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Home My WebLink About2011-00725 - addn/remodel/repair k � � ' CITY OF ORONO PERMIT NO.: 20��-oons 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEn: 08/22/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4195 HIGHWOOD RD PIN : 07-117-23-44-0022 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 45,000.00 NOTE: SEPERATE PERMITS REQUIRED:ELECTRICAL(STATE) AS BUILT SURVEY REQUIRED:�� APPLICANT pERMIT FEE SCHEDULE 628.00 PRECISION DECKS STATE SURCHARGE(VALUATION) 22.50 1120 COVE CIRCLE TOTAL 650.50 MINNETRISTA,MN 55364- (763)22&4429 Minnesota State License#:20583025 OWNER SMITH,DOUGLAS&ROBAN 4195 HIGHWOOD RD. MOUND,MN 55364 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed acwrding 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 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. �-- !_ ____- � � � �� r� �'i��l / A icant Permitee Signature Date Iss d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. , • City of Orono �� .� � � Building Permit Appiication� � for New Structures or Additions Mailing Address: Permit number: �Dl/—�� /�,�,�. PO Box 66 u, � Crystal Bay, MN 55323-0066 Date received: 7 a // �� Received b 7�� 'II,a ,y""'K� '`" a,�, Sfreet Address:' y� �'�' �� '� 2750 Kelle Parkwa � O�': D c� ^1�j��x_ Y Y Plan review f�: � � \��` �� g.`�� Orono, MN 55356 b ` �G ,,;.�sHo � d " �a - ----- Total Fee: �� Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � � �-, This application form must be completed in fufl and all required informafion must be submit ed. , �� Incomplete applications will be returned. (Please print) 1 �� GENERAL INFORMATION: Job Site Address: � �e - ,� ,,, , , Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes No lf yes, a specia/event permit is required with Police Department and City Councif 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/APPLICANT INFORMATION: Name: /�rc,.s;<�n L��,�'S � C�oh J� �� k ) State License# .�D.�� 3 n a r,— Expiration Date: 3- I� Phone: �L�3 �_5 5 - 5� � � �s�- C�l/ )(c� .�� L��y,;2 y (cell) Mailing Address: �j �o <�✓c- C,'��c l� City: /h,�,�i�-/r,:sf�; ZIP: S Sj�y Contact Person: ��h �� :n v,'�C Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: �,,�� S�%�jK; � r o��'1 PROPERTY OWNER INFORMATION: Name: ��h�.-� ��rl / ��, I'cts SrL�;'t �� Phone (day): �- ,�,� � o � , Address: y�c��- �/;��ti w,,,�,, �� City: ,��'c'�n � ZIP: 55 S'� 7' Email and/or Fax " ARCHITECT/ ENGINEER INFORMATION: Name: /��,ti,e f�l�,.,��,�h� f�� 59G ��1��= S Phone (day): �� - �N(�, �� Address: __,�3�� F��t rct f l�vFa�•c= �L�C City: Sp��1t; L�t kc� �`''�LIP: 5 5 '�5:� Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� Water Supply ❑ New Construction ❑ Single Family with ❑ Residence ❑Addition attached garage q Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building �Single Family with Deck ❑ Relocation detached garage �'Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Muitiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water "'Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial �?,r,: �� ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 18202 Minnetonka Blvd Deephaven, MN 55391 Phane: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ l..] � ��-J � ` • r STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length (ft.)= 5 � , Number of bedrooms= [�]Wood/Frame � ❑ Masonry b.Width (ft.)= 1 k Number of garage stalls: ❑ Metal Attached = ❑ Pole Bldg. Areas in s4uare feet Detached= ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 15i Story = ❑ Other(please specify): e.2"d StOry= f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your appfication to be processed: Not Enclosed Applicable ❑ Permit Application � ❑ Pro osed Buildin Plans ❑ [� MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ Surve meetin all re uirements ❑ �Sl Stormwater Pollution Prevention Plan ❑ Hardcover Calculation s) ❑ Se tic S stem Site Evaluation Re ort ❑ •�1 Access Permit ❑ � Wetland Buffer Im rovement Plan ❑ �l 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 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 govemmental agencies required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow agreement to ensure completion of the as-built survey and all site improvements. .�� / l ApplicanYs Signature: /'`�-�-,�.__/ Date: /"�� , . Plan Review Checklist for New Structures / Additions Address/ PID / Legal: y/cl.S/5�/loffLlJpO� �0/9-/J Description of work: �2c.t� + 5 C�a,Q^sr�, �o(L2�. Septic review by: , Date Approved: Zoning�review by: �.��`��'` �� Date Approved: �� . � Building review by: Date Approved: �- �- 1 '� ��Grading review by: ' �`"� '��'��,. Date Approved:_ �� y Zoning File#: Resolution#: Resolution Date: Zoning District Fire Department Post Office School District Zoning: Lot Ar'�a: °a ��, SF/AC Width: � Depth: �� s; Survey Submitted: �7?'�Fes ❑ No Date of Survey: � �� Proposed Setbacks: � \ Fron�'{Lake�' Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wet{and Side Side �-�_. ., Building Defined Height: Building Peak Height: #of Stories Ok?: ❑ YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/crawl START the distance between the slab and the highest space floor and the highest roof peak, the top of WITH roof peak,the top of the cornice of a flat roof, the comice of a flat roof,the deck line of a the deck line of a mansard roof, or the mansard roof, or the uppermost point on a round uppermost point on a round or other arch-type or other arch-t e roof roof SUBTRACT half the distance between the highest window and SUBTRACT half the distance between the highest window hi hest roof eak of a itched roof and hi hest roof eak of a itched roof SUBTRACT the distance between the basement floor!crawl ADD the distance between the slab and the highest space floor and the highest existing grade within existin rade within the foundafion the foundation or 10 feet,whichever is less. EQUALS Defined builtlin hei ht EQUALS Defined buildin hei ht Lot Coverage: SF % Shoreland District MCWD Permit Received Avera e Lakeshore Setbac�C � Blu � � Yes ❑ No � N/A � � ❑ Yes �, C�'�No ��'�s ❑ No �0 Yes C� No �°NIA � � Permit Number. �p J�;� �� 2 Setback: � � `'� -%�� %�;'_. HardcoverZones Existin Proposed Variance R�quired - CUP Required;,;' 0-75' (� ,�, ,; ' � .��6; ❑ Yes � ,t�lo�� 0 Yes No 75-250' .'�". � �� ,� .��;,''��, TYPe�s): ��` �Type(s}: � . 250-500' 500-1000' REMARKS (in-house): Updated: 09/11/2009 z:\formslplan review checkfist.docx � � • Fees to be Charged YES NO �Perrn��t�` ,��-��;,��3,�- ,� �� ,�,��, �.., , 5 � a �, � �-; �� aa�'.-',` '�.�.y.@t q 1's:ts�, Yi, �`' 3w�h��nr..�� xf.'Af F ,� �F' a �=A '�4`f .5'i+r"'M1. Plan Review -0S�a'xe�x�sc%�arr��ge��`��;��, � `�� ,� ' �`,�,�' � n a x, ,.. � , � .;: , ,, > ,.x�.., . ,�.. ,w, . ,-�"�__r .�.�� .��-� a .�� F �_�.��,s� , . Investigation Fee °SAC �N�:umber--�of��AC�"U,natst` `�-�,,,�� '�+��;�� > _ � �,.�_:.�. � .�.g�;i� m, �. . .....Y,. - ��,: Sewer Connecfion Wate.r°Connection �'s�� _ ,�_<��.'�� t��,�� . �� Park Fee wS�a:te�lns�p�ec�ian * ''�-�, , ��-`�„x'��_�, I �; = ��'�F�' wc..v y .Y� s,+'t�. . Other(specify) �IlPlusce"E�a�rae,�.�s�F�ei��.�� `''�"�:',�'��s�r��`� w '�.R.} �� . ��.� ,e,� ��.�-:.4.;.,.. n��r. �� 3W, �.i�. R� -.rx.. „x ' :w=s.:ti�1, ,n ;.��-E'�`+.' �i. Yx:s Calculated By: Square Foota e $ per Square Foota e Basement X = � 15t Floor X = $ 2nd Floo� X = � Garage X = � Estimated Construction Value: $ �-{��, 0�O °� Orono Inspections Required Work Requiring Separate Permits Required State Permits ❑ Site 0 Plumbing � Grading/Filling � Well � Hardcover Removal � Mechanical � Fire Electrical Footing ❑ Septic � Water Connection ❑ Poured Wall 0 Fireplace 0 Sewer Connection ❑ Foundation Survey ❑ Masonry � Lawn Irrigation ❑ Radon Rock Bed ❑ Mfg. �Framing ❑ Other(specify) ❑ Insulation Built Survey : 'f�inal ❑ Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: � YES ❑ NO New: 0 YES � NO REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) ��,,.s'✓'�eJ�✓V�V� ��,+. ,��'J�✓t� Q•'?��i S,s Updated: Q9/11/2009 z:\formslptan review checklist.docx . 2335 Highway 36 W St.Paul,MN 55113 Tel 651-636-4600 Fax 651-636-1311 www.bonestroo.com August 9, zo�� Bonestroo Ms. Melanie Curtis Planning &Zoning Coordinator City of Orono Post Office Box 66 Crystal Bay, MN 55323 Re: 4195 Highwood Road File No. 000139-11000-1 Building Permit No. 2011-00725 Dear Melanie: We have reviewed the plan for the proposed deck located at 4195 Highwood Road. The plan is dated July 11, 2011. We have the following comments with regards to engineering matters: • The proposed deck appears acceptable from an engineering standpoint. _ • This project will disturb more than 25, but less than 100 CY of material. Sediment and erosion control information meeting the requirements of Orono's City Code 79-7(c)(1) must be submitted. The minimum $2000 sediment and erosion control financial security should be required of the owner for this permit. If you have any questions, please call me at(651) 604-4894. Sincerely, BONESTR00 y�)---� � . � Darren Amundsen • Cc: Tom Kellogg L� _ `� � _ � _ � / , "� � „ I ` 3- i�'4 � ��h 5�� `�+tK � ,Lu�- slG� c� � �z`'�S��ro' `�✓�' �z" � �-� ��s �ut s�a �SS 4-$.�v�� 3''2,�3��q wl,�- i ' 7 � - __ - — ; � �� -- '3_ I�l�J� �8�l-��L- ` � �t __ �_ _—- __� •r �,t I S Tt�t`. � � ' �-(�/�tlG` Can � I �,v� / , _ I .(�. `�z"t S",c�d'' � � , , , � 'l� ; I �- 3�8� �.� � �u��L �� ,, S��ws ��v �-:..�.�_.� + o �A.�u Si�� 3;� 5� �`"''�' y� 3 � �5��. � g�'.�Cio�;��a� . ��/ps� �2 � � .� . i ti.� 4-'�z.a�� L ,. •� ,• • l �L'' D`� �� ' G�o„-r, _ � �_ tilG 12��D. 0 ' -,. � �4 8� r� ��. 5� �.+.N s� � � �- � �� 9 L 1 hereby certlfy that thia plao,speciHcation, ,(`� ��Q n,,. or raport was proparod by me or undar my �'t Ivj/ L�� La rso n diroct supervfsbn and that I am a duly �.icensed Professional Engineer under the laws of the Stete of Min�esota. (��{ Larson SpecisUy Structures Inc 5831 Hobe lane Print Name W rson _ � � Ivw � White Bear Laks,Min�ssota 55110 631 428 5143 Fax:651 429 6761 Slgnalure www.mlldrsdl�cort�casl.net � O � Data �'�4"�L� Licer�se+t 7831 Comm.No. � � )�- �� - 7�. j �`` � 0 ` �� h� � �- 1� "LVL _ __ q'a�' -'p� l , � 3 1�� /��L 5,��.�� . I � ��,�d lan..� I �e e�� " v, �� K v5�.S/�n (S��N� Q : I , 3 � �' .c: � � v � � �� °OM o � � - � � � a r _E��s�-,� � 'Low Rof�' 'ro �NI,p�Fti.� p �o 5 �sS - v1 3 � I � �x�,_ � x� p Z 1 � ' — — — �=• � g' �� N�r G 1 � 'i� � � C� ? G(��{. � o��y (�!_��C' _ � '�' i�t ""i ! � 1 S��o�r� ��.oa �►�� ,� tz�► y. $.�•r� w� L 1 hereby cartffy that this plan,specHFcation, �� O or report wss p►epared by me or under my L�� Larson ��.�,��dthat,.�ad��Y I.icensed Protesslonal Engfneer under Me laws ot the State ot M�nnesota. �p V p,) �,.�, Larson Speciaity Structwes inc 5831 Hoba La�e P�IM Neme White B�r Leke,Mlnneaota 55110 ��O 6S1 429 514� Fax:851 4298781 Si9naturo www.mildredl�comcast.nat B Date D�� LJcense�7831 Comm.No. $ �D . � f ,L � � � � ��ooµ ,��G� . s''s� �y 1�9 � 3_��,,� ^ � � � �c — . ( ";! 1•3 • � �O _C�� 1_�___� �r� �2 3.'v,��Sv,� � v �S 4 9�x¢.�,' ( M ��`5��r , 4 r- �J- ��A� 1�8�LVL . � � ' C=�.��.Y c�ot� ��5 3 L.r C� �-.� �-�- �o�� w I hereby c�rtify that Mis plan,speciHcation, ��+ !�1 �� or report was prepared by me or under my �,w�� L� La rso n d�s� si°n and that I am a duly �-- I.Icen Professional Enginee►under the Iaws of the State of Minnesota. Lerson Specialty Structures inc 5931 Hobe Lame P�int Name V White B.ar Lake,Mlnnesote 55710 651 429 3143 Fax:B51 429 8781 Signature www.mlldredt�comcastnet D�e 30 ��,� �#�1 Comm.No. j,� � t� r . . . . � � __ 7_ j � �� _, � _ Ap 2�►0 �Loo�R� �� 3- t3�4 �1�GLv� � .� . T C1s.� (�-!�ti�c,r'?,.�Jo` ��/,y fD � �� a an N SS �2 y3'L�f�L�+ } .� C-� E-� , � J �• ^;� �u �'�f iC � M�►� F'io�v'R 8 a�� I . - �2 'i2`�s:�tn • 3_ t��4� 1 to` Lv�...—�. :i ,. S %4 y s'�g. p5c. �``"_-� f3! � � 2- �2..�-` K,�c,s � . �r�IS�� Ooo �-ld-�di R•b. � ', LD�s-'I'L i �� . � i .�, . . . , .. � _ .. .. . . �- . �,.. , � l'rN 11' �I��Wh�-r �" . � ' � ,4 �� i �i � �!IGYt t Co � j � 6 �Z L I hereby certiy that this plan,specification, or roport was preparcd by me or unde►my �`� , L�� La rs o n direct supervisio�and that I am a duly I.icensed Prolessional Engfnecr under the laws of the State of Minnesota. La►so�Spocialty Structures Inc 5931 Hobe Lene PriM Name W n n White Bear Lako,Minnesota 55110 � 6S1 429 3147 Fax:B51 429 6781 Sig�aturc w www.mildredl C�comcastnet p �� Dete D'30•�� Lfce�se�t 7831 Comm.No. � �� ATE TIME ✓ ; �-� �� TY OF ORONO CALLED IN INSPECTION NO�TpICE, �,�] scHEou�E� �(� PERMIT NO. CTIi �(—�� `��COMPLETED ADDRESS � �� '�' 1 `�' OWNER TELEPH � E NO. �' �� y�'a-�O�S% CONTRACTOR , �-:��12�'f��C'�� a DESCRIPTION �� - � � � ❑ FOOTING ❑ LUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ 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 ❑ SEPT C FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:�YES_NO � COMMENTS• � w � o c7 � � ��"�`�� a � 0 � w � Q � z w � w � j � �tl1fORKSATiSFACTORY:PROCEED ❑ PROJECTCOMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT [7 CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN 7 STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED INSPECTION RE�UIRED.CALLTOARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46�� OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice � �� - ✓ /� DATE TIME CITY OF ORONO CALLED IN / INSPECTION NO IC —SCHEDULED � � PERMIT NO.�� 07�COMPLET D ADDRESS ��c dDG� OWNER ' TE� NE NO. ��1 —�� CONTRACTOR S l >; DESCRIPTION � � � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ 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 � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � J O � � O � W � Q ti Z W � W � j d W ;�]1yORKSATiSFACTORY:PROCEED ❑ PROJECT COMPLETE � •❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WlLL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952� 249-4600 Owner/Contractor on site:� , ' �Inspector. �' � �� White Copy/inspector's File Canary CopylSite Notice ��C-.�� / � �� DATE TIME / CITY OF ORONO CALLED IN � ! V INSPECTIO TICE SCHEDULED -� �'� PERMIT NOP � OO� COMPLETED ADDRESS � \ OWNER • TELEP E NO.��" ��15 7 CONTRACTOR � �CS ` a DESCRIPTION � - d`��—�� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ 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. ❑ FOILOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL � ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o �fL e,t� A,..� S C(�e Q-� � �G.� �/' I� n....��1� 0 � W � Q � Z W � W � � d W� �WORK SATISFACTORY:PROCEED C� PROJECT COMPLETE W ❑ CORRECT WORK&PROCEED '-! ISSUE CERTIFICATE OF OCCUPANCY 0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ��CITATIGN ISSUED � INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952� 249-46�0 OwnerlContractor on ite: Inspector. . �/�t �� ,� White Copyllnspector's File Canary CopylSite Notice 1 % �, � �� "}�' ' DAT TIME CITY OF ORONO ' � CALLED IN 1� � � � INSPECTION NOTICE SCHEDULED �� ' �-�-� l PERMIT NO.�h� —��J��`3��COMPLETED ADDRESS �� i �� -�--� i �tL1 �.l`i'^ t`�� OWNER � TELEPHONF�NO.LG��'r��-"�� CONTRACTOR f�(' i:��1 t'�-1'l !_1��,� i: DESCRIPTD �� 4`�c3 � ��C' k-- '_��'r�+"/ �, ) ) �{ I 1��_ ly� ❑ FOOTING `'�� `�❑ L M��INAL ❑ EXCAV/GRADING/FILLING �� i � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE�NSPECTION 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES�NO � COMMENTS: � a �f�`� f�� i�.t � �- �� it '2t�C � ! f�\C� �r�C �-��" ��, ~-� . .. o i_��T� ��C`�G'1 ��,j y i�l� ��G�=�1 Y��. I C`I�7 a � 0 � W � Q � Z W � W � � d 4�bRKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR '� GTATION ISSUED C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for ihe next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on si : Inspector. White Copyllnspector's File Canary CopylSite Notice . . . • • • • � • . emo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File 1 � U Date: February 10, 2014 G/L: 101-22205 Re: Escrow Refund Building Permit Numbers 2011-00725 & 2011-00732 pertaining to 4195 Highwood Road is complete. As-built survey has been approved. The Applicant, Doug & Roban Smith, has requested a refund of their$2,500 escrow. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Doug & Roban Smith 4195 Highwood Road Mound, MN 55364 w:�,street files�highwood road�4195\escrow refund memo 2011-00725&2011-007732.doc BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2011-00725�#2011-00732 AGREEMENT made this 3 day of . �.�'r , 20�, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City°)and as a„��1 I?b��• ' , ("Owners°). Recitals 1. A building permit application has been filed for a remodel project located at 4195 Highwood Lane, the ("Subject Property"), legally described as Lots 26, 27 and 28 Highwood Lake Minnetonka, 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 tMe City. All accrued interest, if any, shall be paid#o 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 infirastructure that is caused by the work (including planning, engineering, or legal consultant review) associated with building permit #2011-00725 8 #2011-00732 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 not�cation 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 shalf have the right to certify the unpaid balance to the subje rty pursuant to Minn. Stat. §§415.01 and 366.012. CI : CI F OWNE • ,.�� By: `a:-... � . ItS: Internal Use ONY; ;'..,. . ..: ,.. . ..,x .. �Copy to Property Ovmer O'Copy ta StreeY File � � � � � i 'si�.., ;;� kx�<x;�-�c� � � �;;� Zt �� f►�a��x` � s�,c�nr ;�.� ��3 i� `�' =��'� �tr�i:� � .j1.C�A�.4.% . F `!. .�.. � :__':1�� _u , . . . . rf,Sfi-i �*;:��l�i "'.ri^3`;;� , I =�Y�ti i t1 r� �V . .,j� i�t 1t.�z _ �.��s �:.q:��34 �'3;,a 'lrtYiJ4'"i *tr: , �� . +;_ P; � ,:�, ;�7�� ,� � ue S'�l,c't, _�...__._.__ ___._ _ _ � st+ + T?�"��;: ___.e..,.._..._.._ ._.. �i�'�t ` M „ � �.,, , ��'4,`"'r�..�: Iv�I:. Y k�i- L' � S''�i{) � t F'. ti��d�l a;. �r G�i3•+ `Nt.;.� , tir: � � :H a Y��' ],;� . ;;�?: �+t::.E�:. .. . ..__. !'�i;a'i�.gti ��'"�ll4 r��,�Ct; ___ _—_ . .�.:_ pi s ,;J _ ;:��'ri': , • . CITY OF ORONO PERMIT NO.: 2011-00799 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 08/04/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4195 HIGHWOOD RD PIN : 07-117-23-44-0022 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ESCROW FEE-T1ED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: THIS$2500 ESCROW IS TIED TO BUILDING PERMIT-2011-000725 AND 2011-00732 PD W/CHECK#1395 APPLICANT ESCROW FEE-BUILDING 2,500.00 SMITH,DOUGLAS&ROBAN TOTAL 2,500.00 4195 HIGHWOOD RD. MOLJND,MN 55364 OWNER SMITH,DOUGLAS&ROBAN 4195 HIGHWOOD RD. MOLJND,MN 55364 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 conswction 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 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Christine Mattson From: Christine Mattson Sent: Thursday, January 23, 2014 8:12 AM To: 'roban@smith4.com' Subject: RE: 4195 Highwood Road / Permits#2011-00725 &2011-00732 n Hi Roba , Thank you for sending the pdf copy of the survey. Our engineer has reviewed it and approves. Please have a full-size, scalable copy sent to us for our records. All expenditures, including escrow refunds, require council approval. My next opportunity for submittal is for the February 10`h Council meeting. Your check will be mailed on Tuesday. If you have any questions, please don't hesitate to contact me. Christine Mattson 11��n� �,,��-(�'yh Planning Assistant �-'`� City of Orono �(� (�,i 2750 Kelley Parkway Orono MN 55356 (physical address) ��'�`"� � ��✓� PO Box 66 Crystal Bay MN 55323-0066 (mailing addressJ � n�-�.a��,�.� ,�� /i' 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: Monday, February 17, 2014 From: robanCa�smith4.com [mailto:roban@smith4.com] Sent: Monday, January 20, 2014 12:23 PM To: Christine Mattson Cc: douglas@smith4.com Subject: FW: 4195 Highwood Road / Permits #2011-00725 &2011-00732 Hi Christine- It has been several months since the submission of the updated survey and we are wondering about the status of our escrow refund. Would you check on that and let me know? Thank you! Roban Smith 4195 Highwood Road roban@smith4.com 612-237-4404 � From: roban@smith4.com Sent: Tuesday, November 19, 2013 3:24 PM To: 'Christine Mattson' Cc: Douglas Smith (douglas@networkinstruments.com) Subject: RE: 4195 Highwood Road / Permits #2011-00725 & 2011-00732 Hi Christine- I am attaching the updated survey which now shows the lakeside stairs. Please let me know if you need any additional information to start the escrow refund process. Thank you. Roban Smith roban@smith4.com 612-237-4404 4195 Highwood Road Orono, MN 55364 From: Christine Mattson [mailto:CMattson@ci.orono.mn.us] Sent: Friday, November 08, 2013 10:16 AM To: roban@smith4.com; 'douglas@networkinstruments.com' Subject: 4195 Highwood Road / Permits #2011-00725 &2011-00732 Hi Roban, City Engineer,Jesse Struve, reviewed the as-built survey dated September 19, 2013 which was received in our office on October 29, 2013. After visiting the site to review the as-built survey Struve observed stairs on the lakeside of the home. The stairs were shown on the proposed survey, but not on the as-built. The proposed survey also noted gravel was to be removed on the street side of the property near the wooden gate, presumably to meet hardcover requirements. The gravel remains, but with the newly adopted hardcover ordinance the hardcover calculations show the property is in compliance, therefore, no action is required. Please have the survey updated to reflect the stairs. Once an updated survey is received and approved I can start the escrow refund process. Please don't hesitate to contact me if you have any questions. Christine Mattson Planning Assistant City of Orono 2750 Kelley Parkway ' Orono MN 55356 (physical address) PO Box 66 Crystal Bay MN 55323-0066 (mailing addressJ 'R 952.249.4620 g 952.249.4616 � cmattson@ci.orono.mn.us �1 www.ci.orono.mn.us Office Hours: Monday- Friday 8 am to 4:30 pm OUR OFFICE WILL BE CLOSED: Monday, November 11, 2013(Veterans DayJ z From: roban@smith4.com [mailto:robanCa�smith4.com] Sent: Wednesday, October 30, 2013 7:17 AM To: Christine Mattson Cc: Douglas Smith (douglas@networkinstruments.com) Subject: Closing out our permit and refunding our escrow deposit - 4195 Highwood Road Hi Christine- I dropped off an updated survey yesterday-following our building project at 4195 Highwood Road. Please contact me if you need any additional information to close out our permit. If you do not, please process the refund of our escrow deposit. Thankyou! Roban Smith roban@smith4.com 612-237-4404(cell) 3 � � Christine Mattson From: roban@smith4.com Sent: Monday, January 20, 2014 12:23 PM To: Christine Mattson Cc: douglas@smith4.com Subject: FW: 4195 Highwood Road / Permits#2011-00725 &2011-00732 Attachments: 4195 Highwood Lane Survey 11-11-13.pdf Hi Christine- It has been several months since the submission of the updated survey and we are wondering about the status of our escrow refund. Would you check on that and let me know? Thank you! Roban Smith 4195 Highwood Road roban@smith4.com 612-237-4404 From: robanCa�smith4.com Sent: Tuesday, November 19, 2013 3:24 PM To: 'Christine Mattson' Cc: Douglas Smith (doualas@networkinstruments.com) Subject: RE: 4195 Highwood Road / Permits #2011-00725 & 2011-00732 Hi Christine- I am attaching the updated survey which now shows the lakeside stairs. Please let me know if you need any additional information to start the escrow refund process. Thank you. Roban Smith roban@smith4.com 612-237-4404 4195 Highwood Road Orono, MN 55364 From: Christine Mattson [mailto:CMattson c(�. ci.orono.mn.us] Sent: Friday, November 08, 2013 10:16 AM To: roban@smith4.com; 'douglas@networkinstruments.com' Subject: 4195 Highwood Road / Permits #2011-00725 & 2011-00732 Hi Roban, City Engineer,Jesse Struve, reviewed the as-built survey dated September 19, 2013 which was received in our office on October 29, 2013. After visiting the site to review the as-built survey Struve observed stairs on the lakeside of the home. The stairs were shown on the proposed survey, but not on the as-built. � � �- The proposed survey also noted gravel was to be removed on the street side of the property near the wooden gate, presumably to meet hardcover requirements. The gravel remains, but with the newly adopted hardcover ordinance the hardcover calculations show the property is in compliance,therefore, no action is required. Please have the survey updated to reflect the stairs. Once an updated survey is received and approved I can start the escrow refund process. Please don't hesitate to contact me if you have any questions. Christine Mattson Planning Assistant City of Orono 2750 Kelley Parkway Orono MN 55356 (physical addressJ PO Box 66 Crystal Bay MN 55323-0066 (mailing address) '�' 952.249.4620 , g 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: Monday, November 11, 2013(Veterans DayJ From: roban@smith4.com [mailto:roban@smith4.com] Sent: Wednesday, October 30, 2013 7:17 AM To: Christine Mattson Cc: Douglas Smith (douglas@networkinstruments.com) Subject: Closing out our permit and refunding our escrow deposit - 4195 Highwood Road Hi Christine- I dropped off an updated survey yesterday-following our building project at 4195 Highwood Road. Please contact me if you need any additional information to close out our permit. If you do not, please process the refund of our escrow deposit. Thank you! Roban Smith roban@smith4.com 612-237-4404 (cell) 2 Christine Mattson From: Christine Mattson Sent: Friday, November 08, 2013 10:16 AM To: 'roban@smith4.com'; 'douglas@networkinstruments.com' Subject: 4195 Highwood Road/ Permits#2011-00725 &2011-00732 Hi Roban, City Engineer,Jesse Struve, reviewed the as-built survey dated September 19, 2013 which was received in our office on October 29, 2013. After visiting the site to review the as-built survey Struve observed stairs on the lakeside of the home. The stairs were shown on the proposed survey, but not on the as-built. The proposed survey also noted gravel was to be removed on the street side of the property near the wooden gate, presumably to meet hardcover requirements. The gravel remains, but with the newly adopted hardcover ordinance the hardcover calculations show the property is in compliance,therefore, no action is required. Please have the survey updated to reflect the stairs. Once an updated survey is received and approved I can start the escrow refund process. Please don't hesitate to contact me if you have any questions. 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 '/Z' 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: Monday, November 11, 2013(Veterans DayJ From: roban@smith4.com [mailto:roban@smith4.com] Sent: Wednesday, October 30, 2013 7:17 AM To: Christine Mattson Cc: Douglas Smith (douqlasCa�networkinstruments.com) Subject: Closing out our permit and refunding our escrow deposit- 4195 Highwood Road Hi Christine- I dropped off an updated survey yesterday-following our building project at 4195 Highwood Road. Please contact me if you need any additional information to close out our permit. If you do not, please process the refund of our escrow deposit. Thank you! ' Roban Smith � Christine Mattson From: roban@smith4.com Sent: Wednesday, October 30, 2013 7:17 AM To: Christine Mattson Cc: Douglas Smith (douglas@networkinstruments.com) Subject: Closing out our permit and refunding our escrow deposit-4195 Highwood Road Hi Christine- I dropped off an updated survey yesterday-following our building project at 4195 Highwood Road. Please contact me if you need any additional information to close out our permit. If you do not, please process the refund of our escrow deposit. Thank you! Roban Smith roban@smith4.com 612-237-4404(cell) 1 CITY OF ORONO PERMIT NO.: 2011-00799 •,� � _�.. 2750 KELLEY PARKWAY ORONO,MN 55356- �ATE Iss[1En: 08/04/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4195 HIGHWOOD RD PIN : 07-117-23-44-0022 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 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-2011-000725 AND 20 1 1-0073 2 PD W/CHECK#1395 APPLICANT ESCROW FEE-BUILDING 2,500.00 SMITH, DOUGLAS&ROBAN TOTAL 2,500.00 4195 HIGHWOOD RD. MOUND,MN 55364 OWNER SMITH,DOUGLAS&ROBAN 4195 HIGHWOOD RD. MOiJND,MN 55364 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 permi[will expire and become null and void if construction authorized is not commenced within l80 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. � • �' BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2011-00725 8#2011-00732 AGREEMENT made this 3 day of ks� , 20�, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City°)and I�y1 IZobcs� ' � ("Owners"). Recitals 1. A building permit application has been filed for a remodel project located at 4195 Highwood Lane, the ("Subject Property°), legally described as Lots 26, 27 and 28 Highwood Lake Minnetonka, 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 #2011-00725 8 #2011-00732 if compliance with the approved building permit is not accomplished. 3. MONTHLY BILLING. As the City receives consultant bills fo�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 not�cation is received from the Owners requesting the funds. 6. CERTIFY UNPAID CHARGES. If the project is abandoned by Owners, or if the eligible expenses incurred by the City exceed the amount in escrow, the City shall have the right to certify the unpaid balance to the subje rty pursuant to Minn. Stat. §§415.01 and 366.012. CI : CI F OWNE • By: its: Intemal Use Only: E��r�q�ing G Copy to Property Owner G Copy to Street File CITY OF ORONO PERMIT NO.: 2011-00724 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 07/26/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4195 HIGHWOOD RD PIN : 07-117-23-44-0022 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 45,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 45,000 TYPE OF PERMIT THIS PAYMENT FOR DECK/PORCH PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-00725 APPLICANT ADVANCED PLAN REVIEW 408.20 PRECISION DECKS TOTAL 408.20 1120 COVE CIRCLE MINNETRISTA,MN 55364 (763)228-4429 Minnesota State License#:20583025 OWNER SMITH,DOUGLAS&ROBAN 4195 HIGHWOOD RD. MOiJND,MN 55364 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. 1'his permit is for only the work described and does not grant permission for additional or related work which requires sepazate 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 void if conswction 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. � � �7i � i Applicant Permitee Signature Date Issued Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.