HomeMy WebLinkAbout2011-01253 - demo , � CITY OF ORONO PERMIT NO.: 2011-01253
2750 KELLEY PARKWAY
.
ORONO, MN 55356- DATE ISSUED: 10/24/2011
952 249-4600 FAX: 952 249-4616
ADDRF,SS : 300 BROWN RD S
PIN : 03-117-23-13-0002
LEGAL DESC : UNPLATTED 03 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE
ACTIVITY : 649-ALL OTHER BUILDING& STRUCTURES
NOTE:
1. FOUNDATIONS/ALI.DEMO DEBRIS"I'O BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. INSPECTIONS DONE BEFORE BACKFILLING.
NOTF: A 24-48 HOUR N07'ICE[S REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600.
DEMO: PRINCIPAL STRUCTURE,POOL AND BARN
SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUALIFIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED.
CHrCK TO MAKE SURE THIS PERMIT HAS BEEN PULLED BEFORE ISSUING THIS PERMIT.
APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 75.00
KOTHRADE SEWER& WATER DEMOLITION-ACCESSORY STRUCTURE 100.00
12059 WHITETAIL AVENUE
HANOVER, MN 55341 STATE SURCHARGE DEMO 5.00
(� TOTAL 180.00
Minnesota State License#: 0192 PAID WITH CC# 7104
OWNER
CHALFEN, RICHARD
300 BROWN RD S
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
1'he work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry approvals,and the
State Building Code. This permit is for only the work described and does
no[grant permission for additional or related work which requires separate
penni[s. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
ex nd become null and void if construction authorized is not
co�men ed within 180 days of the date of issuance,or if construction is
suspende for a eriod of 180 days at any time after work has commenced.
`C e applic nt i r spo sib e for assuring ay{.,required inspections are
re Uested i�c f md ce i the�State ui�ding Code.This permit may be
revXYked at any[i e fo d a se ,
�'' � ��� �-1-� � � �� / 2 / �
App 'cant Penm ee ature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
,y;�Y•.";�:;y,
;,�- � � City o�prono
' � ��� P.O.6ox 66 � yUSE ONL1'
r,�0,. O�1, Date Received� / // Permit� �Ol --3
, �;.,;. , 2750 Kelley Parkway
'� ���.�:�. � Crystal Bey,MN 55323 Amounr. �D•� SAC Credir.
� � ��'• ��
� �;gt,;},a,/ (9S2)249-A600
:��stba'A'�;.
'-•�•^''/ Homeowner{s)Signed: ❑Yes
► �� �����'� Resolutions(if eny)Signed:�Xes [�None Required
r -� Zonin Disclosure Si nod:
❑Yes ❑Non�E� uired
CITY OF ORUNO -DEMOLITION �?ERM�T
(All permi�s musc be epproved by the Huilding ott;�ial and/or Zoaing�epartment)
::... , , .,., .
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- o. �te:l Owner Info � ""�
rch�tton^.,,... , . ._,..
Type: � Residential ❑ Commercial
Site Address: 3 6 o PrQ�� I(.J`'- `-' '
Owner: `t�IG�Y�(/l- �I' �Q.,l'� Mailing Address: �S� w�. �•
�,�: a�-� ►�vuU z,p: ��S 3q I �
Home Phone: ��� '�� � 0 � �� Alternate Phone:
... ��..�a.a�ani
' li�ant:�: o . ,t' ;:„:::,;; .,:�:
Contractor./App,' , .... : .. _...:..... ��,..::::.�-�_'`'`:
. . . ... . ..
Contractor/App.: V ��� C ntact Person: Q� ���1 ��,��`e
'�' \ ('�r � �G�
Address: � � ` (�1eState l.icense#:
City: -P/1�,Zip: ���� Expiration Date:
Phone: �6 3` '�"�a '��0� Alternate Ahone:
,. . .
''' SP`ECIAI..C.O Q.l�s�����
. . .. � . .. � OT�A:� ,`��3�:�;AG��N�NT:.;.
General Instructions:
1_ Xou may be required to obtain other permits, i.e.: well abandvnment, sewer, etc.
2. Work must not begin unless tl�e pe�rnnit card is available on the job site.
3. A 24-48 hour notice is required �ot-all �ns[�ectaons. Call (952) 249-4600. �
4. Sewer must be discontinued at the City service by qualif ed contractor before demo permit is issued.
Demoiition by means of: ❑ Manual Disassembly �eavy Equi�ment ❑ Other
Permit(s) issued: �ewer Disconnection ❑ Well.A,bandvnmient#
�r� �retu�rn �'o�r issuaQce o�sa�d De�ol�t�o�Permit,the ux�de3rs�gaed ownex b�ereby agrees to:
1. Submit a survey, aerial photo or sketc� sk�owix►g all structures on the property. Note which
structures are to be demo(ished.
2. Subrrait a su�rvey, aerial photo o�r sketch showing pxoposed erosion control measures in
accoxdar�ce witb Chapter 79, Construction Site Runof,j`'Control.
3. Submit a$2,000 escrow and an escrow agreement signed by the property owner.
�. Keep all structure(s) enclosed and/or secured until such time as demolition is co�'nplete.
5. Keep all denn�o�ition debris off adjoining prope�ty and/or the public rights-of way unless specific
priar approval is obtained ir� writing for temporary use thereof.
6_ Com�letely remove foundation(s) from the ground.
7. Completely dispose of all demolition debris off site in accordance wath all applicable PCA
requarements.
8. Abandon water wells in accordance w�th State Health De�a�trx�ent regulations.
9. Call for an inspection when all debris has been removed, before back��ling.
10. Within 5 working days of superstructure removal, a final inspection si�all be requested. The site
shall be left clean and clear of all debr�s, with any excavation filled witk� ea�th level with the
adjacent ground elevat�on (except wher� such excavation is to be used as pa�t of a new building
and such new building is actually under cv�nstruction).
1�. A,bandon septic systems per Minnesota Rules Chapte� 7080. All septic tanks �rnust be pumped,
crusk�ed and filled with native soils. An inspection is required after the tan�Cs are pumped and
before the tanks are crusl�ed and filled.
12.The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its
agents, employ�es and assigns from and against all claims, dannages, losses or expenses,
including attorney fees, against the City, its agents, employees and ass�gns arising out of or
resulting from the demolition described herein, as performed by the property owner, his
employees, agenrs, subcontractors or assigns. �
PERMIT TYPE A,�TD FEE C,A,LCULATION
�$75.0�—Principal Structure $ � �' �v
$50.00�Accessory Structure x�(how many) l �-�lJ
�1 ��r►�
1. Subtotal of above permit requ sted $
2. State Surcharge 5.00
3. TOTAZ..PER.M�'I'FEE (add lines 1-2 above) $__�O • �
The undersigned herby a�plies to the City of Orono for issuance of a Demolition Permit, agrees to do all
the work in a strict accordanc with the ordinances of the City and the �egulations o� the State of
Minnesota, and ce�-ti�es tk�at al) st temen made on t is applicat' n are complete, true and correct_
Applicant's Signature: Date: � ' '/
�
Owner's Sig�ature: � j�� ���% Date: /6 ;
Approved By: Date: /n ' Z I ` � (1
(B d�ng Official)
� Zoaing Disclosure Required? ��S ❑ �10
*This must be filled out by Zoning Departmcnt—For either answer,a Zoning Official must sign all applications.
'�Approved By: Date: ��'��' ��
(Zoning Officiel) �
O�0
�O Princi al Dwellin Demolition Permit
�}-�Y� p 9
1�'�` - �
�' �`�'�`��° ZONING DISCLOSURE & DECLARATION
�g�o�.
To the property owner: Demolition of the principal dwelling structure on a property may automatically terminate
certain rights which may have accrued to the property by virtue of the continued existence of that building.
• Rebuilding on a substandard lot of record (i.e. a lot that does not meet the zoning district required lot area or
width standards) will, with few exceptions, require variance approval by the City Council, and such approval is
neither automatic nor guaranteed but requires that a hardship be demonstrated.
• Additionally, all current zoning standards will have to be met by the new principal dwelling including setbacks,
lot coverage by structures, hardcover(impervious surface), height limits, etc.
• Where municipal sewer is not available, provision of two (2) sites for a conforming on-site sewage treatment
system is mandatory.
• Unless specifically approved by the City, all accessory structures must be removed at the time of principal
dwelling demolition. This also applies to seasonal and permanent docks, which may not be re-installed until a
new principal dwelling has reached the framing stage.
The following information is presented for the purposes of advising the property owner of the implications of
removal of the rinci al dwellin on the ro ert :
1. Property 300 Brown Road South PIN # 03-117-23-13-0002
Address:
Required Lot Area 2 acres Required Lot Width 200'
2. Zoning District: RR-1 B Actual Lot Area 3.97 acres" Actual Lot Width 425'*
*According t nepin County
Lot area variance is is not equired. Lot width variance is/ is not quired.
3. Required Front 50' Rear 50' Side 30' Side Street 50'
Setbacks:
Average Lakeshore Setback: must be me is not a licable
4. Lot Coverage by Structures: limited to 15% of lot are does not a I lot area > 2 acres
5. Hardcover limitations: are a licable are not a licable. 0-75' zone = 0% allowed
75-250' zone = 25% allowed 250-500' zone = 30% allowed 500-1000' zone = 35% allowed
6. Municipal sewer is not available; on-site system testing and design must be provided confirming that two
conforming drainfield sites are available.
7. X Wetland(s) present. Wetland is classified as "unclassified". Wetland must be delineated and assessed to
determine buffer widths. "'Talk to Planning Department Staff for additional requirements.
The undersigned property owner hereby acknowledges receipt of the above information. Staff Initials
� f� �L� �V bif A_ /lJ /4 �s'1 i/
Property Owner's ignature Da�
(Original: Street File; Copy: Property Owner)
w:\street files\brown road s\300�zoning disclosure form.docx
Created: January 28, 2008
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LOSING DOCUMENTS
� TITLE��_
. 4
�:;;��,��
�.�
�
Richard N. Chalfen
300 Brown Road South
Orono, MN 55356
Closer: Loan Officer: Real Estate A�ent:
Samantha K.Skinner;Marlo M.Fredenberg, Catherinc Kclly
Assistant MATSON REAL I.S"1'ATE SERVICES
TITL�ONE, INC. -MINNETONKA 6509 Sherzuood Avenue
601 Carlson Parkway,Suite 1140 , Minneapolis, MN 55435
Minnetonka, MN SS305 612-720-8495
952-745-7890 kittykellyOC��mail.com
minnetonka2<<?title-1.com
r�de o�E,t��. Pind us on thc wcb at: r;i����.:no7o3s
� ClosingDocumentCoverSheet �]Ti�7:��WWW.LIC�C;-l.COCIl ClosingDate:September30,2011
a. Sett�e1712I1t stc`1t21T1eI1� L'.S.Dep.u�tment uf Housing OMB No.3�02-026�
.ind L'rban De��elopment
� 13.T�� e of Loan
�, C PH:A '_. C FmH.-A :. ❑Cunv Unms 6.Ffle Number '.Loan Number 3..Viortga�e Ins Case Number
» L 4,A � C Cun�Ins. G. ❑Scller Finance 1103038
C.\ote: This furm is funr.sheti to�n�e you a statement of ac[ual settlzment costs. .4mounts paid[o and by fie settlement agent xre shown. Items marl<ed
"lp.u.c.l"were aid ou's�de�he closine;diev are shown here for informational nm�oses and are not included in the total;.
D.Vame a�.?,ddress uf Borro�ver E.Name&Address ot Seller F.Name&Address of Lender �
Richard \.Chalfen Jack C.Uouthit rnd Hazel F.Duuthit
i;Om 13ru��n Huatl 30p tiouth 13ro�rn Road
Lun_I.nl:c.�I\ ii3SG (h�uno.;��I\ ii35G
��� Pio•,�crn:�,c�iiu❑ H.Settlement Agent Name
Title One,Inc.
l��nplatteJ OJ I 17 2l.Hennepin County,.VIN. 1650�Vest SZnd StreeL Sui[e 1070
300 Bruwn Road South Bloomington.�IN SSJ31 Tas ID:JI-17?408R
Orono.�I\ i535G
Place ot SetNement I.Settlement Date
� Titlr One,Inc.-�linnetonka 9/30/301I
601 Carlsnn Parkwa}'.]uite I IJO Pund:9/30/Z01I
1linnctonka.VI\ j5305
J.�umman o(13urru��cr'�Tr:nnacfiun i�.lummarr ul Srllcr's Tr:insac[iun
IUIJ.Urn..4moimt Due(rum 13urru��cr J00.Gruss Amoun[Due[o Seller
1�7i. C��nir;�ct��ic�Price $40I,000.00 �40L Contract5alesPrice $401.000.00
I�i'_ Persunai Prooern- 402. Personal Property
10:. �e[demen[CG•,¢rees to borrower(I d00) $1.473.00 403.
10� 404.
�^ 40�
AJjmhnrn[s tin�items paid bv seller in advance AJjusnnents for items paid b��seller in advance
��� t��.�..n.� ��.�o�r:.�.ases Oy •q:I! :0 12;11-I! 51.?I S.RO :OG C'oun[y nroperty[axes 09�30i1 1 to I2!3111 1 51.?15.80
- �1u'
� .U�
�uv � 9U9.
��!u aio
II; ali
412.
II; 413
11� 414_
il� 41�-
I ic, �I[�
I'_U.(:ru..�-Anminn Uue Frum 13nrru��cr ti403.GHM.RU J'_0. Gra�s�moun[Uuc[o Scller ''bJ02115.80
'_U0.Aniuuul.�Ynid 13��Or In RchaR UI 13urro�vcr 500.Itcductiun�in Amoun[Uuc[o Scllcr
',r)i �Jc�,.o,�t„r�urncst mon�^ �20,OOO.UO �01. Gxcnss Deposi
'_'1'_ Principu;amountul�newluunni SG2. Settleinen[Char�eStoSellerfline1400) $26,224.40�
=0_. C�isun�luan�sl taken sub�ect tu 503. Existing Loanis)Taken Subject to
_'U4 Luun Amuunt'_nd Len 504. Payoff ot lirst mortgage Iwn
'-��= 505. Pawff of second mortsage loan
'-=��� �OG. 20I1 2nd 1'2 RE Taxes 5?,405.45
'��� 507
�,�� ;08
'-'�`� i09. F_vcrow I-k'.d
>Jju.�[mcnt�ILr ilem.�uupaid b�ccller ,\JjustmeuLc(ur ilems unpaid Av scller
'I U Countv:xuperiv m�e, �I Q Coun[y oroperty taxes
31I �II.
5I2.
-'�'� 513-
, a �1-1.
�I5
_'IG �I6
- :�'
��,, �ix
'�'� 'i��
'_'_0.Tntal PuiJ I3��:Fur 13urrm��cr !ti?0.000.00 520.Tutal Reduc[ion Amount Due Seller �?R.4?').ri5
3U0.(�a+h at 5c�tlement From�To 13orrower 600.Cash At Settlemen[TmFrom Seller
?U!.��rn�s�Amoun[d�.ie tiom bon�ower(line 1201 5403,688.80 GOL Gross Ainoun[due to seller Iline 4201 $402.'_15.80
:02.Lcss ainoun[s paid i vr(or bon�ower line 220) $20,000.00 G02.Less reductions m amt.due se!ler(line�20) $28,629.85
J03.(�.a+h From 13orro���er 5383,688.80 603.Cash To Seller $373,585.95
Secuon 3 0(;he Real F3[a[c Settlemant Procedures Act(RESPA)requires the Section d(a)of RESP.4:nandates Ihat HUD develop and prescribe this standard
(ollu���i❑�,- .HI�D❑�u>t de��elup u Special Infonnutiun Bookle[ro help persons form to be used a[the nme of lwn setdement to provide fidl disclosw�e uf all
burro��i�.is n�.nney :u Iinunce tlie purchase uf residenual real esta[e to better charrzes imposed upon the buiTower and seller. These are(hird parry disclosures
unJar,tund Uie nmurc and eust_,of rcul csmte setticmen[sen�mcs: thm are desened to provide die bonu�ver«�ith pertinent inf'oi ination durine the
•I�.ac'a Icnder��nu,t nro4 ido Ihe huukici lu ull opphcunts�'rom�vhum it receives �etdamen[process m order ro be u better shopper.
" or for�.ehum ii prepm�c�a��ritmn upplicunon to bun-u��muncy tu 1lnance the The Public Repornne t�urden tor thu collection uP in�brmation is estimatetl to
pu�ci�sse ur rc,idanual rcal eswm: •Lcnders mus�prepare and distniwre�vi[h averaoe one hour per respunse. including'he ume for reviewin�instrucnons
thc Dooidet a Guod Puith Esnmate uf the se[tlement cos�s that the borrower is searchins existine da[a wurces.�atherin�and maintainin�the data needed,anJ
� Iii<ely to incur in connection with [he setdement, These disclusures are completing and reviewin�die collection of intormation.
n-�.andu;ory. This aeency may not collect this informa�ion, and you are not requireJ to
complete thii form,uttless it displays a cun�endy valid OMB con[roi�;umber.
The intoRna[ion reauested does not lend itself[o caniidentiality.
Pre��iuu,Edinons are Obso!e[e Paee I Form HUD-1(3/R6)
Handbook�30�.3
riir:�o. ��iu,��,y
L. Sctticnteni('har�c�
� � � 'D0. Tntal SaIc��I3ruker's Conuni�.aiun based on pricr YJ01.000.00 u,:'Z� =S2d.135.00 Paid�rom Paid From
I)�.�i.i,�n,if(�nnm•.i,,,�oniliue-l)n�:ulnllu��.. f3u�ruwer'S Seller's
'r�l. i1i.60N.011 - ---- -----F.din:iltc:iltc.luc.-------.--- PunJsat Fundsat
- . >IU.N2i.0U i�, �lanuu Itcal F..I:nr�ercice� �I jc4ltmenl Se[:lemenf
b'_
-U_. lununie�i�in P�ai�l ui Srulemcn� y0.00 524.J35.00
'01 tialler[3rol:er Adnun Fee to
70�. Ciuver Admin Fce �o
500. Items Pa��able in Cum�ection wi[h Lnan
A01. Luan Oii�inab.oi�Fee '% tu
RU?. Laan Di�cow�t '% ta
�eo__ :ap��rmsu�Pcc
Si)J C�rcUii Rcpor.
�Uj I inJUr'i In�pJcl��vn i� .�
.._. . -.. _.. . .__.___ _"'_ ..... .. ... ... . .._____.-"_-'_- __-
_._ .... --- c.
hf( �I n r���e I i ur:uKc \�Ul��cau��n
�C' I�lu,�d CCrCI'iculion I�e�'.
SU�_ Dacument Prepaianon Fee to
`iU9. Commimien[fee �o
.�111. Undernrinn_F�e to
81 I. Prucc�sin�Fce :o
A 13. Tu.�Scrcice Fea to
SI� .AJin��nisva;���ePce [o
;y11 (�, �I�c
. ')00. Iirnn Rcipiircd b� Lrudcr fn 13a P:iiJ in�Adrance
�)UI I:�.�ciaeilr 9�JU!?DII IU;Ii'_UII �u 10�I�.,�
�nl'_. AIrnt^_��^_e i�,�.sm�ncc Prciniunt(ur monti�,s tu
9U1 i-lutaid In�.u��nce Pn;nnum tix Yea:s fo
1000.Resene�Depusi�ed Wi[h Lender
1001 Hazard msurance months� per mondi $0.00
;002.��Init�a_e insurance months C per month �0.00
;003.Ci[�pi�iperty�axes months� oer month 50.00
I U��3 C�uuntv properiv mscs mund�s�� orr month $0.00
IUui _As.c.�i;�enl I��c> �r,un:P�„� ermon�h 50.00
1(iUG �Jhuul p;��iprri�I �n��r.�,h. , ni„nu� $0.00
I Oq%.I I()1 Jucti prr:nunln Y0.00
IUUB.Ud;cr Wces ��r.uct�,•..�.�:, per month $0.00
!01 I-.a=�reeate Adjustment
I 100. Title Charges
I IUI.Settlement or closin�fee [o Title One.Ine. 5500.00
I 102.Abstrac[o:-utleseurch and Revie��� to Edina Realtc Titla tnc. $350.00
i 107.Titic ceunnnauon to Titic One.Inc.
110-1 fiticin�ur�nccuindar to
Ilui Uuc�nncn;urc��iuiunnr.
�I uh.A„tan:�cc.� �, Titic Ouc.Inc.
l I U7 ;Altnrnc�'.��es
(indude�ai�o��e i[cins numbers� a:r` .'a,'�'
� . ... ,,.. .. ,, , .,
I IU3.Titic in;w�ance to?itle One,'Under�cruer ;o Title One.Ine. �_-.p�� �
IinciuJes ubuve itams numbers� �
I109 Lcnder'scuvera2e �0.00/$0.00. �s'���:- �,tf,'
i 1 I�) OwncrS eoverase $401,000.00/$927.00
- ,,� �� ,. .�,i.. �. .;:w,�_.��.
I i I! Plat Dra�uns and l:x�m ,o Titic One.Inc.
I I;? \�mc�carch unG Rc�ie�.i in Title One.Inc.
e:�,ai.�\s.��,incnt���ar�h.:ln;il�.�„ ;o TiticOnr.lne.
I?U0. Gu�crnmcnl KccurdinC nud l r.ui..lcr('h:u��c�
_ . Rr:nni��n_ i��.;l��o.00 �i���i,�.�_�� Itci»o.uu :u r�ue tlnc.inc. 5�16.00 546.00
I'_0?. Clh��cuunto ms�stllmps Dccd -ylort�use io i
LU3. Jt�lc Mortgu�e Decd �.N(on�age m �
Reeis[ranon Tax
1201 �,Uilv Smce Deed Tax �o Hennepin Countv Treasw�er 51363.40
'�,ZO�. Conservanon Fee- :o Hennepin Countv Treasurer 55.00`
I'_06. Rec Fees to Tide One.Inc.
1300. 4dJi[iomtl Settlemeut Char�e.i
;-U: �w��t�� tu
�UZ. �'�In,nrc:�.o❑ .
G01. P;!.i:uee i'rucr.�si���e I�c��• Titic Unc,luc.
LU1. Reeureiin_��cn ice F�c !o Tide One.Ine. S?5.00
130�- Pnvuft Handlm��Courier r"az ro Title One.fuc.
I.OG. Pnur Policv Fee to Title One.Inc.
1100.Tutal Settlemen[Charges(enter on lines 103,Section J and 502,Section K) 51,473.00 S26.229.J0
I ha�e caretii!Iv revie�ved the HUD-I Se[;!ement Statemen[and[o the best o(my Icnowledge and beGe[:i[is a n�ue and aecurate s[atement o[all receipts and
dis�burscmenu made ur.m�nccoun[ur by me in this transacuon. I fur[her cernfy Ihat[hove received a completed copy of pages I.?and 3 of 8ii5 HUD-1 Settlement
Staicm��nt
� . � � _�,�...,�G�.�// _- - -- � '-� -��%t--
iz ,��� � � _ ,,. — — -- ,,_�r.�v
� ,_�iiii_�iivi ���i��i ei<iiiu,an<m � ����,. J,(�'��
Th I-ILD�ISIIuiCnt�latcntenl �-ly�ihllave��-cna� �u�unUaCcura[e ���'""� �� p��� l�
u���Auni '�h,�!r ns�cunn. 1 hpv- � u-d hC�u p . �1e '.mrseU.n Huzel L Duudtit
�
accd�rdm �e��i�h thr .�a� ei[ �
\'� , -!� _.C.�_'
Set ement Agei Dare
N'ar�ing:;,is a criine to icnu���ingly mal:c false statemena[o[he Unrted
Swte�on thu ar unp uther.;inviar tiirin. Pen�ives upon con�icnon aan
incluue a iine end imprisunmcnt �nr iiatails�e�•.Ti:�.t I ti 1,.� (�.�r�e�t�u„n
iU01 anci Sect�.u°,i 1010.
Prr•,-;uu.IlJitiun�arc Uh,��le�..: . _ _ [brm HCD-I r3iS6)
hlannbool<�_Oi.]
- -
(Top 3 inches reserved for recording data)
WARRANTY DEED Minnesota Uniform Conveyancing Blanks
Individual(s)to Individual(s) Form 10.1.1 (2006)
DEED TAX DUE: �1,363.40 DATE: C� y t
FOR VALUABLE CONSIDERATION,Jack C. Douthit and Hazel E. Douthit, husband and wife, ("Grantor"), hereby
conveys and warrants to Richarci N. Chalfen, a single person, ("Grantee"), real property in County of Hennepin,
Minnesota,legally described as follows:
Legal description attached hereto and made a part hereof marked Exhibit"A"
Check here if all or part of the described real property is Registered(Torrens)❑
together with all hereditaments and appurtenances belonging thereto,subject to the following exceptions:
Check applicable box: GrantS�r
❑ Seller certifies that the Seller does not know of any �� �/,�
wells on the described real property. I- / C �;�,�'/
� A well disclosure certificate accompanies this /���^- � �4'�`�"
document. � Jack C. Douthit
❑ I am familiar with the property described in this � ��� ���t�, L� ,f:
instrument and I certify that the status and number Hazel .Douthit
of wells on the described real property have not
changed since the last previously filed well
disclosure certificate.
Page 1 of 3
Page 2 of 3 Minnesota Uniform Conveyancing Blanks Form 10.1.1
State of Minnesota
County of Hennepin
This instrument was acknowledged before me on � " ,by Jack C.Douthit and Hazel E.
Douthit,husband and wife
,. �'' a
(Seal,if any)
(s atuie of notanal o//icer)
�� ERIR! P,��GINL�Y � Title(and Rank):
p� � Notary Public-t,Ainnesoza My commission expires: � t�
�
�J MY Commis;ion Emires Jan 37,2075' �(montW ay/year)
�^�f V Vy�h•.'�nnf!�nMnrv+.M,-.nn%�.•��
THIS INSTRUMENT WAS DRAFTED BY: TAX STATEMENTS FOR THE REAL PROPERTY
(insert name and address) DESCRIBED IN THIS INSTRUMENT SHOULD BE
Edina Realty Title,Inc. SENT TO:
6800 France Ave S , Suite 410 Richard N.Chalfen,a single person
Edina,MN 55435 ,
THE SOUTH 455 FEET OF THE WEST 443 FEET OF THAT PART OF THE WEST 1/2
OF THE NORTHEAST 1/4 OF SECTION 3,TOWNSHIP 117, RANGE 23, LYING
NORTH OF THE SOUTH 15 ACRES THEREOF, THE NORTH LINE OF SAID SOUTH 15
ACRES BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT A
POINT MARKED BY A JUDICIAL LANDMARK ON THE EASTERLY L1NE OF THE SOUTHWEST 114
OF
NORTHEAST 114 OF SECTION 3,TOWNSHIP 117, RANGE 23 WHICH IS 492.4 FEET IN THE
NORTHERLY
DIRECTION FROM THE SOUTHEASTERLY CORNER OF SAID SOUTHWEST 1/4 OF THE
NORTHEAST 114;
THENCE IN A WESTERLY DIRECTION AND PARALLEL TO THE SOUTHERLY LINE OF SAID
SOUTHWEST
1/4 OF NORTHEAST 1/4 A DISTANCE OF 1327.25 FEET TO A POINT MARKED BY A JUDICIAL
LANDMARK; THENCE CONTINUING IN SAID
WESTERLY DIRECTION A DISTANCE OF 33 FEET TO THE CENTER OF COUNTY
ROAD NO. 146. AND THERE TERMINATING, EXCEPT THE SOUTH 30 FEET THEREOF. HENNEPIN
COUNTY. MINNESOTA.
,
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Page 3 of 3 Minnesota Uniform Conveyancing Blaoks Form 10.1.1
EXHIBIT"A"
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� TITLE ONE, INC.
601 Carl�on Parkmay,Suite 1140
[l�linnetonka MN 55305
Pbone: 952-745-7890
� � � � � Fac.rimile: 952-745-7898
■ Web.rite: httfr.//wmw.title-1.com
Compliance, Indemnity and Hold Harmless Agreement
File No.: 1103038
Buyer: Richard N.Chalfen
Seller: Jack C.Douthit and Hazel E.Douthit
Property: 300 Brown Road South
Orono,MN 55356
Closing Date: 09/30/2011
Buyer and Seller agree and swear under oath to the following:
1. Closing Fee. Tide One, Inc. is charging a closing fee of$225.00 to Seller for closing the above sale;
2. No Legal Reptesentation. Tide One, Inc. or its employees have not and cannot provide legal advice, and are not
representing either buyer or seller (.ree Minn. Stat. §507.45 subd.3(a);
3. Owners Title Insurance Policy. You have the option of purchasing an Owner's Tide Insurance Policy. The cost
of this policy is $927.00. If you do not wish to purchase the policy at this time, you may at any time for a period of
30 days. Please indicate your choice by initialing below:
-�,Buyer will purchase the Owner's Policy Buyer will not purchase the Owner's Policy
�,`J
�� �_��i� . NO
'� " uutials
initials
If Buyer is uncertain as to whether buyer should obtain this policy, Buyer should seek independent legal
advice.
4. Reissue Credit. Discounts for Resale or Refinance of properties in which a policy of tide insurance has been
pxeviously issued (by any title insurance company) may be available. This discount is available when evidence of the
prior policy is furnished to Tide One, Inc.
5. Buyer Vesting. Buyer request that tide be transferred as follows:
Joint Tenants .---------�--~� Tenants in Common ��»
General Defuutions: "Joint Tenancy" means that if one owner dies, the remaining owners acquire the share of the
deceased owner automatically. When a "Tenant In Common" dies, the deceased owner's share passes to heirs or
creditors according to the laws of inheritance.
If Buyer is uncertain as to legal consequences of this choice, buyer should seek independent legal advice.
Neither Title One, Inc. nor its employees can counsel you on this choice. The only party that can provide
legal advice is an Attorney.
6. Purchase Agreement. The Purchase Agreement that has been received by Title One, Inc. is the full and final
agreement between Buyer and Seller. There are no side agreements or disbursements that will be conducted outside
of closing.
7. Document Correction. If required by Tide One, Inc. or by Lender, Buyer and Seller agree to execute or re-execute
any documentation necessary to fully facilitate the closing, including but not liinited to transferring tide to Buyer
and/or placing Lender's interest of record.
8. Legal Descriprions and Inserting Names. Buyer and Seller authorize Tide One, Inc. to make corrections to the
legal description on any document if an error or typo has occurred. Buyer and Seller further authorize Title One, Inc.
to insert Buyer's name(s) into documents where spaces have been left blank for insertion,including the Deed that will
convey tide.
9. Taxes, Liens and Other Payments. All payments of assessments, taxes, liens, utilities associated with the above
property or any other payments required by the Lender or Tide One, Inc. will be paid pursuant to the Purchase
Agreement. If any payment is not made during closing, Buyer and Seller agree to pay the agreed to amounts,
indemnify and hold harmless Tide One, Inc. against any disputes as to amounts owed or legal fees required to satisfy
any payments required.
Tide One,Ina File No.:1103038
Compliance Agreement-Purchase Revised OZ07
• Seller certifies that Seller has not received notice of any pending assessments. �r '�y�``.
irutials
10. Additional Fees and Costs. Any fees or costs that are necessary to transfer the property as required by the
Purchase Agreement, including any amounts that are insufficiently collected and reflected on the Setdement
Statement (HUD-1) shall be paid by the responsible party as deternuned by the Purchase Agreement.
11. Final Water Reading. Seller certifies that Seller has made arrangements with the city of Orono water department to
have the final water reading made, and all bills for water prior to this final reading are solely the responsibility of
Seller, unless otherwise agreed in the Purchase Agreement. Seller agrees to deEend and hold harmless Tide One, Inc.
from any and all loss, costs, damages, attorneys' fees or expenses which result from any dispute regarding the water
bill.
12. Property Tax Prorations. In the event that property taxes payable in the year 2011 are not available from the
County Treasurer's office, Buyer and Seller agree that the prorations will be based upon last year's actual property tax
amount or an estimate provided by the county. This proration shall be treated as a full and final payment, and an
adjustment WILL NOT BE MADE if figures differ when finalized by the county,unless otherwise agreed by Buyer
and Seller. Tide One, Inc. will not be responsible for any agreement between Buyer and Seller as to this matter, and
Buyer and Seller agree to defend and hold harmless Tide One, Inc. for any and all loss, costs, damages, attorneys' fees
or expenses,which result from any dispute regarding the proration of taxes.
13. Homestead`�,n,formarion. Seller certifies that the real property taxes are currently classified as:
Homestead ��.�, Non-Homestead
initiais initials
�-.Bu�er,,, owledges that they are responsible for homesteading the property. Failure to do this will result in tax
liability that may be based on non-homestead figures.
14. Cancellation of Automaric Payments. Seller acknowledges that any mortgages,lines of credit or home equity loans
that utilized automatic payment MUST BE CANCELLED. Tide One, Inc. will not be responsible for any
payments deducted by any of Seller's Lenders.
15. Full Disclosure of Mortgages, Liens or Encumbrances. Seller swears and affirms that Seller has disclosed ALL
outstanding mortgages,liens or encumbrances that affect the property to be conveyed.
16. Satisfaction of Mortgages, Liens and Encumbrances. Tide One, Inc. is paying off all liens on the properry.
Seller agrees to pay, or if Tide One, Inc. has to pay to satisfy any lien Seller agrees to reimburse Tide One, Inc. for any
outstanding mortgage, lien, judgment or other encumbrance, whether recorded or unrecorded, reported on the
Commitment or not,addressed on the HUD-1 Statement or not.
17. Payoff Indemnification, Shortages and Overages.
a. Seller is responsible for any shortage in Payoff Amount. Seller agrees to pay any additional amounts that the
lender being paid off requires.
b. Any dispute as to amounts owed shall be taken up with the lender after the requested payment has been
made.
c. Seller agrees to make no further draws on any lines of credit that are being paid off.
d. Many times the lender indicates that they will be recording a satisfaction of mortgage. As a result,Tide One,
Inc. does not collect to record this document. If the lender fails to record this document,Tide One, Inc. will
record a Certificate of Release in its place. Seller agrees to pay for the recording of this document if
requested by Title One, Inc. Any dispute as to the money collected by the lender shall be between Seller and
Lender only, and must be sought only after having paid for the recording of a Certificate of Release.
SEL ER:
/�', <x,���
, `�i,..��� ����f�7�
J k C.Dauthit � , Hazel E.Douthit
1 �
�ATE OF MINNESOTA
COUNTY OF HENNEPIN � �f'
Subscribed and sworn to before me this 30th day of September,2011
��
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Si ce of. otary Public
�'�` p
�,+�--�.. ,.
Fr^�'L'���.,< ��I�! ��1��B�V LE'�
t;��;-� No#ary Publio-Minnes�ta
s�„ <
'�;_�a i�AY Commis^ion Expires Jan 31,2475
.ar.4R.^�s�bR�l�+h1R,1 :
BiJYER:
� �`.—
c ard�en - �
STATE OF MINNESOTA
��UNTY OF HENNEPIN f�'
Subscribed and sworn to before me this 30th day of September,2011
� -� _
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4� fi i. ` �' � '
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Si ature of Notarv u lic
Tide Onc,ln�. File Na.:1103038
Compliance Agreemenc-Purchase Rev�sed 07.07
� . ' ' COUNTY USE ONLY MDH USE ONLY
MINNESOTA DEPARTMENT OF HEALTH
Well Management Section,P.O.Box 64975,St.Paul,Minnesota 55164-0975
651/201-4587 or 800/383-9808
WELL DISCLOSURE CERTIFICATE
PLEASE TYPE OR PRINT ALL INFORMATION
Person filing deed must include a$45 fee payable to the county recorder.
A. PROPERTY LOCATION LEGAL DESCRIPTION
Attach a legal description of the property.
County ! Section No. Township No. Range No. I Quarter(or Govemment Lot)
Henne in ' �
Lot No(s). Block No. I Addition Name �, Outlot ,' Tract
PropeRy Street Address
300 S Brow�Road
City/Township i Zip Code I Property ID No./Parcel No.(optional)
Orono i 55356 0311723130002
B. PROPERTY BUYER MAILING ADDRESS AFTER CLOSING
First Name Middle Initial Last Name
Richard N. Chalfen
Company Name(if applicable)
Mailing Address
Mailing Address
City 'I State/Province Zip Code � Telephone No.(including area code)
Provide Name of Seller(please print) Jack C.Douthit and Hazel E.Douthit
C. CERTIFICATION BY SELLER
I certify that the information provided on this certificate is accurate and complete to the best of my knowledge.
�G>�i �ii��r � 9�3 u / /�
Signature of Seller or Designated Representative of Seller Date� �
D. CERTIFICATION BY BUYER
For fulfillment of a contract for deed,the buyer or person authorized to act on behalf of the buyer,must sign a Well Disclosure
Certifcate if there is a well on the property.
In the absence of a seller's signature, the buyer, or person authorized to act on behalf of the buyer may sign this Well
Disclosure Certificate. No signature is required by the buyer if the seller has signed above.
Based on disclosure information provided to me by the seller or other available information, I certify that the information on this
certificate is accurate and complete to the best of my knowledge.
Signature of Buyer or Designated Representative of Buyer Date
IMPORTANT NOTE: The Minnesota Department of Health(MDH)wiil foliow-up with the property buyer regarding any wells
disclosed as not in use. If a well is not in use,the property owner must either retum the well to use,have the well sealed by a
licensed well contractor, or obtain an annual maintenance permit from the MDH for$175. A copy of this Well Disclosure
Certificate should be provided to the property buyer at the time of closing.
' � M � K N E : a r� MINNESOTA DEPARTMENT OF HEALTH
� WELL DISCLOSURE CERTIFICATE Indicate Total Number of
PLEASE TYPE OR PRINT ALL/NFORMATION wells on Property
DEYItiNEMlo�HEdlfH
Fill out a separate well information page if more than two wells are located on the property.
E. WELL LOCATION LEGAL DESCRIPTION
WELL#1 -If the property legal description has more than one section,township,or range number;quarter(or government lot);
or lot or block number;provide specific legal description information regarding the physical location of this well.
County Section No. Township No. Range No. Quarter(or Government Lot)
Henne in i
Lot No. Block No. Addition Name Outlot Tract MN Unique Well No.or Sealing
Record No.
WELL STATUS(Check only one box) �� Date of Well Construction or
WELL IS: �n Use(1) ❑ Not in Use(2) ❑ Sealed by Licensed Well Contractor(3)' Sealing
�Call MDH to verify sealing recard is on file
Name of Licensed Well Contractor
If the well has been sealed by someone other than a licensed well contractor or a licensed well sealing
contractor,check the well status as not in use. Also see"IMPORTANT NOTE"on page 1.
If well is not in use,is there an MDH variance for this well? If the well is not in use,is there an MOH maintenance permit
❑ Yes ❑ No for this well? ❑ Yes ❑ No
If yes,provide the variance tracking number(TN) If yes,provide the permit number
WELL#2-If the property legal description has more than one section,township,or range number;quaRer(or govemment lot);
or lot or block number,provide specific legal description information regarding the physical location of this weil.
County Section No. Township No. �I Range No. I Quarter(or Govemment Lot)
i
Lot No. Block No. Addition Name Outlot Tract MN Unique Well No.or Sealing
Record No.
WELL STATUS(Check only one box) Date of Well Construction or
WELL IS: ❑ In Use(1) �Not in Use(2) ❑ Seaied by Licensed Well Contractor(3)` Sealing
'Call MDH to verify sealing record is on file
Name of Licensed Well Contractor
If the well has been sealed by someone other than a licensed well contractor or a licensed well sealing
contractor,check the well status as not in�se. Also see"IMPORTANT NOTE"on page 1.
If well is not in use,is there an MDH variance for this well? If the well is not in use,is there an MDH maintenance permit
❑ Yes ❑ No for this we117 ❑ Yes ❑ No
�f yes,provide the variance tracking number(TN) If yes,provide the permit number
SKETCH MAP-Sketch the location of the well(s)and include estimated distances from roads, streets,and buildings. If more
than one well on property,use the well location number above to identify each well. The location of the well(s)must be
provided. If the location of a well is not known,have the well located by a person qualified to locate wells,such as a licensed
well contractor.
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Information provided on this form is classified as public information under Minnesota Statutes,Chapter 13.
To request this document in another format,call 651/201-4600. Deaf and hard-of-hearing: TTY 651/201-5797.
Visit the MDH Well Management Section,Well Disclosure Program web site at: www.health.state.mn.us/divs(ehlwell/disclosures
HE-01387-11 IC#140-0385 origs\well disclosure certificate-instructions 07/08R
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11. G1F�QINA4 COPYTO U87'�NG BF�K�R;COp1E$TO SELLER,HU'�Efi,SEl,LfNGi BROKER
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THE SOUTH 455 FEET OF THE WEST 443 FEET OF THAT PART OF THE WEST 112
OF THE NORTHEAST 1/4 OF SECTION 3, TOWNSHIP 117, RANGE 23, LYING
NORTH OF THE SOUTH 15 ACRES THEREOF,THE NORTH LINE OF SAID SOUTH 15
ACRES BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT A
POINT MARKED BY A JUDICIAL LANDMARK ON THE EASTERLY LINE OF THE SOUTHWEST 1/4
OF
NORTHEAST 1/4 OF SECTION 3,TOWNSHIP 117, RANGE 23 WHICH IS 492.4 FEET IN THE
NORTHERLY
DIRECTION FROM THE SOUTHEASTERLY CORNER OF SAID SOUTHWEST 1/4 OF THE
NORTHEAST 1/4;
THENCE IN A WESTERLY DIRECTION AND PARALLEL TO THE SOUTHERLY LINE OF SAID
SOUTHWEST
1/4 OF NORTHEAST 1/4 A DISTANCE OF 1327.25 FEET TO A POINT MARKED BY A JUDICIAL
LANDMARK; THENCE CONTINUING IN SAID
WESTERLY DIRECTION A DISTANCE OF 33 FEET TO THE CENTER OF COUNTY
ROAD NO. 146. AND THERE TERMINATING, EXCEPT THE SOUTH 30 FEET THEREOF. HENNEPIN
COUNTY. MINNESOTA.
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Form No.115-M AFFIDAVIT REGARDING PURCHASER :�tinnesota Uniform Convevancin Blanks(1978
AFFIDAVIT REGARDING PURCHASER(S)
Richard N.Chal(en ,being first duly swom,on oath say(s)that
1. They aze/He/She is Richard N.Chalten ,the person(s)
named as mortgagor(s)in the document da[ed 09/30/2011 ,and filed for record as Documen[No.
in the Office of the County Recorder of Hennepin Counry,Minnesota.
2. Said person(s)(is/are)of legal age and under no legal disability with place(s)of business respectively at:
and for the last ten(10)years(has/have)resided at: '*SEE ATTACHED*"
3. There have been no:
a. Bankruptcy,divorce or dissolution proceedings involving any of the Person(s)during the time the Person(s)(have/has)had any
interest in the premises described in the above documents.("Premises");
b. Unsatisfied judgments of record against said person(s)nor,to your�ant(s)knowledge,any actions pending in any court,which
affect the Premises;
c. Ta�c liens against said person(s);except as herein stated:
4. Any Bankruptcy,divorce or dissolution proceedings of record against paRies with[he same or similar names,during the period in which
the above named person(s)(has/have)had any in[eres[in the Premises,are not against the above named person(s).
IVONE.
5. Anyjudgments or tax liens of record against panies with the same name or similar names aze not against the above named person(s)
NONE.
6. There has been no labor or ma[erials furnished ro[he Premises for which paymen[has not been made.
YONE.
7. There are no recorded or unrecorded contracts,leases,mortgages,easements,or o[her agreements or interest relating to the Premises
except as herein stated:
NONE.
�ant(s)know(s)the matters herein stated are vue and make(s)this�davit for the purpose of inducing the acceptance of title to the
Premises.
STATE OF MINNESOTA ��`-- — ' '6/�
chard N.Chalfen
COU�ITY OF HENNEPIN ss.
Subscribed and swom to before me Se tember 30,2011 '�
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- SIGNATU O PE TAKING ACKNOWLEDGEMENT
THIS INSTRI.`h�NT W AS DRAFTED BY(NA.^.�A'JD?.DDRESS):
Title One,IRC. NOTARIN STAMP OR SEAL(OR OTHER TITLE OR ftANK)
]4985 Glazier Ave.
Suite 335
Apple Valley,MN 55124
File No.:1103038
Ti[le One,Inc. File No.�.I 107078
Fortn�.Affidavit-Purchaser Revised�.02.04
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TITLE
TITLE ONE, INC.
Buyer Address Information Form
File No.: 1103038
Closing Date: September 30,2011
Please fill in or verify all information.
Buyer(s): Richard N. Chalfen
SSN: B1: B2:
Property Address: 300 Brown Road South
Orono,MN 55356
Primary Residence?� YES �No
If NO,please provide
HOME Address
/
Home Phone No.: B1;;'w ,� .�,� B2:
Work Phone No.: %�B1: B2:
Cell Phone No.: ' B1: B2:
e-mail:
Buyer's Closer: Samantha K. Skinner
Company: Title One, Inc. -Minnetonka
Phone No.: 952-745-7890
//l_ �
Rich N.Chalfen
Please attach a photocopy of drivers licenses.
Tidc One,Inc.
File No.:ll03038
Fo�rn:Address Infonnanon Fo�rn-Buyer Revised:OB.OS
/
S�� Dq� TIME "
CITY OF ORONO CALLED IN �� L�
INSPECTION OTJ� E SCHEDULED l-2-`� �
PERMIT N0. Y�D�G � COMPLETED
ADDRESS � •
OWNER TELEPHONE N0. 7�3 T/� �7o Z
CONTRACTOR �`�-�"a�- S'��
J�'� �
�: DESCRIPTION �'�� r L� d--���
�
l� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL � ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
�
Q ❑ 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
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATiON/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW �/ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED C7 ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR W{LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUtRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-460�
OwnerlContractor on site:
Inspector. � ` ��
White Copy/lnspector's File Canary CopylSite Notice