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Home My WebLink About2015-00902 - addn/remodel/repair CITY OF ORONO * z 0 1 5 - 0 0 9 0 2 * � ' 2750 KELLEY PARKWAY DATE ISSUED: 1U16/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1120 COX FARM RD PIN : 27-118-23-31-0021 LEGAL DESC : SHADOWOOD FARM : LOT 005 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 35,000.00 NOTE: SEPARATE PERMITS REQUIRED: ELECTRICAL(STATE) NOTE: PRIOR TO RELEASG OF ESCROW MONEY AN AS-BUILT SURVEY MUST BE SUBMITTED AND APPROVED. INfTIAL: �" � . APPLICANT PERMIT FEE SCHEDULE 546.55 STATE SURCHARGE(VALUATION) 17.50 TONY SCHREMPP CONSTRUCTION LLC 1450 81ST STREET TOTAL 564.05 VICTORIA, MN 55386- Payment(s) (952)443-2529 CHECK 3108 564.05 Minnesota State License#: BUIL-4357 OWNER WAGENER,GREGORY& LAURA 1 120 COX FARM 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 goveming this type of work shall be compied wi[h whether or no[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. �-� �._ k �- �G, ,� o Sti /l � �� Applicant Permitee ture Date Issued By Sig re Date � City of Orono Building Permit Application for New Structures or Additions Mailing Address: Permit number: or��S--(� 9D � �� PO Box 66 Q Crystal Bay, MN 55323-0066 Date received: 7—��— S StreetAddress:' Received by: {�/� � ,� 2750 Kelley Parkway � y�' c,` Orono, MN 55356 Plan review fee: lqKfSHO�� Main: 952-249-4600 — o � -S—�� D � Fax: 952-249-4616 ww�.ti�.ci.orono.mn.us �� U� C'� This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) ��j-�S�� j ;—i 3 't5 GENERAL INFORMATION: ✓ -J Job Site Address: � � �d �� Will this be a Parade of Homes, Remodelers Sh wcase 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 service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Nam e: l" o�� S�_t-� 6ZG � �� c'� ��"��'Lv c r � �w �-- � �,` State License# 1`� � o � � 3 �a Expiration Date: � ��\- 1 C Phone: cell ('i'�'�_ �— ''�� (office) � r Z� `�� '�- � 5 ��,�� Mailing Address: � -� S o e3 � S� Cit : V� C b (�) L� ZIP: S �' � � Contact Person: �' �� y Applicant is: Contractor, / Homeowner �c��ie o�e� Email and/or Fax: PROPERTY OWNER INFORMATION: Name: G �. G �C v� � 6 �� c� 1� Phone (day): C � �- "� "J� — � Address: � � � � c o� � A �.`� d�0 �� City: � �c� �d ZIP: Email and/or Fax ARCHITECT/ ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of project: "� ° d t,� � 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8 Water Supply � New Construction � Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck ❑ Public Sewer ❑ Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage ❑ Residence ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater ❑ Public Water *"Any earth movement may require ❑ Commercial Storage MCWD review& permits. ❑ Industrial Warehouse ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(speCify) 15320 Minnetonka Blvd Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.mmnehahacreek.or Estimated Construction Valuation (excluding land) $ � �� b � � ! � C Packet Last Updated: January 2015 Page 20 STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction . - a. Length(ft.)= a 6 � Number of bedrooms= �Wood/Frame b.Width(ft.)= � � ' Number of garage stalis: ❑ Masonry Areas in square feet Attached = � ❑ Metal ❑ Pole Bldg. c. Basement= Detached= ❑ ICF d. 151 Story = k ❑ On-site Prefab e. 2"d StOry= ❑ Off-site Prefab f. 'h Story = ❑ Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ ❑ Plan Review Fee ❑ ❑ Com leted A lication Form • ❑ ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/z x 11 set � ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ ❑ Surve —2 full size,to scale meetin ALL surve requirements ❑ ❑ Hardcover Calculations ❑ ❑ Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired ❑ ❑ Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan SWPPP ❑ ❑ Access Permit ❑ ❑ Data Privac Adviso Form 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 femporary 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: C'�� , �� Date: �7 � �' ` � � Owner's Signature: Date: Packet Last Updated: January 2015 Page 21 - PLp►N REVIE�W CHEGl4LIST FOR I�EW STRtJCTURES / �DQ�ITIO�S Address: � [�J l�J� ��1'�, f�A Permit No.: �l� '�QQ�-- ^ ,�,� � Description of work: �1 I �� Da�e Rec'd: � ' �.� • t� s�p •c �ta�ct ��, eptic review by: Date�pproved: �� '.1� � `�' Zoning review by: '�--- Date Approved: 61 ' �� ' t� Building review by: Date Approved: � � ' � 2. � �� ;"` .r�".- . Grading review bye _�F��-� Date Approved: �,��:��%`�� , Zoning District: ��,,� Zoning File#: Reso#: Reso� Date: Zoning: Lot Area: Z..�r _�AC IlVidth: Lot Coverage: �I� SF % Survey Submitted: � Yes Q No Date o4�Survey: Revised date(?): Proposed Setbacks: � �}• ` Front(I.�k�5� Rear(St�fS� � N S E W ) ( N S E W� Other Buildings Wetland Side Side ��' ; Defined Height: Peak Height: FFE: FFE minus 6 feet= (�xisting Contour) Perimeter(linear feet)= 50% = L.F. beio�nr grade #of Stories FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: The distance between the lowest proposed The distance betweeh the top of START WITH floor(of the basement or crawl space)and START WITH slab and the highest point of the _ the highest point of the roof. roof. If you have a_. If you have a... • GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF(no (no windows): Subtract half windows): Subtract half the distance the distance between the between the highest point of the roof highest point of the roof to to the low point of the corresponding SUBTRACTION gable or hipped roof the low point of the corresponding gable or (BASED ON . GABLE OR HIPPED ROOF(with SUBTRACTION hipped roof ROOF TYPE) windows): Subtract half the distance (BASED OPJ . GABLE OR HIPPED ROOF between the top of the highest ROOF TYPE) (with windows): Subtract window and the highest point of the half the distance between roof the top of the highest window and the highest • ALL OTHER ROOF TYPES(flat, point of the roof mansard,etc):No subtraction. . ALL OTHER ROOF TYPES SUBTRACTION Subtract the distance between the (flat,mansard,etc}:No (BASED ON basemenUcrawl space floor and the subtraction. EXISTIPIG highest existing grade adjacent to the ADDITION Add the distance between the top GRADES) foundation OR 10 feet(whichever is less). (BASED ON of slab and the highest existing EQUALS Defined building height EXISTING grade adjacent to the foundation. i GRADES EQUALS Defined building height �, Average Lakeshore Setback Shoreland District MCWD Permit Met? Bluff �es � No Per it Number: � Yes O No N/A � Yes No � N/A—see attached Setback: � Storrnwater C�uality Proposed ' Existing Hardcover E Overlay District (o�o and s� Hardcover Variance Required CUP Required ( Tier circle one %and s �` C5 Yes � No � Yes � No � 1 2 3 4 5 Type(s): Type(s): � Updated: January 2015 � z:\formslplan review checklist 2015.docx � E � � � �,:-. _ REMARKS (in-house): Fees to be Char ed YES NQ ; Permit �'•. Plan Review State Surcharge investigation Fee � � SAC—Nurnber of SAC Units Other(specify) S uare Foota e $ per Square Fo�ta e Basement X = $ 15t Floor X =. $ 2nd Floo� X = $ Garage X = $ Estimated Construction Value: ��E� Orono Inspections Required Work Requiring Separate Permits Required State Permits Y 0 Site 0 Plumbing � Grading/ Filling ❑ Well � O Silt Fence/ Erosion Control 0 Mechanical � Fire Electricaf � Hardcover Removal 0 Septic � Water Connection Footing � Fireplace 0 Sewer Connection 0 Poured Wall 0 Masonry � Lawn Irrigation � Foundation Survey 0 Mfg. � Landscaping ❑ Foundation Waterproofing a Other(specify) � Radon Rock Bed � � ""� �' /� � ' ' ' `" C�G°�(/ �� ,.� C��C � Framing �i 1lnsulation ' 4 As-Built Survey O� /��0 � � l��' Final � � Other(specify) ��/`��-�, / , ,� REMARKS in-house : �� a � � � ( ) � �(i� �� - f � � . . �' , � Other Review: Reviewed by: Date A� �,�Q.(5 �� P(.�f'L� S�GW �-� i Acces�: Existing: � YES 0 NO New: C � � �� • R� OFFICIAL REMARKS -TO BE NOTED ON PERM{T AND INITfALLED ��i r � � -�U� ��' �� i� I�� .2 �t��►�ti t-' t��V 0(• Updated: January 2015 z:\forms\plan review checklist 2015.docx >. Christine Mattson From: Adam Edwards Sent: Monday, November 09, 2015 8:31 AM To: Christine Mattson Subject: RE: 1120 Cox Farm Road/#2015-00902 Approved From: Christine Mattson Sent:Thursday, November 05, 2015 3:25 PM To:Adam Edwards<aedwards@ci.orono.mn.us> Subject: 1120 Cox Farm Road/#2015-00902 Adam, We received a building permit application for a garage addition. Please review and provide comments. Thank you. Christine Mattson Planning Assistant City of Orono 2750 Kelley Parkway `` Orono ; MN ; 55356 (physical addressJ PO Box 66 ; Crystal Bay ' MN 55323-0066 (mailing addressJ '� 952.249.4620 8 952.249.4616 � cmattson@ci.orono.mn.us ' � www.ci.orono.mn.us Office Hours: Monday- Friday 8 am to 4:30 pm OUR OFFICE WILL BE CLOSED: Wednesday, November 11, 2015 1 ' � City of Orono �o�o Hardcover Calculation Worksheet ' ��j _ ' Property Address: �� 2p CoX FARn, QOA� �'^'��'-�� Prepared by: '.�'�k�.Y e.� � • l sc.k� Date: tl( E l� Stormwater Quality Overlay District Tier: (Circle one) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Step 2: PROPOSED HARDCOVER In the following table, identify all items of proposed hardcover on the property, keyed by letter to Certificate of Survey (survey must accompany this form). Include all existing hardcover items that are intended to remain, as well as all proposed hardcover items that will be added. Use as many lines as necessary to accurately depict proposed hardcover status of the property. For Tier 1 properties, identify any features by letter which are split at the 75' setback line and calculate hardcover square footage se aratel for each ortion. Key to Hardcover Item (Describe) Length x Width Total Surve S uare Feet Exam le Gara e 24'x 30' 720 S.F. A Cust h S. Rc IRA. • 23 s.F. B L. O t�/ Y � S.F. C T NO T S 1 0 0 S.F. D q SL A ,k l 1 S.F. E �.ny Nous s.F. F F�+ �r �T�o ; s.F. � STo�+L wNTtIZ A t� 153 S.F. H Anci �c w Rrt s.F. � a�� o s.F. � CoNtRt wT�o )O 3 S.F. K VT1� �9V� 'S/ Ltiv q '3 ! S.F. L o00 1�LTrl /Nlw+� lr,r9�. $ S.F. M ite�o�tq A4r1 L rJplTld V S.F. N S.F. O S.F. P S.F. Q S.F. R S.F. S S.F. T S.F. U S.F. V S.F. W S.F. X S.F. Y S.F. Z S.F. 1 Total Pro osed Hardcover Z.Z S.F. Excludable Hardcover See Ci Code Sec 78-1684: O S.F. S.F. S.F. S.F. S.F. 2 Total Excludable Hardcover S.F. 3 Net Pro osed Hardcover Subtract line 2 from line 1 lp ZZ S.F. 4 Total Lot Area 1 S.F. Proposed Hardcover Percentage [(3)s(4)] ��,p 3 °� RECEIVl�� This is an information packet regarding Harz�cover. Every effort has been made to insure the accuracy of the informationQ�(�n�i� �O�;� herein;howeve�,if any information is not consistent with provisions of the City Code,the Code provisions will prevail. IVu a U ' Page 9 of 9 CITY OF ORONO � � City of Orono �otio Hardcover Caiculation Worksheet ' Property Address: = � � 112o CoX �qR rn Ro�p ��'��w`�\� Prepared bY� Date: S�ven Y . 1 bcy,rc. to/z6 �5 Stormwater Quality Overlay District Tier: (Circle one) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Step 1: EXtSTING HARDCOVER In the following table identify all items of existing hardcover on the property, keyed by letter to Certificate of Survey (suniey must accompany this form). Use as many lines as necessary to accurately depict existing hardcover status of the property. For Tier 1 prope�ties, identify any features by letter which are split at the 75' setback line and calculate hardcover square footage separately for each portion. Surve Hardcover Item(Desc�ibe) Length x Wfdtl� TO�� S uare Feet Exam e Gara 24'x 30' 720 S.F. A !1 0 5� it A L 3 zL�s. v. 1 R�i• Z S.F. B LAL1C Tu f�R Lh�r1Y IR�C• ; S.F. C 1.ST la�RtN stct. �aJcRt. �. tR�L 1 S S.F. � sTat��►�R �tA ►0.4 k � 1 s.F. E ►..qY ovbti d�-1 S.F. F �111 Y� Al'1 O I R R• S.F. G bTst�t, wqSL/�Rqa�s � I S 3 S.F. H Ri^ts� AY� Stp1�+A IR \l S.F. � q t� 1 a0 S.F. � SOVC� Cotl 4. A �o O Y. 7. Z'�O S.F. K �t► �IVL� S�4t,y.+�L 3 1t 3 S.F. L WOVC fa.��1�wt 1N� wh t�S K • 3 S.F. M S.F. N � S.F. P S.F. Q S.F. R S.F. S.F. S T S.F. S.F. U v S.F. S.F. W X S.F. S.F. Y Z S.F. S.F. 1 Total Existin Hardcover 3 S.F. ExcludaWe Hardcover See C Code Sec 7&1684 : S.F. S.F. S.F. S.F. S.F. 2 Total Excludabte Harcicover O S.F. 3 Net Existin Hardcover Subtract iine 2 from line 1 S.F. 4 Total Lot Area 1 p� q S.F. Proposed Hardcover Perce�tage [(3)+(4)] 8,4.� � (Proposed Hardcover next page) Thls/s an iMprmatbn pecket regarding Hardcover. Evoery effort has been made to insure the accuracy of the in�L4Alalni3c�ifd�ln; howevei if any information is not t�nsistent with provisions of the City Code, U�e Code provisions will prevail. Page 8 of 9 4'�k(� �q'�. ��i� Cm'OF ORONfl �°�o C ITY OF ORONO ,a � Street Address: Mailing Address: Telephone(952)249-4600 'S G� 2750 Kelley Parkway P.O. Box 66 Fax (952)249-4616 F � t�, Orono, MN 55356 Crystal Bay,MN 55323 www.ci.orono.mn.us �kESHOR July 31, 2015 Tony Schrempp 1450 815t Street . Victoria, MN 55386 Re: Building Permit Application#2015-00902 1120 CoxFarm Road On July 20, 2015 the City received a building permit application for an addition to the principal structure. Staff conducted a preliminary review based on the information provided and recommends the following items be submitted or revised in order for your application to be considered complete and for the plan review to continue: 1. Certificate of Survey. A survey from when the house was constructed in 1998 was submitted with the application. The survey is missing several of the City's current survey requirements(copy enclosed). The survey from 1998 indicates the house was to move 6' and an as-built survey was to be provided. We have no record of an as-built survey. Therefore, please provide two copies of an updated,full size certificate of survey which meets all of the City's survey standards outlined on the attached sheet. Please note our engineer has not performed a review of the proposed project,so additional changes or corrections may be forthcoming. 2. Hardcover Calculations. The property is located in Tier 1 of the Stormwater Quality Overlay District. Please have the surveyor prepare hardcover calculations, showing existing and proposed hardcover. Attached is a copy of our hardcover information packet. 3. Septic System. Our records indicate this property has a 5-bedroom home and which currently has two, 1,000 gallon septic tanks. According to City code section 58-50(2)(b), a 5-bedroom horne must have a minimum of one, 1,250 gallon septic tank and one, 1,000 gallon septic tank. City Code section 58-47(b)states no building permit can be issued until a sewage treatment system is in compliance. State septic code 7080.1670 states that the septic tanks to be installed must be designed by a licensed business or certified individual. This design must be submitted with the Septic System Permit. Before the building permit can be issued for the proposed addition,the septic tanks must be brought into compliance. Copies of the City code sections are attached. 4. Escrow&Escrow Agreement. Permits involving grading and/or review by the City's engineer require submittal of an escrow and an escrow agreement. The purpose of the escrow is to guarantee reimbursement to the City for out-of-pocket costs incurred during the review of your plans. Additionally this escrow will guarantee conformance with City Code Chapter 79 relating to erosion control and stormwater. The required escrow amount forthis project is$2,500. The escrow agreement is enclosed. The propertyowner must sign the escrow agreement and submit a check for$2,500. 5. Separate City Permits Required for: a. Exterior/Landscaping Improvements. Please note any other exterior/landscaping projects including patios, grading, sidewalks, retaining walls, etc. proposed at this time must be shown on the survey including the name of the individual performing the work. b. Septic System Permit July 31,2015 1120 Cox Farm Road Page 2 of 2 Your project may trigger the Minnehaha Creek Watershed District's (MCWD) permitting requirements; please contact the MCWD directly at 952-471-0590 regarding your project. Please note, the City of Orono will not issue a building permit without a copy of MCWD permits or documentation from the MCWD stating the proposed project does not trigger any oftheir permitting requirements. The above information is required in orderforthe plan reviewto continue. Please feel free to contact me at 952.249.4620 or by email at cmattson@ci.orono.mn.us if you have any questions on the above requirements. Sincerely, CITY OF ORONO 1 Y�� 1'`��I�-�G , Christine Mattson Planning Assistant c Gregory Wagener; 1120 Cox Farm Road; Long Lake, MN 55356 Roger Peitso, Building Official enclosures Christine Mattson From: Terrence Chastan-Davis <tchastan-davis@minnehahacreek.org> Sent: Tuesday, November 03, 2015 9:42 AM To: sische@premier-survey.com Cc: Christine Mattson; Melanie Curtis Subject: RE: Permit Inquiry Hello Steve, Per our recent phone conversation,you will not need a permit with the MCWD for your proposed garage addition. Please feel free to contact me if you have any other questions or concerns. Thank you, Terrence From: sische@premier-survey.com [mailto:sische@premier-survey.com] Sent:Thursday, October 29, 2015 2:49 PM To: Permitting<permitting@minnehahacreek.org> Subject: Permit Inquiry I am working with a builder on a proposed garage addition on a residential property at 1120 Cox Farm Road in Orono, MN. The proposed garage is 24' X 26' off the back side of the existing garage. We anticipate disturbing 850 sq. ft of land area and moving approximately 30 yards of material. Please review and notify me via email regarding any permitting requirements. Thank you for your assistance. Steven V. Ische, PLS Premier Land Surveying, LLC 952-443-3010 (Office) 952-393-0497 (Cell) i Hennepin County GIS - Printable Map Page 1 of 1 Her�ne4a+� ' ■ � + - � � - !►_. �. , . :.. _ : ,... .._ . ��r� �- � � -� , . �� 'o , -'� '��'`� �''��.r.' . � ?� .�'*�- q �.� �� u � • _ '�!, �{�,.,,� : _ � �' y -.I� �, �� . . �� j,� � _-:��i�'1�� '�� d� ��.,� ?��'' :�i � L 1�� '*��r- •� ��. �,� � ,�► � - .�• � _ " �. �IP � '� �a�, �� " ��•• '�Y . 4 }' -� �; t� Y��ai �� , �' '� . �.,� �� .. , , � � � -- � ,.. _ . - * , � ` ^� • �� <�..r �- „ . � _ ., �„ „ , ._ , T _ ,_ . . ,: � - - , � . , ., �._-.r., ,. ' -•�� -'l�a�� .. ...,.. � ��+ F ��#�" >#�uV�= . 4 ... -� 4� y, * .� �� ,j w �� r �� W "5 I �� . � . �.• ��v � t,l�. _r1V4��e� ' �. _ � �J1.1. 4��. 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' '� .. �' ��. ., ,,,�� e7'�� .� -'C '10� '��". .. +J'�. �� J. __ �r'�.w.'��F�.�'� .�..,, '�� :� �. . , . . .a a$...s.�� _ :�� Parcel 2�_118-23-31-0021 A-T-B: Abstract Map Scale: 1"= 100 ft. N ID: Print Date: 7/8/2015 � Owner G R Wagener& L L Wagener Market �509,000 Name: Total: Parcel 1120 Cox Farm Rd Tax $6,017.76 Address: Orono, MN 55356 Total: (Payable:2015) Property Residential Sale $555,000 Type: P�ICe: This map is a compilation of data from various sources and is furnished"AS IS"with no Home- HOmestead Sale 08/2011 representation or warranty expressed or stead: Date: imPiied,including ftness of any particular purpose,merchantability,or the accuracy and completeness of the information shown. Parcel 2.35 acres Sale Warranty Deed COPYRIGHT OO HENNEPIN COUNTY 2015 Area: 102,277 sq ft Code: � Think Green[ http://gis.hennepin.us/Property/print/default.aspx?C=454350.33529348543,4982904.649493... 7/8/2015 - � -- — � ROtV� � � � _ �� y� � O �} `�Kf S H�� '} � �. •�• Legend �Q�s � Railroad � � City Limits �� Parcels(6-1-2015) �:..� � Stormwater Quality Overlay C �' � ■ Tier 1-25% i " ." ❑ .., ._.__... Tier 2-30% -. �... ': M1. � '. ,.�-�_. . �� ...... � - �' .. _. ,,_r.,...-�..,. . .�.. . �. .�� . . .. .. .. ..., _.m.... . . _.:... � Tier 3-35% �. sixrx a vF N � ... :.��... .. ,. �.. ...... .: . Tier 4-50% .. �� .�- -�d� � ...,,...,_,. ._ ,i,: - � �., � 'j,�... ` - .. �. �... .. — -— . Tier 5 85% L;'.. k ,.. . :�.., .. .�.,` '''� 3 ' ' . ., �� Exempt �� .. _ . • .��y . � � . � Y �`� � � � � �'.:�v, � 5. i , :t� � �.,. '� �' .�.. i •.�" '� . 4_ .�:.^�' �''> `��" ..,��3� �. ffi' ..'F . � ��.� t . . �l , '� '�� . _ � . " s ' .,.,.,...:.: .. 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O� ,Y, �,�. , � I , Gr; � � , �:> � ' ;�� , +� ,-°,� I r '' .,,�y.. �"'^ x�1' .a '�.. � '�'� � _ � � k �;�� i � �"^ ..Ny `<�p t yn'," ¢: * r�. � 1120 Cox Farm �� ,, '�" � . w� � � � �� Rd � � ��. �� y�y��►� '� � �� I� � y�+� ��'"� - , _ k,�� 7*��_ �'' �.�M a„ v"'�� ;� � , .gs+ ,r� I U6clalmec This drawing is neilher a legally recorded map nor a rvey and is not mtended m be used as one.This drawing is a mmpilation oF re<ords,in(ormatlon,and data 0 82 Fee[ e located in various ciry,counry,and state oHices,and other sources affe<ting the area shown,and is m be useJ Far reference purpos only.lhe City of Oro�is�wt 9 Bolton&Menk,Inc-Web GIS 7/8/2015 10:44 AM ��n�P r�.,��am��.,.;P.na.P�„�M�ea��d �/� =—�-�_ V TIME CITY OF ORONO CALLED IN S � INSPECTION NOTICE SCHEDULED �.�--� '�' J � PERMIT NO. a� -�� OMPLEf ADDRESS OWNER ELEPHONE NO�'! g 7`7 7�� CONTRACTOR � DESCRIPTION «� Ll� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION _ ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERlCONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: a JQ��i.--�,rc�fi�,lw�- l��Q✓ ��r�e� f�� J � O - � _G �� ,�.� �a �� 6�a�-� , ��w�. _ � 0 � Q � rvvc�0 e -lt�� t�cc� - 2 -��C. - � W � 1 � d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT NfORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT VYORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECT UNSAFE CONDITION WITHIN HOURS. p 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. (g52) 249-46�� Owner/Corttractor on site: Inspector: w White Copyflnapecto�'s File Canary CopylSite Notice (� � DATE TIME ' i CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO.� � /S � COMPLEfED ADDRESS I� o��J ��C ,��2JZ%�YI /� OWNER TELEPHONE NO. �.'��/�g��7�S9�; CONTRACTOR j��'f-' ' Od �l� ?S f � DESCRIPTION tu ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE EPTIC INSTALL � OWNERICONTRACTOR TO MEET YOU� YES_NO � COMMENTS:`'"�— � �-�� . R-�-�/` � � O �/ � � rG� w�� - b1�� 0 � W � Q � 2 W � W � j W RK SATISFACTORY:PROCEED � ❑ CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERINCa PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR WFLL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca ion 2a hours in advance. (952) 249-4600 OwnerlCo or on si - d� . Inspector. � ""' White Copyllnspector's File Canary CopylSite Notice \ �; � � � DATE TIME \ CITY OF ORONO CALLED IN INSPECTION NOTIC SCHEDULED -� ___�� PERMIT NO. COMPLET ADDRESS T 1 �2- O �D X � cl TYYI /�-CY OWNER 1 �TELEPHONE NO l� /a �- �'��Rc� CONTR TOR �� L� �r�� . �'�� wD CRIPTION ��' -�'�- C D W OOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � ❑ P URED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP = AS BUIL SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL J DEMO- E ❑ S PTIC INSTALL Z OWNE NTRACTOR TO MEET YOU:�YES_NO v�i COMMENTS: � W a 2 J / 0 0 � 0 � W � Q � 2 W � W 2 � J d W ❑ KSATISFACTORY:PROCEED ❑PROJECT COMPLEfE � ❑ ECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDEH POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 ho in advance. -46�0 OwnerlCorttractor on site: Inspector. White Copyllnspector's Fiie Canary CopylSite Notice � � /!-,- ' DATE TIME ; � CITY OF ORONO CALLED IN INSPECTION N��}�IC�} SCHEDULED PERMIT NO." '{- � � '� COMPLEfED �� ADDRESS � 2�c-' C C�?� �C��V`�"��C=� OWNER TELEPHONE NO. �'- � �C��l �5�� CONTRACTOR ��_ ��G �`��' �-��S�- � DESCRIPTION r��u�� .�-�S�c� �.�� ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOU ATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RA ON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ F AMING ❑ MECHANICAL FINAL ❑ RATED WALLS � NSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � INAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL � OWNERICONTFiACTOR TO MEET YOU:_YES_NO c�.� COMMENTS: � W a j � O � O I � W � Q � 2 W � W � � J W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE C01/ERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance 2) 249-4600 OwnerlContractor on site: Inspector_ White Copyllnspector's Ffle Canary CopylSite Notice �� `"�� $�''�� RECEI�/�� DESCR/PTION OF PROPERTY: � "' f0/" � Gregory Wagener Lot 5, Block 1, SHADOWODD FARM, NOV 0 4 Z015 1120 Cox Farm Road Hennepin county, Minnesota. CITY OF OROMf3 � � Long Lake, MN 55356 -�-- - - - - - - - - - - - - - - - -£-�AI�Y- - - �p�#f}- - - -�y@: - - - -�- - - - - - - - - - - - - - - - - � 3� O %'` o. �.'`�' �.'�o �.5�, � �.��° � 40 �` � er �.�,��.• EDGE OF BfTUMINOUS .�O ^5 ,�O �. ,�O y. �t O �p , � " p � �.��. x x�. x,�p�` . ��, ^006`' x'�° N 89°41'16"E x 1a�.��' NORTH LINE OF LOT 51, ,�3ti �= x�.�° ,--- x 511.99 X�°^ "�-, ,� ; / � -x ; x ' DRAINAGE 8 UTILITY EASEMENT � ` �" � - - - - - - - - - - - - - - -� - - - + — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -'- - �� ,n i r — �-$- � 0�- - - - - - ' i � — p� 9 � i �1 ~ � 10 � �� °`�� 1 01� i i X�-,?� .y�0 WOOD FENCE x ,o�.a- I 10 O 0 ° �,,� o, ti� o i,`� �� X °� X � I o o�� ,�, �,� .,� I W � � B OR/VE�,�, 0,,9 , C � p x,�o�. �020 ,�ti �^� � 2 O �p� I �,e`' A y , i i STORAGE SHED "�� ^� ,�R�' �i ,g�' ) 8'X 8'PLAY HOUSE x'�� I �x'�O Z ^�O � I 100� 0,09 6 � � (NO FOUNDATION 1016 I y � x ti 6 o,ti �ti�� concrete � 6 1014 `3 J " � -,�--- ��-----------------------,�_ ------- ° �s.o � ,,ti ,,ti� o�,tig E Ci��; ,� � 111 0 �_�___,op b �92.2 0 26.3 X�0 ^� � W � 9 ^ _____________________x______________ 6 '� W � � I x�0°�o "^°oR. `o�, � " 240 268.4 �o�.--X^o�c�'------------ .�� ISflt11R------ ,��l�Fl . ;ti';.''tiJ o � �ti q � 060� ,ry,� o 'o �o N � PROPOSED 24'X 26' "� I � � � ��' 4 � ^° '° ry$� ti er^ N GARAGE ADDITION ��,ti � SitF �, 6 . -,�tQ; _.. . 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X,00 x�003� ,� '� 000� /V 81a42,55„ — _ _ _ _ _ �—.�� lo � 0 o�`�� w — — �� "° X oo� � - - - - _ - - - - - - � � l hereby certify thaf this survey was prepared by me ^� o0o SOU7-y��NE �` � o ' or under my direct supervision and thar I am a duly x�.o OF�OTS J ��-- 56.40 --� � licensed Professional Land Surveyor under the laws NOTE: SEE ATTACHED HARDCOVER oo� �, :� . � N 87°47'S1" Uy x^°°`� of the Sfate of Minnesota. CALCULATION WORKSHEET FOR x 10 �6� x�° LETTER KEY x,�o � �� BENCH MARK: X�°�^ � 0°�6� �RE M I E R 22703 11/03/15 • DENOTES FOUND Top of iron pipe at southwesf x�,0`�9� x� l n N n ti��r�v F��i Nc,. L Lc� Steven V. Ische License No. Date IRON MONUMENT corner on Lot 5, Block 1. PROJ. # 1349-00 Elevation = 1004.51 (NAVD88) 952-443-3090 Treverse PC 112�o C� �etrw� ZA15-NC7�tOt— � � � �� DATE TIME CITY OF ORONO CALLED IN INSPECTION N TICE SCHEDULED __� PERMIT NO. �OMPLEfED ADDRESS f/ �' D ,x �a/�/Y1 !� OWNER TELEPHONE 1�f0. l�`o?'IO�J-��i� CONTRACTOR � DESCRIPTION � , ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERlCONTiUCTOR TO MEET YOU: Y NO � COMMENTS: � W a � � O .,� � �O � �. Q �� W � � W � J d � RKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W RRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CA RECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hou in advance. 2� 2 OwnerlContractor on site: inspector_ White Copyflnspector's File Canary CopylSfte Notice ti . • • • • � � • emo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: October 3, 2016 G/L: 101-22205 Re: Escrow Refund Zoning Permit#2015-00902 pertaining to 1120 Cox Farm Road is complete. Please refund $2,500 to the property owner, Gregory Wagener. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Gregory Wagener 1120 Cox Farm Road Long Lake, MN 55356 w:�street files\cox farm rd\1120\escrow refund form 2015-00902.docx . . BUILDING PERMIT ESCROW AGREEMENT ' Orono Buiiding Permit#2015-00902 , AGREEMENT made this �� day of�lo�a,.►.�� , 20 i S, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and Gregory Wagener("Owners"). Recitals 1. A building permit application has been filed for an addition located at 1120 Cox Farm Road the ("Subject Property"), legally described as Lot 5, Block 1, Shadowood Farm, Hennepin County Minnesota. 2. Owners request the City to review this appiication. 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 tt�e 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 #2015-00902 if compliance with the approved building permit is not accomplished. 3. MONTHLY BILLING. As the City receives consultant bills for iacrnred 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 Wotic Order unti! 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 writte� notification is received from the Owners requesting the funds. 6. CERTIFY UNPAID CHARGES. If the project is abandoned by Owners, or if the eligible expenses incurred by the City exceed the amount in escrow, the City shall have the right to certify the unpaid balance to the subject property pursuant to Minn. Stat. §§415.01 and 366.012. CITY: CITY OF ORONO OWNER: By: C.��-- I�+�� its: V� . , .� . _ . � �:. , jx : z ��.. . � .. . �� .... � ._� _ � ,. . � a . .� . � a. � ��,.. _ . �� . � � CITY OF ORONO �c Z 0 1 5 — 0 1 4 6 4 * � ` 2750 KELLEY PARKWAY DATE ISSUED: 1 U16/2015 ORONO, MN 55356— 952 249-4600 FAX: 952 249-4616 ADDRESS : 1120 COX FARM RD PIN : 27-118-23-31-0021 LEGAL DESC : SHADOWOOD FARM : LOT 005 BLOCK 001 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: THIS ESCROW IS TIED TO BUILDING PERMIT-2015-00902 APPLICANT ESCROW FEE-BUILDING 2,500.00 TOTAL 2,500.00 WAGENER,GREGORY&LAURA Payment(s) 1120 COX FARM RD CHECK 5726 2,500.00 LONG LAKE,MN 55356- OWNER WAGENER,GREGORY&LAURA 1120 COX FARM 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 aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / Applicant Permitee Signature Date Issued By Signature Date � �, _ _ , _ , _ . , _ ,. _., . . . _.. � � - � , GRE�ORY WAGENER ' ` ;;; , � 5��6' 1320 CL3X FAHM%RD - . - ' ': -': ., '-: i , ;=� ; ' 17 7000/29tO f !> 'LOf,IG 1.AKE,MN 553�6 ' _ - - . . 9866307519 - � � � � , l Dake ' - �ay tg';th� -, ;_' _ , : __ _ Ordez of ' �Z�i � - y1 - _- _ c� � - iSollars �i s��' � . �. � D�Y�I _ � . �. � . .��. . �. . E�Ik. ; �� ;T�F a�ional Ba�k - ' - _ _ , :`^� .t�fbank.cbm - , - � I�ie�ip, �Sca^{fv..J � � : " - i _ ._ .. �� _ �� - �3572.G � , : ; _��., _ . . City of Orono 2750 Kelley Parkway Orono MN 553�6 952-249-4600 Receipt No: 3.014665 Nov 16, 2015 I,r�.�l��i y Wayener F�revious Balance: .00 Permits 2015-003u� 1i20 Cox Farm 2,500.00 Road 101-22205 DefF�� e� R� v-Devei�?per Deposit Total: 2,500.00 -------------- Check Check No: 5726 2,500.00 Payor: Gregory Wagener Total Applied: 2,500.00 C17ange Tendered: .UO --------------- --------------- 11/16J2015 10:37AM i_ __i j ai � ! rol�;,��.�;��.Ir) j �k�a� i�:'�i'�at� ; , m,a.`aia;a�aa �w:a�;m:mi m m . o��!�i�!�� a� n ; ��ti ti��.�� m�m:m�m;d�m{m� �-'' I �,Iv;v ��v;��ro� � O:O O;OiO i o d E'E E:E:.E'�, dlm�d mlm�d!d 2 31��i�;��(�i • ei�:� �;� �� u c!ro�v;vlv v v4 "'b ''�I'n"nl"�.'n) '' w�Q!4;Q:Q�Qj4� __I -•—,._..__._�._.{.__ __ O. ' j I ( i T ! � F- �a��a'm ro!ro��a�b� ( ;._�._ . 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ZO i5-6("�QOZ COMPLETED i ADDRESS � i � � OWNER TELEPHONE N�. � CONTRACTOR � f,, ! � DESCRIPTION �S► tt_- Y�S�� Q4i ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING i ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL ' Z ❑ RADON SLAB ❑ MECHANICAL RI I Q ❑ FRAMING ❑ MECHANICAL FINAL � SITE INSPECTION � ❑ INSULATION ❑ RATED WALLS v ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT 1 Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP � _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL ! v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNER/CONTRACTOR TO MEET YpU:_YES_NO ' � COMMENTS: � � , �S� � Si ��C.� '�G �QA_ t Q f'1 C�-�.1.� � ; o _ �(.t,(�f�QJ„{� �J �u,i I � ' o , W y� � � l �� Q ✓' . / !�r j� ! � W � W I � J � W ❑WORK SATISFACTORY:PROCEED � �JECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ I CERTIFICATE OF OCCUPANCY � � ❑CORRECT 1NORK,CALL FOR REINSPECTION (� BEFORE COVERING TEMPORARY + ❑CORRECT UNSAFE CONDITION WITHIN HOURS. PERMANENT j INSPECTOR WILL REfURN � PHOTO TAKEN I ❑CITATION ISSUED � ❑STOP ORDER POSTED.CALL INSPECTOR j ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. � i � Call for the next inspection 24 hours in advance. (952) 24g-46�� i OwnedContra r on site: i Inspector: ! ite Copyllnspector's File Canary Copyl$fte Notice