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HomeMy WebLinkAbout2013-00782 - shed CITY OF ORONO 2750 KELLEY PARKWAY * 21 - 0 0 7 2 DATE ISS - 007 08/15/22 013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4705 WATERTOWN RD PIN : 31-118-23-22-0003 LEGAL DESC : UNPLATTED 31 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ZONING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : SHED< 120 SQ FT APPLICANT STRUCTURE PERMIT 50.00 PRCHAL, DEREK&KELLY ENGINEERING REVIEW COSTS 4705 WATERTOWN RD MAPLE PLAIN, MN 55359- TOTAL 50.00 PAID WITH CC# 7312 OWNER PRCHAL, DEREK&KELLY 4705 WATERTOWN RD MAPLE PLAIN, MN 55359- 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 requeste in conforman a with the State Building Code.This permit may be revoked a any tiiu or e cause. ' Applicant ermitee Sign ture Date Issued By natureate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. City of Orono Zoning Permit Application O�l Mailing Address: Permit number: ,�o�3—d�7 g o� g- j V PO Box 66 Date received: g_j o'Z—/ V Crystal Bay, MN 55323-0066 Escrow#and Street Address: amount: -A ,. 2750 Kelley Parkway Permit Fee: r y� Orono, MN 55356 ,5700. /0,03-6078 5 0' C Approved by: 4kESH0�:c. Fax: 952-249-4616 Notes: Main: 952-249-4600 : __-___ This application form must be completed in full and all required information must be submitted. (Please print.) Job Site Address: 147(2`- Lk)A7 clarow4 20 ; 0gc-40 3C-9 CONTRACTOR/APPLICANT INFORMATION: Name: DEQ PRCr-1.42_ Phone: 0/2 22,2 (ot2c2 Fax: Address: 4/705 i,J.4 zz si "2:3 City: 0,2_043 ZIP: 55351 Contact Person: j)CI?t& /fir'-CLdQL-- Contact's phone number iz .2 60:=)-2_0 Email Lam, y. OCn1I144e_ce,,�., Applicant is: Contractor Homeowner (Circle One) PROPERTY OWNER INFORMATION: Name: 4-it Phone (day): Mailing Address: ZIP: Email and/or Fax Overall Project Description: £ 4'CKEf./ Coop Check TYPE OFPERMIT Box COST* Dock, Residential-Permanent dock on any lake or initial seasonal dock not on $50 + engineering review costs Lake Minnetonka (permanent dock requires CUP) Dock, Commercial $50+engineering review costs Escrow for erosion control and engineering review costs $2,000 Hardcover Permit: Driveway, Patio, Sidewalk, Etc. (New or Replacement) No charge Also required is a Minor or Major Land Alteration Permit Land Alteration, Major(grading, filling, or excavating) more 500 cubic yards or $50 more than 10 cubic yards in lakeshore setback (also requires CUP) Escrow for erosion control and engineering review costs As determined by CUP Land Alteration, Minor(grading, filling or excavating)-500 or less cubic yards $50+ engineering review costs outside of lakeshore setback or less than 10 yards in lakeshore setback Escrow for erosion control and engineering review costs $2,000 Retaining Wail measuring under four feet require a zoning permit. $50+engineering review costs Retaining walls measuring more than four feet(from bottom of footings to top of wall) require a building permit. (Tiered retaining walls are considered one wall unless the walls are separated by twice the height of the lower wall.) Escrow for erosion control and engineering review costs $2,500 Stairway to Lake (New or Replacement) $50+engineering review costs Escrow for erosion control and engineering review costs $2,000 Structure Permit for other structures not requiring a building permit but $50+engineering review costs v/ regulated by the zoning code (including, but not limited to accessory building of less than 120 square feet, detached deck or platform and sport court) Escrow for erosion control and engineering review costs $2,500 Tree Removal or other vegetation removal in 0 to 75 foot zone No charge. Temporary Construction Office/Trailer(associated with building permit) $30 (over) *Permit fee will be collected when the permit is issued. Updated: November 30,2012 APPLICANT/OWNER ACKNOWLEDGEMENT: • • Applicant/Owner agrees to provide all information required or requested by the Planning Department; • Owner agrees to pay the City of Orono for engineering consultant review costs where applicable; • Applicant/Owner 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; • Applicant acknowledges the attached Escrow Agreement is completed and signed by Owner; • Applicant/Owner understands their project may require an initial and as-built survey per City Code Section 86-68. • 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. The undersigned certify that the i formation sup1 lied is true and correct to the best of their knowledge. ,�,�Applicant's Signature: Date: Q I '1,3 Property Owner's Signature: Date: SUBMISSION REQUIREMENTS: Except for tree removal permits, all permits TYPE OF PERMIT: require a completed application form, escrow agreement(signed by the property owner) and escrow check from owner, two copies of all plans, and three copies of all grading plans or surveys/site plans Dock, Residential Seasonal Dock—survey showing proposed dock Permanent Dock—plans as approved by CUP and copy of LMCD permit(if applicable) Dock, Commercial 1. Structural plans for the dock 2. Survey showing the proposed location of the dock 3. Copy of LMCD permit Hardcover Permit 1. All Minor or Major Land Alteration Permit requirements apply as appropriate 2. Hardcover calculations, existing and proposed 3. Plans Land Alteration, Major 1. Plans as approved by Conditional Use Permit 2. Erosion control plan or copy of MCWD Erosion Control Permit Land Alteration, Minor 1. Survey/grading plan including existing and proposed contours (Less than 10 cu.yds. within 75'of 2. Amount of fill to be imported and/or exported and haul route lake or less than 501 cu.yds 3. Amount of earth to be moved around on site elsewhere.) 4. Erosion control plan or copy of MCWD Erosion Control Permit Retaining Wall 1. Plans for wall(s) 2. Unless repair or exact replacement of existing wall, submit an updated survey with grading plan including existing and proposed contours 3. Hardcover calculation worksheets if in shoreland district 4. Erosion control plan or copy of MCWD Erosion Control Permit Stairway to Lake 1. Construction plans for stairway, including footings 2. Topographical survey of property with proposed stairs shown 3. Erosion control plan or copy of MCWD Erosion Control Permit Structure Permit 1. Construction plans. 2. Survey of property with proposed structure shown and with setbacks to property lines, other structures on property and the septic system indicated. The general location of any sewer and water services should be shown if applicable. 3. Grading plan if grading is proposed. 4. Hardcover calculation worksheets 5. Erosion control plan or copy of MCWD Erosion Control Permit Tree Removal Call: 952-249-4600 to schedule a single tree removal inspection. A re-planting plan/ management plan required for clear cutting, buckthorn or other intensive vegetation removal. Updated: November 30,2012 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address/Permit Number: 1 - l .0 �r ��. Description of work: G k< C le--�(0 C 00P1 Septic review by: (A ----` Date Approved: I,)---( 3 Zoning review by: 1./4 Date Approved: Building review by: C9 Ubl'wghDate Approved: Ce ' f L-I - Z•U Grading review by. /�� Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: Lot Coverage: SF _% Survey Submitted: , Yes 17 No Date of Survey: nu ,-i L Revised date(?): Proposed Setbacks: Front(Lake) Rear(Street) ( N S E W ) ( N S C W ) Other Buildings Wetland Side Side —7601 +- Zct ` 19 i 2— LttV AiI A Defined Height: 0 , k— Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50% = #of Stories Ok? D YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: The distance between the lowest FOR A BUILDING ON A SLAB FOUNDATION: "N START WITH proposed floor(of the basement or crawl tel` space)and the highest point of the roof. START WITH The distance between the top of slab and the highest point of the roof. If you have a... If you have a... • GABLE OR HIPPED ROOF(no • GABLE OR HIPPED ROOF(no l windows): Subtract half the --.-'' windows): Subtract half the distance distance between the highest point ......-- between the highest point of the roof of the roof to the low point of the to the low point of the corresponding SUBTRACTION corresponding gable or hipped roof SUBTRACTION gable or hipped roof (BASED ON ROOF BLE OR HIPPED ROOF (BASED ON • GABLE OR HIPPED ROOF(with TYPE) winces): Subtract half a ROOF TYPE) windows): Subtract half the distance distance'b een t op of the between the top of the highest highest windo d the highest window and the highest point of the point of the of roof • ALL ER ROOF TYPES fta • ALL OTHER ROOF TYPES(flat, sard,etc):No subtraction. mansard,etc):No subtraction. ADDITION Add the distance between the top of slab SUBTRACTION Subtfact the distance between the (BASED ON and the highest existing grade adjacent to (BASED ON EXISTING asement/crawl space floor and the EXISTING the foundation. GRADES) highest existing grade adjacent to the GRADES) foundation OR 10 feet(whichever is less). EQUALS Defined building height EQUALS- Defined building height £fioreland District MCWD Permit Received Average Lakeshore Setback Me Bluff 0 Yes 0 No /0 N/A 0 Yes A No 0 Yes p1 No 0 Yes 0 No p N/A / Permit Number Setback: Stormwater Quality Existing Proposed Variance Required CUP Required Overlay District Tier Hardcover Hardcover _ D Yes 71 No D Yes Al No /STD Type(s): Type(s): Updated: January 2013 v:\forms\plan review checklist 2013.docx REMARKS (in-house): Fees to be Charged YES NO Permit Plan Review State Surcharge Investigation Fee SAC-,Numbers of'SAC Units ' Other(specify) Square Footage $per Square Footage Basement X = $ 1st Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ Orono Inspections Required Work Requiring Separate Permits Required State Permits O Site 0 Plumbing 0 Grading/ Filling 0 Well O Hardcover Removal 0 Mechanical 0 Fire 0 Electrical O Footing 0 Septic 0 Water Connection O Poured Wall 0 Fireplace 0 Sewer Connection O Foundation Survey 0 Masonry 0 Lawn Irrigation O Radon Rock Bed 0 Mfg. O Framing 0 Other(specify) O Insulation D s-Built Survey Final Wetland Buffer O Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES 0 NO New: 0 YES 0 NO OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED_ Updated: January 2013 v:\forms\plan review checklist 2013.docx DATE TIME T/ CITY OF ORONO CALLED IN INSPECTION OTICE SCHEDULED C1-5-(3 �Y1 PERMIT NO.V-10k 3-&lap' COMPLETED ADDRESS Li-l05 tLCG. r-10u)n rr__ OWNER `''"r' P'Q r�� TELEPHONE NO. l0 2 • Z2 2- C°9 a° CONTRACTOR P2"'ri)ct ?Y E t 1 - c f\k am.. coDESCRIPTIO 1.4 ❑ FOOTING 0 PLUMBING FINAL 0 EXCAV/GRADING/FILLING Q ❑ POURED WALL 0 MECHANICAL RI 0 LAKESHORE/WETLANDS h ❑ FRAMING 0 MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 SITE INSPECTION • 0 RADON SLAB ❑ WATER HOOK-UP 0 PROGRESS ,FINAL 0 SEWER HOOK-UP 0 COMPLAINT ❑ DEMO-SITE 0 SEPTIC MAINT. 0 FOLLOW-UP IL 0 DEMO-FINAL 0 SEPTIC INSTALL 0 HARD COVER REMOVAL 0 PLUMBING RI 0 SEPTIC FINAL 0 FOUNDATION/REMOVAL • OWNERICONTRACTOR TO MEET YOU:_YES NO cc4• COMMENTS: cc W CC CC CC Q 12 W W Ci LU ❑WORK SATISFACTORY:PROCEED ROJECT COMPLETE CC W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY • ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY j BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Derek& Kelly Prchal 4705 Watertown Road Maple Plain, MN 55359 w:\street files\watertown rd\4705\escrow refund memo 2013-00782.doc Christine Mattson From: David Martini [davidma@bolton-menk.com] Sent: Thursday, September 19, 2013 8:41 AM To: Christine Mattson Subject: RE: Unbilled WIP I don't see any time associated with these projects. Thanks. David P. Martini, P.E. Bolton & Menk, Inc. P: (952) 448-8838 ext. 2458 M: (612) 756-4315 email: davidma(c�bolton-menk.com From: Christine Mattson [mailto:CMattson@ci.orono.mn.us] Sent:Thursday, September 19, 2013 8:20 AM To: 'Sherry Charboneau'; David Martini Subject: RE: Unbilled WIP Good Morning, I need to submit my request to the finance department soon. I am wondering if you will have a chance to look up this information this morning? Thanks! From: Christine Mattson Sent: Wednesday, September 18, 2013 2:47 PM To: 'Sherry Charboneau'; David P. Martini Subject: RE: Unbilled WIP Sorry, I knew as soon as I'd hit send, I'd think of one more....sure enough 1565 Orchard Beach Place Zoning#13-3614 Herbert Pfeffer/Fred Johnson Thanks again! From: Christine Mattson Sent: Wednesday, September 18, 2013 2:43 PM To: 'Sherry Charboneau'; David P. Martini Subject: Unbilled WIP Hello, Any unbilled WIP for the following: Address Building Permit Applicant 1 2990 Sussex Road 2012-01052 & 2012-01055 Justin &Susan Kelly 1545 Maple Place 2013-00029 Maple Place, LLC 1587 Maple Place 2012-00436 Maple Place, LLC Thanks! Christine Mattson Planning Assistant City of Orono 2750 Kelley Parkway Orono MN 1 55356(physical address) PO Box 66 Crystal Bay MN '` 55323-0066 (mailing address) 'B' 952.249.4620 u 952.249.4616 cmattson@ci.orono.mn.us ! www.ci.orono.mn.us Office Hours: Monday- Friday 8 am to 4:30 pm This email has been scanned by the Symantec Email Security.cloud service. For more information please visit http://www.symanteccloud.com 2 Christine Mattson From: Sherry Charboneau [SCharboneau@ck-law.com] Sent: Thursday, September 19, 2013 9:09 AM To: Christine Mattson Subject: RE: Unbilled WIP Hi Christine: Just wanted to make sure that Soren did not have any outstanding time that he has not given me to post yet - he responded this morning that he did NOT have any additional time. However, there is a previous balance outstanding on Zoning # 13-3614 in the amount of $202.50 from our statement to the City for services rendered through August 31, 2013. Other than that, there is no unbilled WIP for any of the items listed below. Have a good day! Sherry Sherry L. Charboneau Legal Assistant CAMPBELL KNUTSON P.A. 1380 Corporate Center Curve•Suite 317• Eagan,MN 55121 (651)234-6230• Fax: (651)452-5550 scharboneau(Tck-law.com•www.ck-law.com From: Christine Mattson [mailto:CMattson©ci.orono.mn.us] Sent: Wednesday, September 18, 2013 2:47 PM To: Sherry Charboneau; David P. Martini Subject: RE: Unbilled WIP Sorry, I knew as soon as I'd hit send, I'd think of one more....sure enough 1565 Orchard Beach Place Zoning#13-3614 Herbert Pfeffer/ Fred Johnson Thanks again! From: Christine Mattson Sent: Wednesday, September 18, 2013 2:43 PM To: 'Sherry Charboneau'; David P. Martini Subject: Unbilled WIP Hello, Any unbilled WIP for the following: Address Building Permit Applicant 2990 Sussex Road 2012-01052 & 2012-01055 Justin & Susan Kelly 1545 Maple Place 2013-00029 Maple Place, LLC 1587 Maple Place 2012-00436 Maple Place, LLC Thanks! 1 ZONING PERMIT ESCROW AGREEMENT Orono Zoning Permit# ZOO - 0ln_ AGREEMENT made this day of , 20 by and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and cruciuccit j Pr'C}1A4 ("Owners"). Recitals `A 1 buildi permit application has been filed for a zoning permit for a ro rty located at 4 0S O IC�e ("Subject Property"), legally described as 3e,L.akieffia Hennepin County Minnesota. 2. Owner requests 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 $ -1,10 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 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 zoning 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 zoning permit # 2oi .Ka ,if compliance with the approved zoning 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 subject property pursuant to Minn. Stat. §§415.01 and 366.012. -� ---- CITY: 'CITY OF +:p_k,o" OWN R: By: I V Its: Ince l*1se;On9;rOtfg nal;to''Fina"""nce"`O iff em nt WU 4Copjr o reef tF eil 24‘11,9 nibactow r t.2O13 © T62_ EXISTING LEGAL DESCRIPTION: That part of the Northwest Quarter of Section 31, Township 118 North, Range 23 West of the 5th Principal Meridian, described as commencing at the northwest corner of said Northwest Quarter; thence on a bearing of South along the West line of said Northwest Quarter a distance of 29.3 feet; thence South 48 degrees 32 minutes 14 seconds East a distance of 326.8 feet; thence South 43 degrees 22 minutes 14 seconds East a distance of 260.91 feet; thence southeasterly a distance of 21.87 feet along a tangential curve concave to the northeast having a radius of 1432.39 feet to the point of beginning of the land to be described; thence southeasterly a distance of 202.83 feet along;the southeasterly continuation of saidcurve; thence South.9 degrees 12 minutes 20 seconds West. not tangent to said curve, a distance of731.44.feet; thence North 80 degrees 50 minutes 39 seconds West a distance of 374.01 feet; thence North 29 degrees 17 minutes 20 seconds East a dtance of 217.08 feet; thence North 11 degrees 23 minutes 20 seconds East a distance of 598.42 feet; thence North 79 degrees 00 minutes 20 seconds East a distance of'112.51 feet, more or less, to the point of beginning. PROPOSED LEGAL DESCRIPTION (to be reviewed by Torres Office) That part of the Northwest Quarter of Section '31, Township 118 North, Range 23 West of the 5th Principal Meridian, described as ollows: Commencing at the Northwest corner of said Northwest Quarter; thence on an assumed .bearing of South 0 degrees 40 minutes 32-seconds East along the West line of said Northwest,Quarter a distance of 29.3 feet:to the point of beginning of a line hereinafter referred to as Line K;therice South 49 degrees 12 minutes 46 seconds Easfa•distane of 326.8 feet; thence.South 44 degrees 02 :minutes 48 seconds East.. a distance of 260.91 feet; thence southeasterly a dime of 224.7 feet-along a ;tangential come concave to the north- east having•a radius-of 1432.39 feet to'the feint of beginning-of tee prop , .described and said '.Line A. there ending; theme South 8 degrees:31 res 48 seconds West a''distance of 731.44'440; thence North $1 degrees 31 minutes 11 seconds Welt a distance of 374.01 feet;°ttr b..North, 30 degrees 41 minutes 28 seconds East a,:distance of 100..85 feet; thence Noah 29 degrees minute 34 seconds East,a -distance of 70.53 feet;, thencencfrtherly`ate` a .tangential=tee concave'to the west having a central angle of 22 le lees 11 mimes 30 seconds and radius of 150.00 feet a distance of 58.10 teet; thence 1,forth.1:degrees 45.minutee,East .tangent to:last.described curveorf.a distance 65* :feel; thence North 9 .degrees-=30 minutes East a.dista d of.275:00°feet;.-thence tort 12 degrees 30;: itnutes'East •distance of 165:0'feet~"#hence North"20`d s.,.30 minutes East a aintit10 44�1k`'i'., feet.thence,,along a tangential curve concave to the'southeast having_a-central angle of-57 degrees 17 minutes 't 8 seconds"and a rad, rs of 75.00 feet a distance of 74. feet; thence North 77 degrees 47 minutes 18 s_East lint;to- said' . its"intersection with said Line A ; thence southeasterly'along,said "Line'K to.,the point: .of beginning. City fOrzinc 5rom -55352 �-L‘&.+608 Receipt No; I009474 Atio 15, 2013 Derek Prchal Planninp arc Znnzng 20.2-0VD08 700.O0 101-22205 Deferrer. Rev-Ueveloper Deposit. Total: 700.00 ------'------ Check No; 2744 7N.00 payor. Derek Prchal Total Applied: 700.00 Change Tenderet: .00 ---- - cli:�prf. CITY OF ORONO 11111111111111 ��I I HI I 11 2750 KELLEY PARKWAY DATE ISSUED: 08/15/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4705 WATERTOWN RD PIN : 31-118-23-22-0003 LEGAL DESC : UNPLATTED 31 118 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: TIED TO ZONING PERMIT 2013-00782 APPLICANT ESCROW FEE-BUILDING 700.00 PRCHAL, DEREK&KELLY TOTAL 700.00 4705 WATERTOWN RD MAPLE PLAIN,MN 55359- OWNER PRCHAL, DEREK&KELLY 4705 WATERTOWN RD MAPLE PLAIN, MN 55359- 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 re ed at any im j r due cause. ' t / / Wt3 .6-/ / i Applic e itee ignature Date Issued`Si_rture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED ABOVE. I , 12x] r0 2 L I1:1 Le _ (!., V IIfl r r 1 4 L• cY 4 t,. 1 W;too u• o - 473' d Li_ r, 2 di , t G g' I xd r0 My� UJ 11 a a b u CJ C 41 aC .0 p ti ' ra C N I I 20 c W a "n Itl ce .- . p '^ C ',' c 06 0,6 o, E U- g i a