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2012-01026 - new structure
CITY OF ORONO * 2012 0102 $ * 2750 KELLEY PARKWAY DATE ISSUED: 11/06/2012 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS 2645 WATERTOWN RD PIN 04-117-23-12-0008 LEGAL DESC OLD CRYSTAL BAY ROAD ADDN LOT 001 BLOCK 001 PERMIT TYPE NEW STRUCTURE PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE SINGLE FAMILY ACTIVITY 101-SINGLE FAMILY HOUSES,DETACHED VALUATION $ 857,000.00 NOTE: SEPERATE PERMITS REQUIRED:PLUMBING, MECHANICAL,SEPTIC,FIREPLACE, FIRE, LAWN IRRIGATION,OTHER WELL(STATE),ELECTRICAL(STATE) *WINTER WETLAND DETER DONE. $3000 ESCROW REQUIRED&HELD FOR SPRING DELINEATI N. NOTE: AS BUILT SURVEY REQUIRED PRIOR TO CERTIFICATE OF OCCUPANCY ISSUANCE. INITIAL: NOTE: BE AWARE,IN THE EVENT 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. INITIAL: 6.2 APPLICANT PERMIT FEE SCHEDULE 5,069.50 GORDON JAMES CONSTRUCTION STATE SURCHARGE(VALUATION) 428.50 5159 MAIN STREET E P.O.BOX 306 TOTAL 5,498.00 MAPLE PLAIN,MN 55359- (763)479-3117 Minnesota State License#:20531961 OWNER VANOVERBEKE,PETER&AMANDA 2645 WATERTOWN RD 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 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 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. // / (P / lZ Xpplicant Permitee Signature Date Issued By Sig ure Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED B V . 440 ATT-AC R E D o2 SET5 T (DF 5EPTTC IDESI6ti 4- City of Orono SET OF P60L T�vfo . Building Permit Application for New Structures or Additions 5 a �0 — �0 MaihPO Boxr66 Permit number: � (� Crystal Bay, MN 55323-0066 Date received: a (t Received by: a Street Address:' ��, Gtiti 2750 Kelley Parkwayply CJ �� Oi�LGj Orono, MN 55356 r d CIG 1J /U l Ian review fee: kESHOg' Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.usyxt1w rew d to . q-1L 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: 96 q5 X 4T ERTOeA)y h014 D Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. M l4v BE CONTRACTOR/APPLICANT INFORMATION: Name: trRI 6V -Q+fi1E S 6cr1V5—t ZUC'T-TC-t,-' State License# E G 531 cr(0I Expiration Date: 3 -3) a0/3 Phone: (rtLo3 q7q-311 7 (office) (G 1a) 36cr_- 3 7 3 G (cell) Mailing Address: P0 _ UX 30 to City: J`' t e_ to_rn!ZIP: SS Contact Person: �O-E M C 1:::,41:--210-,/ Applicant is: ontrac or Homeowner (Circle One) Email and/or Fax: Q©r`C) 'a m c s. PROPERTY OWNER INFORMATION: Name: PETE + 4vvit>,q t)4-,V 0UER l3EKG Phone(day): 6z,( - -155 a Address: City: ZIP: Email and/or Fax amahac+ . ✓►�, �sano�t� kc 0. CC�n,4ltire , ccs-, ARCHITECT/ENGINEER INFORMATION: Name: p. F. P. 4- Phone(day): 67103 7F0- SDO y Address: 9t 00 NA-L7-17,*0RE s'r, V.- - ;' Joe, City: BL,4xw E ZIP: YLLA q Email and/or Fax: d Ss cl es PROJECT INFORMATION: 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ONew Construction Single Family with Residence ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑Relocation detached garage ❑Office/Commercial RPrivate 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) ❑Other:(specify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacMtk.org Estimated Construction Valuation (excluding land) Packet Last Updated: 03-06-2012 — �� Q Q. 0 0 P DO 1— S -v//z -21 - d0' i S57 , poo, "o newh� pv� J013 -oloZb STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= /15- , Number of bedrooms= ,APP x• Wood/Frame b.Width(ft.)= Number of garage stalls: ElMasonry Areas in square feet Attached= 4 ❑Metal c. Basement= !rDetached G = ElPole Bldg. d. 15t Story = S4 ❑ ICF ❑ On-site Prefab e.2nd Story= ❑ Off-site Prefab f. Y2 Story = ❑ Other(please specify): g.Total Area= 5 239 REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable IlEr, ❑ Permit Application ❑ Proposed Building Plans ET5 ❑ MN State Energy Code Calculations and Mechanical Qode Requirements Form ❑ Survey(meeting all requirements) T 5 ❑ JR� Stormwater Pollution Prevention Plan igr Hardcover Calculation(s) 19.' ❑ Septic System Site Evaluation Report a 5 E r-6 ❑ Access Permit ❑ Wetland Buffer Improvement Plan ❑ Engineered Plans for Retaining Walls 4 feet or above ❑ Plan Review Fee ❑ Other: V60 L Z/L) =0 ( :5r-r-) APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a$10,000 escrow to ensure completion of the as-built survey and all site improvements. Applicant's Signature: Date: Owner's Signature: Date: Packet Last Updated: 03-06-2012 -22- Plan Review Checklist for New Structures / Additions Address/ PID/Legal: ��'� Description of work: 77 Septic review by: Date Approved: Zoning review by: Date Approved: Building review by: Date Approved: t 0 ZS - e) Grading review by: 'fv Date Approved: Zoning File#: Resolution#: Resolution Date: Zoning District Fire Department Post Office School District Zoning: Lot Area: �� 2 SF/AC Width: X15' Depth: la.� Survey Submitted: Yes 0 No Date of Survey: 10 10 .1z' Proposed Setbacks: Front(L/-*e") Rear(S/t) ( N S o) W ) ( N S E ) Other Buildings Wetland Si Side v t l IS 1 Building Defined Height: Building Peak Height: #of Stories Ok?VYE FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/crawl START the distance between the slab and the highest space floor and the highest roof peak,the top of WITH roof peak,the top of the cornice of a flat roof, Qthe cornice of a flat roof,the deck line of a the deck line of a mansard roof, or the mansard roof,or the uppermost point on a round uppermost point on a round or other arch-type or other arch-type roof roof SU$ RAPT half the distance between the highest window and SUBTRACT half the distance between the highest window �� �< < highest roof peak of a pitched roof and highest roof peak of a pitched roof SUBTRACT the distance between the basement floor/crawl F0.1 5Z ADD the distance between the slab and the highest ' p space floor and the highest existing grade within` existingrade within the foundation he foundation or 10 feet,whichever is less. EQUALS Defined building height EQUA efined building height Lot Cove age: SF % Shoreland District MCWD Permit Received Average Lakeshore Setback Blu 0 Yes 13/oes 0 No 0 N/A / 0 Yes 0 Yes 0 0 0 Yes 0 No /!yN/A Per it Number: Z"!-�(� Setback: Hardcover Zones Existing Proposed Variance Re fired CUP Re uir d 0-75' 0 Yes No 0 Yes No 75-250' Type(s): Type(s): 250-500' 500-1000' REMARKS (in-house): Tt lJr �;Il�l l W� Updated: 09/11/2009 z:\forms\plan review checklist.docx Fees to be Charged YES NO ,Permit . Plan Review State.Surdharge Investigation Fee `SAC ..'=Number=of_SAC Units ' T'1 C_ Sewer Connection -Vllater Connection Park Fee 'Sitelnsio on Other(specify) 'Miscellaneous}Fees Calculated By: Square Footage $ per Square Footage Basement X = $ 1St Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ 91 O., 000 Orono Inspections Required Work Requiring Separate Permits Required State Permits 0 Site eMlPlumbing 0 Grading/Filling Well 0 Hardcover Removal A—mechanical 0 Fire Electrical ,Footing eptic 0 Water Connection Poured Wall Fireplace 0 Sewer Connection Foundation Survey 0 Masonry Lawn Irrigation Radon Rock Bed "I"Mfg. Framing 0 Other(specify) Insulation Built Survey F�_zal 0 Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: 0 YES 0 NO New: 0 YES Cl NO REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) r f� Wtv>.Fev- I�IICnc# dei-2+�r>zin�fiZ� ceyv�e. � 3Qov �s�ow �ec�u i�--cd � ��o( -Fb✓c�e i Updated: 09/11/2009 zAforms\plan review checklist.docx BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2012-01026 C`in- AGREEMENT made this _ I day of 06+vkx_� , 20 1_?by and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and Peter&Amanda Vanoverbeke ("Owners"). Recitals 1. A building permit application has been filed for a new principal structure and pool located at 2645 Watertown Road the ("Subject Property"), legally described as Lot 1, Block 1, Old Crystal Bay Road Addition, according to the recorded plat thereof, 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$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 #2012-01026 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 subje rope pursuant to Minn. Stat. §§415.01 and 366.012. CITY: Cl jORONO OWNi: Its: Internal Use Only: 0 Original to Planning 0 Copy to Property Owner 0 Copy to Street File '�. WETLAND BUFFER ESTABLISHMENT ESCROW AGREEMENT Permit#2012��-�01LL026 AGREEMENT made this day of WOIi►►XA 20J2, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and Peter&Amanda Van Overbeke("Owners"). Recitals 1. A building permit application has been filed for a swimming pool located at 2645 Watertown Road the ("Subject Property"), legally described as Lot 1, Block 1, Old Crystal Bay Road Addition, Hennepin County, Minnesota. 2. The City has reviewed and approved this application. 3. The scope of the project which is the subject of building permit #2012-01026 triggers the application of the City's wetland buffer requirement as established by City Zoning Code Article XI Wetlands Protection 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$3,000 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 the establishment and development of the required native wetland buffer and to reimburse the City for all out-of-pocket costs the City has incurred (including planning, engineering or legal consultant review) or will incur in reviewing the plan. Eligible expenses shall be consistent with expenses the Owners would be responsible for as part of the establishment of the wetland buffer. The escrow will also guarantee reimbursement to the City for all out-of-pocket costs the City has incurred associated with permit #2012-01026 if compliance with the wetland buffer establishment 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, the native wetland buffer established 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 OF ORONO INER: / &_ By: -17 Its: aeI -d''(kz / U Internal Use Only:. O Original to Planning O Copy to property Owner;. _ f7;Copy o.Street File New Construction Energy Code Compliance Certificate illiJl�tl�,� 1hi Per N1101.8 Building Certificate.A building certificate shall be posted in a permanently visible location inside Fle Certificate Posted the building. The certificate shall be completed by the builder and shall list information and values of components listed in Table NI]01.8. 1 10/11/12 Mailing Address of the Dwelling or Dwelling Unit City COMM. NO. 212 306 2645 WATERTOWN ROAD ORONO Name of Residential Contractor MN License Number GORDON JAMES CONSTRUCTION BC531961 THERMAL ENVELOPE RADON SYSTEM Type: Check All That Apply X Passive(No Fan) o c T Active(With fan and monometer or F- > other system monitoring device) C 2 Insulation Location cC 'ro c U O ro o = 70 F E z ii w w cG cc Other Please Describe Here Below Entire Slab ---- X Foundation Wall R-5 X Exterior w/Waterproofing Perimeter of Slab on Grade X Rim Joist(Foundation) 2 1/4"Thick X Type in location:interior exterior or integral Rim Joist(1st Floor+) 2 1/4"Thick X Type in location:interior exterior or integral Wall R-19 X Ceiling,flat R-44 X Ceiling,vaulted R-44 X Bay Windows or cantilevered areas R-34 jxt Bonus room over garage R-38 Describe other insulated areas Windows&Doors Heating or Cooling Ducts Outside Conditioned Spaces Average U-Factor(excludes skylights and one door)U: T 0.29 lNot applicable,all ducts located in conditioned space Solar Heat Gain Coefficient(SHGC): 0.30 R-value MECHANICAL SYSTEMS Make-up Air Select a Type Appliances Heating System Domestic Water Heater Cooling System X Not required per mech.code Fuel Type Geothermal Natural Gas Geothermal Passive Manufacturer GeoComfort Rheem GeoComfort Powered Interlocked with exhaust device. Model GXT060-GWT036 42VP75FW GXT060 Describe: Input in Capacity inOutput in Other,describe: Rating or Size BTUS: 100000 Gallons: 75 Tons: 60000 Heat Loss: 98635 Heat 47098 Location of duct or system: Structure's Calculated Gain: AFUE or SEER: 20 EER HSPF% 4.0 COP Calculated 51021 Efficiencycoolin load: Cfm's "round duct OR Mechanical Ventilation System "metal duct Describe any additional or combined heating or cooling systems if installed:(e.g.two furnaces or air Combustion Air Select a Type source heat pump with gas back-up furnace): Not required per mech.code Select Type X Passive Heat Recover Ventilator(HRV) Capacity in cfms: Low: 180IHigh: 183 Other,describe: Energy Recover Ventilator(ERV)Capacity in cfms: Low: I lHigh: I Location of duct or system: Continuous exhausting fan(s)rated capacity in cfms: MECHANICAL ROOM Location of fan(s),describe: I Bathrooms,Laundry Room&Vent Hood 80 Cfm's Capacity continuous ventilation rate in cfms: 6 "round duct OR Total ventilation(intermittent+continuous)rate in cfms: "metal duct Created by BAM version 052009 SATHRE-BERGQUIST, INC. 150 S.Broadway Ave,Wayzata,MN 55391 Tele: 952-476-6000 Fax: 952-476-0104 Web:www.Sathre.com CITY OF ORONO HARDCOVER CALCULATION WORKSHEET CLIENT: James Gordon Const. JOB# 31380-004 ADDRESS: 2645 Watertown Road,Orono DATE: 10/11/2012 REV. REV. EXISTING HARDCOVER LENGTH WIDTH AREA COMMENTS STRUCTURES x = S.F. x = S.F. x = S.F. DRIVEWAY x = S.F. x = S.F. SIDEWALKS x = S.F. x = S.F. PATIO/DECKS x = S.F. x = S.F. LANDSCAPING x = S.F. x = S.F. RETAINING WALLS 88 x 0.50 = 44 S.F. Retaining Walls x = S.F. OTHER x = S.F. x = S.F. HARDCOVER INZONE AREA INZONE 44 / 110,795 x 100= 0.04% PROPOSED HARDCOVER LENGTH WIDTH AREA COMMENTS STRUCTURES Misc. x Misc. = 4,327 S.F. House/Garage Misc. x Misc. = 284 S.F. Front Stoop x = S.F. DRIVEWAY Misc. x Misc. = 3,307 S.F. Driveway x = S.F. SIDEWALKS Misc. x 4 = 264 S.F. Front Walkway x = S.F. PATIO/DECKS Misc. x Misc. = 1,001 S.F. Patios/Decks x = S.F. LANDSCAPING x = S.F. x = S.F. RETAINING WALLS 88 x 0.50 = 44 S.F. Existing Ret. Wall-Remove 100 x ? = 100 S.F. Proposed Ret.Wall OTHER 26 x 52 = 1,352 S.F. Pool/Pool Deck x = S.F. HARDCOVER INZONE AREA IN ZONE 10,591 / 110,795 x 100= 9.56% ;.Prim Point WATER RESOURCE PERMIT APPLICATION-COMBINED JOINT NOTIFICATION FORM Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD),their engineering consultants,and the DNR of a proposed project or work which may fall within their jurisdiction.These agencies should advise you of their jurisdiction or permit requirements within 10 days.Fill out this form completely and mail with your site plan,maps,etc...to the MCWD,18202 Minnetonka Boulevard,Deephaven,MN 55391.Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1.Property Owner Name(First,Last): 41 p A TER V4.,V 0 O t4'S E K F- Mailing Address: o?4 7 S 5rwrp Vre" OR City: d>Roy o State: 1n1v Zip: S'5'3,S' Email Address: aha«da.m, vcanoucr ecce""."-Phone: - -z Fax: vo v 2.Location of proposed project(Attach map with directions to site): Project Address: R6 q 5 W4T1FR TOWnJ R6 City: IJRp v0 County: NtNNEP.r v Qtr Section(s): Section(s): Township(s): Range(s): Lot: I Block:_�Subdivision: OtD CAYSMt 84V RD PID: 0-/- t I?- 3- ! -000? 3.Size of site: R.5 4 Acte e S Area of disturbance: 4J/IA square feet,or . ?S acres Volume of excavation(or fill): o7o -,3,o cubic yards Length of shoreline affected: .v 1A feet Area of existing impervious surface: r✓ A Area of proposed impervious surface: in k4 4.Type of permit being applied for(Check all that apply): 9EROSION CONTROL 0 WETLAND ALTERATION STORMWATERMANAGEMENT 0 WATERBODY CROSSING 0 FLOODPLAIN ALTERATION 0 SHORELINE/STREAMBANK IMPROVEMENTS 0 DREDGING 0 OTHER(DESCRIBE): 5.Project Purpose(Check all that apply): SINGLE FAMILY HOME 0 MULTI FAMILY RESIDENTIAL HOUSING(apartments,etc. COMMERCIAL CONSTRUCTION 0 INSTITUTIONAL CONSTRUCTION(churches,schools,etc.) 0 ROAD CONSTRUCTION 0 SUBDIVISIONS(include number of lots) 0 UTILITIES 0 LANDSCAPING(pools,berms,etc.) 0 DREDGING 0 SHORELINE STABILIZATION(lakescaping,bioengineering) 0 OTHER(DESCRIBE): 6.NPDES/SDS General Stormwater Permit number if applicable): AJIA 7.Alternatives(Describe any other sites or methods that could be used to avoid or minimize impacts to water bodies to achieve the project purposed.Attach additional sheet if needed.) ,vl,, 8.Project Timeline: StartDate: iD-.29-ao is Completion Date: S-- 30 - q o 1 3 9.Applicants Representative(Licensed contractor,engineer,etc...) Business Name: CoQ Dov -TA*"JF S 60x.57• Representative Name: SrnE ✓h9C,0tV 'RS'd-c/ Business Address: PO Box 304, City: rr/oPtC [Arr✓ State: �N Zip: S-S3S9 Email Address: 'o c P oi-da, - owners. co"+Phone: '163 U74-3/!7 Fax: ?�3 y'29-3/�g 10.Names and addresses of adjoining property owners(Attach list if necessary): L�t4Y ?AR K &-ov orvf- S.}ibE — orto,,eR ,yffrGHBoK .dol- .Cwourx/ Permits have been applied: City County 0 MN Pollution Control Agency-DNR_ COED_ Permits have been received:City0 County © MN Pollution Control A enc 0 DNR 0 COE I hereby notify the recipients of this form of the project proposed herein and request I be advised of any permits or other determinations concerning this project that I must obtain.I understand that proceeding with work before all required authorizations are obtained may be subject to Federal,State and/or local administrative,civil and/or criminal penalties. Signature of Property Owner Date Pagel of 2 INSTRUCTIONS—PLEASE READ CAREFULLY A copy of this form,with copies of all plans,drawings,etc...may need to be sent to an agency indicated below...Please check the appropriate spaces below to show everywhere you are sending this form,Remember to keep a copy for your records. MINNESOTA POLLUTION CONTROL AGENCY(MPCA)for NPDES phase H permit The LOCAL GOVERNMENTAL UNIT(LGU),city,county or water management organization EL MINNESOTA DEPARTMENT OF NATURAL RESOURCES(NIDNR)Regional Office ❑ US ARMY CORPS OF ENGINEERS(ACOE)at Dept.of the Army,Corps of Engineers,St.Paul District ATTN:CO-R,190 Fifth St.East,St Paul,MN 55101-1638 Note:The above Agencies may provide a copy of your completed form to the Minnesota Pollution Control Agency(MPCA). MPCA water quality requirements may apply to your proposed project. ATTENTION(from USDA):Any activity including drainage,dredging,filling,leveling or other manipulations,including maintenance,may affect a land user's eligibility for USDA benefits under the 1985 Food Security Act as amended.Check with your local USDA office to request and complete Form AD-1026 prior to initiating activity. Application is hereby made for a permit to authorize the activities described herein.I certify that I am familiar with MCWD Rules and that the proposed activity will be conducted in compliance with these Rules.I am familiar with the information contained in this application and,to the best of my knowledge and belief,all information is true,complete and accurate.I further certify that I possess the authority to undertake the proposed activity or I am acting as the duly authorized agent of the applicant. A✓/14 x Signature of Applicant(Property Owner) Date Signature of Agent Date NOTE:The application must be signed by the property owner where the proposed activity is to occur.The application may be signed by a duly authorized agent if a letter bearing the original signature of the property owner is submitted stating that the agent noted in the permit application is the authorized agent of the landowner for all matters relating to the permit Please provide authorized agent information below: Agent's Name 8t Title: n�/A Agent's Address: /✓Z Agent's Telephone:L� /�� 18 U.S.C.Section 1001 provides that:Whoever,in any manna within jurisdiction of any department or agency of the United States knowingly and willfully falsifies,conceals or covers up by any trick,scheme,or device a material fact or makes any false,fictitious or fraudulent statements or representations or makes or uses any false writing document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than$10,000 or imprisoned not more than five years,or both. Page 2 of 2 ,GORDON JAMES CONSTRUCTION CEWPA BM 1019 7 P.O.BOX 306 EMN 55344 5159 MAIN STREET EAST 75.511-919 MAPLE PLAIN,MN 55359 DATE 763-479-311 10/12/2012 r PAY TO THE ORDER OF Minnehaha Creek Watershed District *"10.00 Ten and 00/100**************************** DOLLARS Minnehaha Creek Watershed District 18202 Minnetonka Boulevard Deephaven, MN 55391 MEMO r VanOverbeke __ _ __ Nn 11'0 &019X1' 1:09L905LL41: 24@1111, 343n, 11 GORDON JAMES CONSTRUCTION 10197 Minnehaha Creek Watershed District 10/12/2012 Date Type Reference Original Amt. Balance Due Discount Payment 10/12/2012 Bill 10.00 10.00 10.00 Check Amount 10.00 Central Bank Checkin VanOverbeke 10.00 GORDON JAMES CONSTRUCTION 10197 Minnehaha Creek Watershed District 10/12/2012 Date Type Reference Original Amt. Balance Due Discount Payment 10/12/2012 Bill 10.00 10.00 10.00 Check Amount 10.00 Central Bank Checkin VanOverbeke 10.00 CNO>Pl- 1z�' DATE TIME V CITY OF ORONO CALLED IN 1t INSPECTION NOTICE SCHEDULED PERMIT NO. all -Dl COMPLETE ADDRESS OWNER TELEPHON NO.&,IA 70 CONTRACTOR !J DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q [I TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: W a j U O a cc O W W QZ Q 2 W Z W cc Lu PAM SATISFACTORY:PROCEED El PROJECT COMPLETE Qc W ElCORRECT WORK&PROCEED ElISSUE CERTIFICATE OF OCCUPANCY OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY tJ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White Copyllnspectoes File Canary Copy/Site Notice ZD E TIME V CITY OF ORONO CALLED IN E. INSPECTION KQTICE OBD SCHEDULED PERMIT NO. /o - CIOMPL6TED ADDRESS OWNER ELEPHONE NO. � CONTRACTOR O DESCRIPTION -- ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING JL Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS h ❑ FRAMING ❑ MECHANICAL FINAL O El TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_YES_NO COMMENTS: QC W C J O a O W W Cc Q 2 W Z W CC J LURK SATISFACTORY.PROCEED ElPROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site- Inspector. A 1-64 P=f� White CopylInspector's File Canary Copy/Site Notice V/ DATE TIME F11 C&OF ORONO CALLED IN �f _ INSPECTION NOTICE SCHEDULED PERMITNO. 20312- 010LD COMPLETED ,� 2-19 -13 ADDRESS L.cD waits U y) ELL., OWNER TELEPHONE NO. CONTRACTOR1m, 1 DESCRIPTION bo%, UI L ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING LLA Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ 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 ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNER/CONTRACTOR TO MEET YOU:_YES_NO COMMENTS: cc W CL cc O cc O LL W cc Q Z W z W CC O d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE LU W ❑CORRECT WORK&PROCEED 7J ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY U BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR 11 CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. cftsa m-(!_(E White CopylInspector's File Canary Copy/Site Notice v T /f TIME CITY F ORONO ALLED IN T ! / INSPECTION 1LOTICEr, SCHEDULED PERMIT NO. (a - bic)z& COMPLETED /�s I ADDRESS 2-&U S ��2 fey"'"fUU�-''l�1 VC OWNER TELEPHONE NO.�� Z3(3 CONTRACTOR ',, /'�I�'fJ�& DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z El 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 ❑ SEP I FINAL ❑ FOUNDATION/REMOVAL OWNER/CONTRACTOR T�YOU: YES—NO COMMENTS: cc W a J O cc O W W cc Q Z W z W CC O W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY OO ElCORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White Copy/Inspector's File Canary Copy/Site Notice - CITY OF ORONO CALLED IN DATE TIME _V INSPECTION TIC C O�� SCHEDULED •� PERMIT NO17? COMPLETED 1 ADDRESS y � lam'r� -� J '��'�.�^j 9 cl OWNER T14 � TELEPHONE NO.C)GAIS4 C �"�� 3- CONTRACTOR Q ( )eAj je CC)A C-CLQ 44-_Q Ljcjq 6 > DESCRIPTION Z40 ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_YES_NO COMMENTS: CC W CL cc O UL W CC Q Z W z W CC d U, �ORKATISFACTORY:PROCEED ❑ PROJECT COMPLETE W T WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN 11 CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. 1� White CopylInspector's File Canary Copy/Site Notice { � DATE TIME CITY OF ORONO CALLED IN ^�?�� 1-30 INSPECTION NOTIC SCHEDULED 1 PERMIT NO. � � ��Cr('' I COMPLETED t� ADDRESS G-�G t C� p /r` v �-( �Yr�r OWNER _ TELEPHON"O. 3 CONTRACTOR C � �� /1 —_T–a DESCRIPTION —6- am L1 ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING tt Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPT C INAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOF{T0MEETYOU: YES_NO COMMENTS: ; Y me I C �e, Q. LT1 �` J cc -4 Ifo r v_sS Q `1_1;?j A L c , e, r s� Wh LU cc �� P L *T/t e/Adm W ❑WORK SATISFACTORY:PROCEED /� 1-1 PROJECTCOMPLETE W CORRECT WORK&PROCEED // ❑ ISSUE CERTIFICATE OF OCCUPANCY OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. ` ls White Copy/Inspector's File Canary Copy/Site Notice 8—a—) L—e� DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE_�a SCHEDULED PERMIT NO. —10 / 2 COMPLETED ADDRESS o2(P OWNER TE PHONE N0.�3 — S g 3U Zb CONTRACTOR DESCRIPTION v ' *5"d L4 El FOOTING ❑ PLUMBING FINAL ElEXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_YES_NO COMMENTS: W Q. cc J 0 W W cc Q z W z W CC LAJ ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY U BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White Copy/Inspector's File Canary Copy/Site Notice DATE TIME CITY Of ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. 2-012--01 ZOSO COMPLETED ADDRESS 2A5 wa krimo- �d OWNER TELEPHONE NO. CONTRACTOR DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS h ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNER/CONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: W C C; J O f1 cc O W W cc Q 2 W Z W Cr O W ❑WORK SATISFACTORY.PROCEED ❑ PROJECT COMPLETE cc W ❑CORRECT WORK&PROCEED [_1ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White CopylInspector's File Canary Copy/Site Notice ^� -// T TIME v CITY OF ORONO D'ZI CALLED IN INSPECTION NQ_TIC/E ` HEDULED PERMIT NO. o`d` OMPLETED ADDRESS OWNER LEPHONE NO. CONTRACTOR DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ XCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q El TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_YES_NO o COMMENTS: cc W C o e✓S 12 S �44 cc 0 LLUj cc Q Z W z W cc d Wi El SATISFACTORY:PROCEED ROJECTCOMPLETE W ❑CORRECT WORK&PROCEED SUE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ♦ ' V BEFORE COVERING PERMANENT w ❑CORRECT UNSAFE CONDITION WITHIN HOURS. LlPHOTOTAKEN •1// INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White CopylInspector's File Canary Copy/Site Notice Planning & Zoning Department Me o To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: June 20, 2013 G/U 101-22205 Re: Wetland Buffer Escrow Refund Mark Perry, Wetland Specialist, determined a wetland was not on the property addressed 2645 Watertown Road, therefore the wetland buffer escrow, associated with building permit 2012-01026 can be refunded. Please refund $3,000 to the Applicants, Peter&Amanda Van Overbeke. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Peter&Amanda Van Overbeke 2645 Watertown Road Long Lake, MN 55356 wAstreet files\watertown rd\2645\escrow refund memo for wetland buffer 2012-01026.doc W, WETLAND BUFFER ESTABLISHMENT ESCROW AGREEMENT Permit#2012-01026 AGREEMENT made this day of JKA , 20_12, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and Peter&Amanda Van Overbeke("Owners"). Recitals 1. A building permit application has been filed for a swimming pool located at 2645 Watertown Road the ("Subject Property"), legally described as Lot 1, Block 1, Old Crystal Bay Road Addition, Hennepin County, Minnesota. 2. The City has reviewed and approved this application. 3. The scope of the project which is the subject of building permit #2012-01026 triggers the application of the City's wetland buffer requirement as established by City Zoning Code Article XI Wetlands Protection 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$3,000 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 the establishment and development of the required native wetland buffer and to reimburse the City for all out-of-pocket costs the City has incurred (including planning, engineering or legal consultant review)or will incur in reviewing the plan. Eligible expenses shall be consistent with expenses the Owners would be responsible for as part of the establishment of the wetland buffer. The escrow will also guarantee reimbursement to the City for all out-of-pocket costs the City has incurred associated with permit #2012-01026 if compliance with the wetland buffer establishment 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, the native wetland buffer established 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 OF ORONO NER: By: Its: _ / e &IcY(kwz �Y City of Orono 2750 Kelley Parkway Orono MN -F5,356 952-249-4600' Receipt No: 3.007907 Nov 1 2012 Amanda Van Overbeke Planning and ?oning 2'012-01026 Wetland Duffer 3,000.00 Escrow 101-22205 Deferred Rev-Developer Deposit - Total: 3000.00 Check --------------- Check No: MI 3 Payor: ,000.00 Amanda Van Overbeke Total Applied: 3,000.00 Change Tendered: M -- .00 i1101/2012 02:32Ppf '-�- MW CITY OF ORONO * 2012 - 0111S * 2750 KELLEY PARKWAY DATE ISSUED: 11/01/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952)249-4616 REPRINTED ON 11/1/2012 ADDRESS : 2645 WATERTOWN RD PIN : 04-117-23-12-0008 LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN LOT 001 BLOCK 001 PERMIT TYPE ESCROW FEE-WETLAND PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ESCROW FEE-WETLAND NOTE: THIS$3,000 WETLAND BUFFER ESCROW IS TIED TO PERMIT 2012-01026. APPLICANT ESCROW FEE-WETLAND 3,000.00 VANOVERBEKE,PETER&AMANDA TOTAL 3,000.00 2645 WATERTOWN RD LONG LAKE,MN 55356- OWNER VANOVERBEKE,PETER&AMANDA 2645 WATERTOWN RD 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 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 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. Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. w ■ • • Zoning Department Memo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: 08/06/2013 QW G/L: 101-22205 Re: Escrow Refund Building Permit #2012-01026 pertaining to 2645 Watertown Road is complete. The applicant, Peter & Amanda VanOverbeke, has requested their escrow of $2,500 to be refunded. Engineering review was completed in-house. Certificate of Occupancy has been issued. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Peter&Amanda VanOverbeke 2645 Watertown Road Long Lake, MN 55356 wAstreet files\watertown rd\2645\escrow refund memo for 2012-01026.doc BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2012-01026 AGREEMENT made this �—rj day of 20_1.27 by and between the CITY OF ORONO, a Minnesota municipal corporation("City")and Peter&Amanda Vanoverbeke("Owners"). Recitals 1. A building permit application has been filed for a new principal structure and pool located at 2645 Watertown Road the ("Subject Property"), legally described as Lot 1, Block 1, Old Crystal Bay Road Addition, according to the recorded plat thereof, 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$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 #2012-01026 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 subje rope pursuant to Minn. Stat. §§415.01 and 366.012. CITY: Cl NO OWN By: ! Its: ILI Internal Use Only: 0 OriginaLto Planning O Copy to Property Owner 13 Copy to Street File r i BMW ft'Tar is+ c� -��r�iF3tS t1(s CITY OF ORONO * 2 0 1 2 - 0 1 0 9 4 2750 KELLEY PARKWAY DATE ISSUED: 10/29/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS 2645 WATERTOWN RD PIN 04-117-23-12-0008 LEGAL DESC OLD CRYSTAL BAY ROAD ADDN LOT 001 BLOCK 001 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 2012-01026-PD CCHECK#2951 APPLICANT ESCROW FEE-BUILDING 2,500.00 VANOVERBEKE,PETER&AMANDA ESCROW FEE-EROSION CONTROL 0.00 2645 WATERTOWN RD LONG LAKE,MN 55356- ESCROW FEE-GRADING 0.00 TOTAL 2,500.00 OWNER VANOVERBEKE,PETER&AMANDA 2645 WATERTOWN RD 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 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 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. Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.