N CALLED IN r`� INSPECTION NOTICE SCHEDULED ?-// �� PERMR N P��eo ADDRESS � OWNER TELEPF,�ONE NO. a�TO Sj CONTRACTOR � � DESCRIPTION C � ❑ FOOTI ❑ PLUMBING FINAL ❑ EXCAV/G ING/FILLING � ❑ P RED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS Q FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ pqpC,qE� � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � � DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INST�4LL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERlCONTtiAf„TOR TO MEET YiOU:_YES_NO y COMMENTS: � a j 0 � � W � W � � J d W 4YORKSATISFACTORIF.PROCEED �PROJECT COMPLEfE ❑CORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT YYORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED O STOP ORDEH POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 rs in advance. 2) 249-46�� OwnerlContractor on site• Inspector: White CopyAnspector's File Canary CopylSite Notiee DATE TIME ✓ CITY OF ORONO CALLED IN — -� INSPECTION OT CE SCHEDULED —� --�'� PERMIT NO. � '� �7�OMPLEfE � A��RESS � �l /Y��-� � /j/�-e OWNER TELEPHONE NO. S�^��'�of� CONTRACTOR � DESCRIPTION �� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS y FRAMING ❑ MECHANICAL FINAL � ❑ TREE REMOVAL SULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q,•'*❑ RA ON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI � SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERiCONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: � � ��__� ,� , � ----, � i;,-' I o �-l� � �� , ,� � �="" ,T,;' -, , � ', 1 O 'L___ , -_ .----�, �-��-�7�i�—� J� ? T--- i: �i W � � Q � �- -S , 2 W � W � � � d W�1lYORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W��RECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED_CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hpurs in advance. (g52) I49-46�� OwnerlContractor on site: P � � � ;' L- � Inspector. � '`� ��. � . ; White Copyllnspector's File Canary CopylSite Notice � A E TIME � CITY OF ORONO cnLLED IN - INSPECTION NO�I `A/��SCHEDULED ' `' �� eD PERMIT NO. U �� COMPLETED ADDRESS 31�5 os�-'� �'4'� OWNER TELEPHON NO.��Z Z7� S3Zv CONTRACTOR _ � �n � DESCRIPTION �� ❑ FOOTING ❑ PLUMBING FI O EXCAV/GRADING/FILLING Q ❑ POURED WALL O MECHANICAL RI ❑ LAKESHORE/WEfLANDS y �FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB O WATER HOOK-UP ❑ PROGRESS � ❑ FINAL � SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YiOU:_YES_NO � COMMENTS: ��.. �•�'b�� , . � F��w►,K s f�r l�l�r.� r.�� .� � I.�- L• �titti�oo.K � 0 � -� w� Kec c.� !s f��`.c 9� O � �,�4�!/ � vi� W � Q � t�. �'4�. - „��.�1,P� 1K�wl• - a K � � QlL `� �o r..r�- J � �1110RK SATISFACTORY:PROCEED ❑PRW ECT COMPLETE � ❑CORRECT VYORK 3 PFiOCEED ❑ISSUE CERTiFICATE OF OCCUPANCY O ❑(�RRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail br next inspection 24 hours in adv�. (952) 249-460� on site: o � Inspector: �'v White CopYllnaPecto�'s File Canary CopYlSfte Notfee J ��p�,TE / TIME CITY OF ORONO CALLED IN �- � INSPECTION OTICE SCHEDULED � � � PERMIT NO. �� OMPLETED ADDRESS ��QS � OWNER TELEPHbNE NO� ' 7�rS CONTRACTOR S � DESCRIPTION v�' ` � ❑ FOOTiNG ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS h ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z '�FNSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q��❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP p COMPUUNT v ❑ DEMO-SITE ❑ SEPTIC MAINT. O FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YiOU:_YES_NO v�i COMMENTS: � �12�iLt�- '� S,O✓Qti �lS�et,� D'� ex.Ze'rw.' o .J a!!- D,..� �. � o �.� � , � � �Q �{-- i,,,� � . �" Sfi•�cap G4v G� �l�i a e 2 � C 6 r F cc.¢ —� 8��'— C°6 v� r. o� j W ❑WORKSATISFACTORY:PROCEED ❑PROJECT COMPLETE � CORR W'ORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOMERING PERMANENT • ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pH0T0 TAKEN INSPECTOR W{lL RETIJRN ❑STOP ORDER POSTED.CAIL INSPECTOR O CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. t inspection 2a hours in advance. (952) 249-4600 ctor on ' � Inspector: �- White Copyllnspector's File Canary CopyfSite Notke 1 a � � � I�� TIME CITY OF ORONO CALLED IN � INSPECTION TICE SCHEDULED p PERMIT NO. U �' OMPL ED ADDRESS j�, I�S �°jL�� OWNER TELEPHONE NO. " 0' CONTRACTOR ��(' Mr 6 � DESCRIPTION �1 �� X �Y1-�,� 0 � W ❑ FOOTtNG ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � O POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS H Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INS ATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ DON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEEf YOU:_YES_NO � COMMENTS: � W a � J O �. � O � W �'' � , Q � 2 W � W � J GW ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVEHING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN � INSPECTORWFLLREfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. 9 � -46�� OwnerlContractor on site: Inspector. White Copyllnspector's Ffle Canary CopylSfte Notice , i . • , • . • • � • , emo To: Finance Department From: Christine Mattson, Planning Assistant��(�(� f� . CC: Street File Date: March 31, 2015 G/L: 101-22205 Re: Escrow Refund Building Permit#2013-01176 pertaining to 3185 Sixth Avenue N is complete. Please refund $2,500 to the property owner, Henry 8�Nancy Brantingham. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Henry& Nancy Brantingham 3185 Sixth Avenue N Long Lake, MN 55356 w:�street files�sixth avenue�3185�escrow refund 2013-01176.doc�c , i BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2013-01176 AGREEMENT made this �2 day of vV , 2�, by and befinreen the CITY OF ORONO, a Minnesota municipal corporation ("City") Henry&Nancy Brantingham ("Owners"). Recitals 1. A building permit application has been filed for an addition to the principal structure located at 3185 Sixth Avenue North the ("Subject Property"), legally described as that part of the West 371.31 feet of the Northwest Quarter of the Southwest Quarter of Section 28, Township 118 North, Range 23 West of the Principal Meridian lying south of the centerline of Hennepin County State Aid Highway Number 6, Plat 5, per pocument Number 3844152. 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$2,500 with the City. 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 #2013-01176 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 Owne�s. 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 subject property pursuant to Minn. Stat. §§415.01 and 366.012. CITY�CITY OF ORONO O I�ER: gy. `� i Its: lJ _ �: . ._.. . . ._ f �._ . w �_ ��'�,��;� _.. . , s¢ <,..: � N.,: _ _ , � i � � r`i i 'vT �tY+[ j �r��l �"��l��y �xKkk3� i Q1`Of!G 1� .�C.��u �^_�u�_:iE*�1i� i �'L�i`�1N� ��r:�� .�.i1Glc`� ��'', ; w+rl.' � ��'�i'G` �7'a1'i�i.i'i�i"taa: �!"P.`13L•:+ �31c:CS�`!: ,��t1 I� �`CYF1S1.tS ' . ' �CJL'i'Y�J ' � ^�y��}t�4!y? 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' ' ' CITY OF ORONO * Z 0 1 3 - 0 1 2 3 8 * 2750 KELLEY PARKWAY DATE ISSUED: 11/2?✓2013 ORONO,MN 55356- (952) 249-4600 FAX: (952)249-4616 ADDRESS : 3185 SIXTH AVE N PIN : 28-118-23-32-0006 LEGAL DESC : UNPLATTED 28 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: THIS$2500 ESCROW IS TIED TO BUILDING PERMIT#2013-01176 APPLICANT ESCROW FEE-BUILDING 2,500.00 BRANTINGHAM,HENRY&NANCY ESCROW FEE-EROSION CONTROL 0.00 3185 SIXTH AVE N LONG LAKE,MN 55356- ESCROW FEE-GRADING 0.00 TOTAL 2,500.00 OWNER BRANTINGHAM,HENRY&NANCY 3185 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 separate permits. All provisions of Iaws 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 aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. - A k,.� �"o"�"'v`W,F' ."��z,.'�: `'��.*:- "-. .:. _.'s'.�.s'��, "�� - ,d .�-�. . �._._,�,,,, �= ... s q'�".. i dA A:i ._. . . ., .. , _. ..... " ' „�.; , ,. . . . � . " .....:.. .��' .�..". '� �.. � I� � ► ►I J� � �� 0liN - ' � � PlmYt#: �13-01176 L3p�ate Acfc�t�ss C fWalr t��hl AC�dr85s � PrmYtAddnss: 3785ShdhAveN C' Additi�a�al PIN��e€ress (Additwn} ` Parcel iss� C Pamtit Issus � i ��i�F� ��t�1�no��e��ei��co o�f�� Seq Inspectian Type. Ir�pecfor_D�e Status H Fee Rec �„1 Foot� :METJ ;12/18/2U13;P Y�Q � ; ► ;�: + 3 Fra REINSPECTION . _ Y 0 ' ; �_ _ . � _ 1 � , .�4 Ittsti{at�n METJ 8/18/2U14 P Y 0 �! 5 Ftnai �METD _.F1117/2014 P Y jq , , � I � _� ►� x Add lf�w Delete