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Home My WebLink About2011-00236- addn/remodel/repair CITY OF ORONO PERMIT NO.: 2011-00236 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE Iss[1ED: 07/12/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1265 BRACKETTS POINT RD PIN : 11-117-23-32-0010 LEGAL DESC : RGT ORONO POINT : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPA[R ACTI V ITY : 434-RESIDENTIAL VALUATION : $ 250,000.00 NOTE: SEPERATF PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) ADVANCED PLAN REVIEW$1,271.89 PD WITH CHECK#081252 PERMIT FOR A TRELLIS APPLICANT PERMIT FEE SCHEDULE 1,956.75 STREETER&ASSOC[ATES STATE SURCHARGE(VALUATION) 125.00 18312 M[NNETONKA BLVD WAYZATA, MN 55391 TOTAL 2,081.75 (612)449-9448 Minnesota State License#: 1380 OWNER O'SHAUGHNESSY, ROGER 1265 BRACKETTS POINT RD. WAYZATA, MN 55391- 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 goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and oid if construction authorized is not commenced within 180 of the date of issuance,or if construction is suspended,�r a period f 80 days at any time after wark has commenced. The appli t is respo le for assuring all required inspections are requested n conform e with the State Building Code.This permit may be revoked any time due cause. / �� / �� /�� Appl' ant rmrtee Signature Date Iss d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �� ) ��►Z �1 City of Orono l Building Permit Application for New Structures or Additions �a�8� - 7� Mailing Address: Permit number: ��,�,� PO Box 66 ,\ � Crystal Bay, MN 55323-0066 Date received: // �'k '� �I �-. . Received by: `� }y {,�,� , �,� Sf�eet Address: �/• Q \�.�c, ��,�t� G�� 2750 Kelley Parkway Plan review fee: l / �.tR �<�"� � Orono, MN 55356 �D!�—OO� �?fEsxos'' --___ ' Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: 2,(p,, � �''� ��j�, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATIpN: Name: � � �((� � "�c�Cl,'�-'f'�C J�� State License# Expiration Date: 3 3( �2 Phone: G.�72-�-l.��j - (office) S'%� ��f(✓` ?`{�j (cell)t�/z-��- Mailing Address: I��Z M�rv�-�'o+-3� �J�� Cit ZIP: 5��3`�l yL�' Y� `l,?�}`'l�r�r�4 Contact Person: ^�,�� EZ,,�� Applicant is: ontrac� / Homeowner (Circle One) Email and/or Fax: rvd�aic.�,�� 57f�'�,�- q.�,src��q�s • C�� PROPERTY OWNER INFORMATION: Name: �E;�,�2 C� ��69vbr�� Phone (day): �($�Z.-�ZZ"t - Z�,pl Address: �Zb�} '��a:r--,5 �,;�T 2v� City: (�2,C� ZIP: !��3`t/ Email and/or Fax LTp./�Gv� � (�,4(Li�j��r�i, L�,�.�'.('��.� ARCHITECT/ENGI ER INFORMATION: Name: �9�,4t-�►�1M �� F!'RP.�tI r'6F;�'tG�.- Phone (daY)� Zpl.,- ��Z.�-�"l�'1�Z. Address: �4�g /Z ry �� City: �(�E �lU� ZIP: ��Z Z Email and/or Fax: 2�.-iT l� (o24E�1/a�i�G}P�•C'.�� PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ❑ New Construction ❑ Single Family with ❑ Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ��her: (specify) �'S ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water ""Any earth movement may require ❑ Commercial �Other(specify) MCWD review 8�permits. ❑ ndustrial ��5 ❑ Private Well Minnehaha Creek Watershed District(MCWD) ther: (SpeCify) 18202 Minnetonka Blvd �J�r�,q}-�� Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ �� CUSTOM HOMES • RENOVATION • DESIGN BEN DUNLAP,Senior Project Manager Neu�Nome Division � Dicect 952.4495746 z 1��R Streeter�Associates,Inc■ 18312 Minne[onka Btcd.,Wayzata,MN 55391-32 3 2 952.449.9448■Cell 612.801.4002■Fa�952.449.4987■MN Lic.�1380 E-inail I�unlap�StreetervA.sociares.com�wwwSereeter-Associatescoin I STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= Number of bedrooms= �I Wood/Frame ❑ Masonry b.Width (ft.)= Number of garage stalls: �,Metal Attached= ❑ Pole Bldg. Areas in square feet Detached= ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 15`Story = ❑Other(please specify): e. 2nd Story= f. YZ Story = g. Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ Permit A lication ❑ Pro osed Buildin Plans O MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ Surve meetin all re uirements ❑ G� Stormwater Pollution Prevention Plan ❑ Hardcover Calculation s ❑ � Se tic S stem Site Evaluation Re ort ❑ ,� Access Permit ❑ � Wetland Buffer Im rovement Plan � ❑ En ineered Plans for Retainin Walls 4 feet or above � ❑ Plan Review Fee ❑ ❑ Other APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; • Certifies that the 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 ail 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 co �ditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested a tempo ertificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the a -built su nd all site improvements. 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O .Y = � � at m ._ � a� � Q O � t g � � �- p� � � -� � U � ... u� .- E O .c L .- u� ... 0 N � p o p � � �; a � 3 � o> c � � � a� a�i ca c � in �n � o -� 0 3 0 �' � � +� Y d I� N � r � �` O Q •� � � � •� � � � � Z 2 N � y � � � � •� N'� ; n- � � p � L. N p � � J � � ~ U U � i N V o � � p r' � � � a eA N m U' ji N cn � C a� m � � � � a� ._ } � N `n Y o m � •� � � � ° o � a ¢ m m � � � = Q �g U € - Q � N N (A � LL m I�i � � � W� o W a� � � N y-� r �j, ' �Q�f^^.F� kJR � �,�SaJ�f{v�k"�c`�•'. �'1.2-�� KFAd21��kNT t1� OROr►G+ �4�+*�ET HARDCOVER CALC�I.LL�TION WORKSHEET SETBACK ZONE: (CiRCLE ONE} 0-75' S-250' 250-500' 500-1000' t `'� ��j � €� EXfSTING HARDCOVER IN ZONE A. House x = �b� S.F.-�fl�SC Length Width x = 6�t� s.F.- +3�r4Drt�� x = 96� S.F. -OOOV B. G�age x __ = i'i�� S.F.-P40L (��sT�t7 C. Driveway x = b6�S S,F.-Q��GK��'��`'�'°`'Y x = 4�43 S.F.- STONc' w.4UG D. Sidewalk x = 2$I S.F.-FZo�T fNTf2�1�e� x = i S� S.F.-�'��ppt��e;- �`•:��'S �. E. Patio/Deck x = �3 S S.F. `W�'Up �N�:uC x = 30�3 S.F.-�pT -rvf; pEcr< F. Landscape x = S.F. Underlain x = S.F. By Plastic x = S.F. G. Retaining x = 1L}-��j S.F.- ��p"��" Walls S .41G�f3 �LrC- H. Other x = �2.{� S:F.- T;aGr»� l;�„Q,i TOTAL HARDCOVER IN ZONE - 2i,��61 S.F. A TOTAL PROPERTY ARE;4 IN ZONE - 45,,42D S.F. B A 2►{f,b1 = B 4�42� x100 = 2?,7D % PROPOSED HARDCOVER IN ZONE �vEr G�.N�r -- p�2o P�S�� A, HOUse x = �' I25 S.F. `"��r?F vvE,2 P��T�O Lengtn Width = S.F. ' u� ❑ � � . = S.F. a� — ,°'�, m v � -o �.� B. Garage 'D 'D �' � .+ = S.F. � -* C. Driveway 0 O O x� � � = S.F. rn x< p� -e - S.F. � � � � 3 D. Sidewalk xp �° n = S.F. �' S.F. x� � � E, Patio/Deck � X I� _ s�F� LL1 0 0 _ X � - S.F. ) `�' � z ' ' rr O F. Landscape �' x � = S.F. U �, � Underlain x = S.F. W � 0 By Plastic x � = S.F. � ,Q � G. Retaining x = S.F, U UValis � 21� G� � H. Oth2r x = * � �� 5.�. TOTAL HARDCOVER 1N ZONE - �� , 7�� S.F. A TOTAL PROPERTY AREA IN ZONE - q�,42 D S.F. B q = B x 100 = 22,$3 °� � • � - K.C>c�Ei', �. �!,�r.�1�a �;��r' J�"x+�n� �='�"'� ��.!�2A N6,�I�•�h r.{�" 4'�' 4_'].tj -ND G�-lqr+�e'� HARDC ER CALCULATION WORKSHEET '��~� ��"�� SETBACK ZONE: {CIRCLE ONE) 0-75' 75-250' 250-500' 500-1000' �N �-aT �(� EXISTING HARDCOVER IN ZONE A. House x = S.F. Length Width X = S.F. x - S.F. B. Garage x - S,F. C. Driveway x = S,F, x = S.F. D. Sidewalk x = S.F. x = S.F. E. Patio/Deck x = 3�Z S.F.-,�� a�L 7;� ''u f` _ x = S.F. ' F. Landscape x = S.F. Underlain x = S.F. By Plastic x = S.F. G. Retaining x = S.F. W alls H. Other x = S.F. TOTAL HARDCOVER IN ZONE - 343Z S.F. A TOTALPROPERTYAREAINZONE ;"'_'� '� ��'��-_= �? ��"- ��"•,� - 5?.44o S.F. B A 3$2 ;. g S?.'�4 p x 100 = ��.67 % PROPOSED HARDCOVER IN ZONE A. House x = S.F. Length Width x = S.F. x = S.F. V` B. Garage � -J � ��—, n = S.F. C. Driveway z � � � �� _ S.F. n p x� �° ... = S.F. m m m N r D. Sidewalk. � � �• � = S.F, � � � = S.F. � Z _ � W = O E. Patio/Deck x = S.F. � N � rr x �. = S.F. U � 0 � F. Landscape x = S.F. � 0 Underlain x = S.F. W Q }- By Plastic x = S.F. � � _ � � G. Retaining � Dc = S.F. Walls I H. Other � v x = S,F. TOTAL HARDCOVER IN ZONE - S.F, A TOTAL PROPERTY AREA IN ZONE - S.F. B A = B x 100 = % �� ' � �] DATE TIME ✓ CITY OF ORONO CALLED IN / � INSPECTION NOZI�E �� CHEDULED 7 _�� PERMIT NO. �� l�(/v�/�OMPLETED ADDRESS d OWNER TELEPHO E NO. l —� � �C� CONTRACTOR ��-�� ' �� >; DESCRIPTION � t� ❑ 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 � ❑ 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: � W C � � O � �, � `�1`�� ..t �`- 0 � W � Q � z W � W � � � d �y�� W Y�wORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑ CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY W O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-460� OwnerlContractor on site: . � Inspector. o� ' =� -- White Copyllnspector's File Canary CopylSite Notice Planning • Zoning Department Memo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: 5/21/2012 G/L: 101-22205 Re: Building Permit Escrow Refund Building Permit #2011-00236 pertaining to 1265 Bracketts Point Road is complete. The Applicant, Streeter & Associates, on behalf of the property owner, Roger O'Shaughnessy, has requested a refund of his $2,500 escrow. The following is attached: • Escrow Refund Request • Email from Bonestroo indicating no unbilled WIP on this project • Email from Campbell Knutson indicating no unbilled WIP on this project • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Roger O'Shaughnessy 1265 Bracketts Point Road Wayzata, MN 55391 wAstreet files\wakefield road\220\escrow refund memo 2011-00339.doc Christine Mattson From: Darren Amundsen Sent: Wednesday,May 16, 2012 9:17 AM To: Christine Mattson Subject: RE: Unbilled WIP None for us From: Christine Mattson fmailto:CMattsonCalci.orono.mn.usl Sent: Monday, May 14, 2012 4:26 PM To: Amundsen, Darren; 'Sherry Charboneau' Subject: Unbilled WIP Hello, Any unbilled WIP for the following? Zoning Application Address WIP 11-3533 3980 Dahl"Road NO Building Permit 2011-00236 1265 Bracketts Point Road O 2011-00339 220 Wakefield Road O 2011-00417 1255 DickensonStreet O 2011-00448 2940 Fox Street O 2011-00010 f/k/a/155 MacKinnon, now 155 Kintyre O Lane Christine Mattson Planning Assistant City of Orono 2750 Kelly Parkway Orono I MN 155356(physical address) PO Box 66 1 Crystal Bay I MN 155323-0066(mailing address) 2 952.249.4620 1 8 952.249.4616 ®cmattson@ci.orono.mn.us 1 -16 www.ci.orono.mn.us Office Hours: Monday-Friday 8 am to 4:30 pm Summer Office Hours begin Monday,May 21,2012 Monday-Thursday: 7:30 am to 5 pm/Friday 7:30 am to 11:30 am OUR OFFICE WILL BE CLOSED: Monday, May 28,2012(Memorial Day) 1 Christine Mattson From: Sherry Charboneau [SCharboneau@ck-law.com] Sent: Tuesday, May 15, 2012 10:53 AM To: Christine Mattson Subject: RE: Unbilled WIP Christine: No unbilled WIP on any of these for Campbell Knutson. Have a good day. Sherry Sherry L Charboneau Legal AWstant CAMPBELL KNUTSON P.A. 1380 Corporate Center Curve•Suite 317•Eagan,MN 55121 Iff(651)2346230•Fax:(651)452-5550 ®scharboneauOck-law.com•www.ck-law.com From: Christine Mattson [mailto:CMattsonlalci.orono.mn.usl Sent: Monday, May 14, 2012 4:26 PM To: Darren Amundsen (darren.Amundsen(&bonestroo.com); Sherry Charboneau Subject: Unbilled WIP Hello, Any unbilled WIP for the following? ZoningApplication Address 11-3533 3980 Dahl Road Building Permit 2011-00236 1265 Bracketts Point Road 2011-00339 220 Wakefield Road 2011-00417 1255 Dickenson Street 2011-00448 2940 Fox Street 2011-00010 f/k/a/155 MacKinnon, now 155 Kintyre Lane Christine Mattson Planning Assistant City of Orono 2750 Kelly Parkway I Orono I MN 155356(physical address) PO Box 66 1 Crystal Bay I MN ( 55323-0066(mailing address) 9 952.249.4620 1 A 952.249.4616 ®cmattson@ci.orono.mn.us I -t www.ci.orono.mn.us Office Hours: Monday- Friday 8 am to 4:30 pm i Checklist for Refunding Building Permit Escrows Building Permit # I-M53q Street Address: = Watd "K&d_.. Applicant Name: -- 1� Escrow request received Date: Permit Type: l on Are all completed?inspections es No P If not, list what is outstanding: Was there a Temporary Certificate of Occupancy issued? Yes No Date: Was there a Final Certificate of Occupancy issued? Yes No Date: ❑ As-built survey required? Yes, approved on NO DNA ❑ Email CK & Bonestroo to see if there is any unbilled WIP. Date email sent: ❑ Prepare memo for Finance Department z:\fonns\zoning standard forms\checklist for refunding building permit escrows.doc Last Updated: 10-31-2011 BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2011-00339 AGREEMENT made this 7 day of , 2k0 &/ , y d between the CITY OF ORONO, a Minnesota municipal corporation ("City")and al A.il/.f AV'(5 ("Owners"). Recitals 1. A building permit application has been filed for an addition located at 220 Wakefield Road the ('Subject Property"), legally described as Lot 1, Block 1, Wakefield Farms 2nd Addition , 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 #2011-00339 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 b the City exceed the amount in escrow,the City shall have the right to certify the unpaid balance to the subj ct'pirio5pypu uant to Minn. Stat. §§415.01 and 366.012. CITY: OWNER: By: Its: `" �► \ 4 i cit of of Kelley Parkway 92-249-40 Sm Receipt !b: 3.004927 Jul 08, 2011 Beth # Rick Davis pla"* and Zcnin 2 500.00 201101 20D Wakefield , Rd 101-2m elo r Deposit Deferred Rev-Dev Pe Total: 2,500.00 Cfieck k too: 1026 2,500.00 Payor: Betfi & Rick Davis 2�5g0.00 Total Applied: Change Tendered: .00 07/08/11 07:47PA CITY OF ORONO PERMIT NO.: 2011-00601 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 07/08/2011 952 249-4600 FAX: 952 249-4616 ADDRESS 220 WAKEFIELD RD PIN 36-118-23-31-0010 LEGAL DESC WAKEFIELD FARMS 2ND 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 2011-00339 APPLICANT ESCROW FEE-BUILDING 2,500.00 DAVIS,RICHARD&BETH TOTAL 2,500.00 220 WAKEFIELD RD WAYZATA,MN 55391- OWNER DAVIS,RICHARD&BETH 220 WAKEFIELD RD WAYZATA,MN 55391- 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 grantpermission 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. . �. #I- PervitWorks File Transaction Maintain Reports i� Geobase Property Record * Permit Permit#: 20114MM Update Address Permit Address: 1220 WakefieW Ind r' Main PIN Address r Additional PIN Address General I Fees WsPectioos X41 I Nates I Appicant Detai I CO Defarl I Seq InspecOon Type Inspector Date Status tHFee Rec2 Franc ng WGtD 9fi=11 P 3 Insulation SOMA 9V20I2011 P 4 Final WGIB 12H62011 P I Ml Add New Dalale