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Home My WebLink About2013-00781 - retaining wall CITY OF ORONO * z 0 1 3 - 0 0 7 S � 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2014 < ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3532 IVY PL PIN : 20-117-23-42-0033 LEGAL DESC : TAYLORS SUBD OF SPRING PARK LO : LOT 000 BLOCK 000 PERMIT TYPE : ZONING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RETAINING WALL<4 FEET ACTIVITY : O/S GENERAL NOTE: $2,500 COLLECTED IN ESCROW FEE 2014-00306 ' ESCROW FEE FOR: EROSION CONTROL&ENGINEERING REVIEW COSTS APPLICANT RETAINING WALL<4' S0.00 MINOR LAND ALTERATION 50.00 PAUL,JONATHAN&JULIE ENGINEERING REVIEW COSTS 3532 IVY PL WAYZATA,MN 55391- TOTAL 100.00 Payment(s) CHECK 5168 100.00 OWNER PAUL,JONATHAN&JULIE 3532 IVY PL 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 sepazate 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 confottnance with the State Building Code.This permit may be revoked at any time for due cause. � � �'(l� 1 � � p cap�t�Permitee Signature Date Issued By i nature Date tl Z `- � � City of Orono Zoning Permit Application Mailing Address: Permit number: ��l 3 ��o 7 �� 0�� PO Box 66 Date received: t2 ( Crystal Bay, MN 55323-0066 Escrow#and q�� Street Address: amount: •I � �, 2750 Kelley Parkway Permit Fee: �`� y � Orono, MN 55356 �! �' Approved by: qKfSN�� Fax: 952-249-4616 Notes: Main: 952-249-4600 W`�`i`N•ci.orono.mn.us This application form must be completed in full and all required information must be submitted. (P/ease print.) Job Site Address: �J S �Z i �� ''�-�' CONTRACTOR/APPLICANT INFORMATION: Name: �u.�r%�f'�� ..�k.� Phone: � L L�i L ZS Fax: Address: ?iS 3 Z- l.Jv1 l�t City: (��"U�1c; ZIP: �;�"3�? ( Contact Person: (�,� W i � ��, �_ ContacYs phone number f� l L �FG� �' t Email ,c v�.c11-�czvt _ �:i+.��z-22 Applicant is: Contractor Homeowner � (Circle One) �,l C�d'�el i 1 .L:�.vl �-t�,� •t ^'v f� -�'l�''1 • G�- PROPERTY OWNER INFORMATION: ` � �.r �� Name: ��►c,: ti..v� �,�-(— Phone (day): Mailing Address: ZIP: Email and/or Fax , ,(� Overall Project Description: �� \��`� Check � Box � 'OST* Dock, Resic; \�� +� � + engineering review costs Lake Minnetc �\ � Q,��"' Dock, CommE " engineering review costs Escrow for erc e� • _ � � � Hardcover Pern � �� ,(�� rge Also re uired is a �'" �\\�-- � �`�� Land Alteration, n n\��,� � . V more than 10 cubic v� Escrow for erosion c. � �' �ed b CUP Land Alteration, Min � - -`,� � �QQ�. �ering review costs � outside of lakeshore se �V,A-` �� "- �.,- � < Escrow for erosion cor, • n`� Retaining Wall measurir `I`�' � � �g review costs Retaining walls measurin5 � � wall) require a building pen ��\�,�\ unless the walls are separal 6 \�C.,,,V' Escrow for erosion control a� ��\` _ .,�� Stairway to Lake (New or Re � �-i� $50+ engineering review costs Escrow for erosion control and `IIp / $2,000 Structure Permit for other stru� Vl�( ,��c but $50+ engineering review costs regulated by the zoning code (inc, �(��, � � .,.;essory building of less than 120 square feet, detache �%�\1 - and sport court) Escrow for erosion control and en ,��w costs $2,500 Tree Removal or other ve etation .,�val in 0 to 75 foot zone No char e. Tem ora Construction Office/Trailer associated with buildin ermit $30 (over) *Permit fee will be collected when the permit is issued. Updated: November 30,2012 ' APPLICANT/OWNER ACKNOWLEDGEMENT: • Applicant/Owner agrees to provide all information required or requested by the Planning Department; • Owner agrees to pay the City of Orono for engineering consultant review costs where applicable; • ApplicanUOwner certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; • Applicant acknowledges the attached Escrow Agreement is completed and signed by Owner; • ApplicanUOwner understands their project may require an initial and as-built survey per City Code Section 86-68. • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other overnmental a encies re uired b law. If ou refuse to su I the information, the a lication ma not be issued. The undersigned certify that the information supplied is true and correct to the best of their knowledge. Applicant's Signature: " Date: �! �Z�� Property Owner's Signature: Date: SUBMISSION REQUIREMENTS: Except for tree removal permits, all permits TYPE OF PERMIT: require a completed application form, escrow agreement (signed by the property owner) and escrow check from owner, two copies of all plans, and three copies of all grading plans or surveys/site plans Dock, Residential Seasonal Dock—survey showing proposed dock Permanent Dock—plans as approved by CUP and copy of LMCD permit(if applicable) Dock, Commercial 1. Structural plans for the dock 2. Survey showing the proposed location of the dock 3. Copy of LMCD permit Hardcover Permit 1. All Minor or Major Land Alteration Permit requirements apply as appropriate 2. Hardcover calculations, existing and proposed 3. Plans Land Alteration, Major 1. Plans as approved by Conditional Use Permit 2. Erosion control plan or copy of MCWD Erosion Control Permit Land Alteration, Minor 1. Survey/grading plan including existing and proposed contours (Less than 10 cu.yds. within 75'of 2. Amount of fill to be imported and/or exported and haul route lake or less than 501 cu.yds 3. Amount of earth to be moved around on site elsewhere.) 4. Erosion control plan or copy of MCWD Erosion Control Permit Retaining Wall 1. Plans for wall(s) 2. Unless repair or exact replacement of existing wall, submit an updated survey with grading plan including existing and proposed contours 3. Hardcover calculation worksheets if in shoreland district 4. Erosion control lan or co of MCWD Erosion Control Permit Stairway to Lake 1. Construction lans for stairwa p y, including footings 2. Topographical survey of property with proposed stairs shown 3. Erosion control plan or copy of MCWD Erosion Control Permit Structure Permit 1. Construction plans. 2. Survey of property with proposed structure shown and with setbacks to property lines, other structures on property and the septic system indicated. The general location of any sewer and water services should be shown if applicable. 3. Grading plan if grading is proposed. 4. Hardcover calculation worksheets 5. Erosion control plan or cop of MCWD Erosion Control Permit Tree Removal Call: 952-249-4600 to schedule a single tree removal inspection. A re-planting plan/ mana ement plan required for clear cuttin , buckthorn or other intensive ve etation removal. Updated: November 30,2012 Plan Review Checklist for Zoning Permit Applications Address: Z 'Vv �� Description of work: 1��( �1� ��.! 1 � . �1� Type of permit: Zoning review by: Date Approved: Grading review by: �.• Date Approved: f � � Other Review, Reviewed by: Date Approved: Zonin : Zoning File#: Resolution#: Resolution Date: Lot Area: SF/AC Width: Depth: Survey Submitted? Yes 0 No Date of Survey: g-a- Existin Setbacks: Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Pro osed Setbacks: Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Shoreland District MCWD Permit Received Average Lakeshore Setback Met? Bluff 0 Yes 0 No 0 N/A 0 Yes No Yes � No � Yes 0 No �/A Permit Number: Setback: Hardcover Zones Existin Pro osed Variance Require CUP Re uir 0-75' t 'G ,�rno ��2 � Yes o � Yes No t J "� �J �75"2�6�g' 3� � 1�`�- � �� TYpe(s): Type(s): ,�5fl-�--=; Zoning File#: Zoning File#: Resolution#: Resolution#: Created: March 29,2011 z:\forms\plan review checklist for zoning permit applications.docx Planning Review Checklist for Zoning Permit Applications � Page 2 of2 Cubic Yards In Out Total Haul Route? ? � Yes 0 No Explain haul route in detail: Fees to be Charged Amount I Orono Inspections Required Permit Amount � � � Site Escrow Amount �( � Hardcover Removal s�`� � Footing 0 Poured Wall Signed escrow received? I As-Built Survey � Yes � No 0 Planting Plan 0 Wetland Escrow amount received? Final ❑ Yes � No 0 Other(specify) Engineering review needed? Yes 0 No REMARKS (in-house): Other Review: Reviewed by: Date Approved: REMARKS TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) � - i ► 5(rtr ve, i �rc� I� � �— r► r � Created: March 29,2011 z:lforms\plan review checklist for zoning permit applications.docx Christine Mattson From: Jonathan Paul [Jonathan Paul@cargill.com] Sent: Monday, April 07, 2014 10:06 AM To: Christine Mattson Cc: Tim Subject: 3532 Ivy Place Christine, well, it looks like spring is finally here. As such,Julie and I are interested in kick-starting our landscaping project back into gear, having made the decision last fall to postpone due to contractor availability issues, etc. As you may recall,we got as far as holding a preliminary meeting with the City to review our draft plans,got the LMCD approval document and then made the decision to hold. I know I need to get a copy of the LMCD document to the City, but if I could, can you please let me know what next steps I need to complete to formally submit my permit request? Thanks. Jon (952) 232-8251 c (952) 923-1755 h 1 5 �Z 1 � �l , CITY OF ORONO � stTE A��t�ss LEGEND ILIRDCO��ERCALCUL.ATIfJ\�i'ORKSHEET-Iu1KE�1iL�\ETO�I�a � DENOTES ITYDRANT AC DENOTES AIR CONDITIONING UNIT CLIE\T: IonathanPaul JOB# 6�Y3i4001 aDDRESS: 3�321�vPface 3532 Ivy Placc,Orono,MN 55391 , 'YYV yy DATE: 7/30/2013 REY. RE!". � DENOTES SET IRON MONUMENT EM DENOTES ELECTRIC METER C EI�SCI�G HARDCO�'ER I\TiER 1 25% LEsYGTH Ji"IDTH -aRE-a C0.1t<t1EYTS � DENOTES FOUND IRON MONUMENT GM DENOTES GAS METER � � STRCCTL'RES Aiisc. x +.iisc. = 2300.t S.F. Howe DESCR TION OF+� • �„ O ` DENOTES EXISTING DECIDUOUS TREE TB DENOTES TE�EPHONE BOX �� x = s.F. x S.F. Lots 179 d 180,Taylor Subdivi n of in�.��4y�C�p� �� DENOTES 9"x9"CATCH BASIN DRII E�i:a£ Misc. x nti��. = sas S.F. Bituum�oiu Drivewav Accordin tq�t(herecordcd plat thcr�f, i�� '��1 idne�dt�! DENOTES EXISTING CONIFER TREE � N x = s.F. " � DENOTES EXISTING CONTOUR �"- DENOTES PROPOSED DRAINTILE � � � SlDER:{LKS Misc. x wiisc_ = 9� S.F. FmncConcrereSidewa0c ; �''' � aiIITH VI�IONS _ , TOW DENOTES TOP OF WALL Q a � = x = s.F. 'A�O� - ��v---DENOTESPROPOSEDCONTOUR p� � � P.aTID/DEC%S Mec. x Misc. ll3 SF. RrarConcmtePads BOW DENOTES BOTTOM OF WALL O !C 3. 3 Mi�c. x Misc. = 2l2 S.F. FrontDeck `, Jlf� ' O � �� W `Q La:1USC9Pl.�G x = S.E. 0 , � !3 �.�'� wl O p� � 0 Q W RET.-1l.YI.\GIf'AL4S x = S.F. � ` � � � � •� a a a Z x = S.F. ; ,J 1'� �� 3 � X� � � � � Q Q � � OTHER z = s.F. I ' � D C 3 v� X S.F_ ' X 945fS� �//9��•�/Z��pP : �,., � �' K�Rnco��m n�x i :a��n�r�x i � �_��s�� ; � ��J I , � � , ,� , � g�r.a � , , s� 1�y 3»s , zi,z� r i�o= �s�o 1 '�=�950.�; � 948.9 � / 932. � °�° � �i ►^� v, � � �� 950.5 �,�a�, 4�� / � � � o �� r � r�zoros��:��n:�avco�-�:x��rtF:R i ?>�a ��{� �L i�►��"�� '� ��v E 9 4 � X 9 / � / / �35.1 9 .I � LE.1'GTK !i'ID7H .�REA CO.tI:NE;\'TS G ` '�1----- � o � 4 .. 94 /G � ( :.�, C� \ .1� STRL'CTCRE.S �ti�c X Afisc. = 2361 S.F. fxivtui House z � _ � 953.11 N,6 �X 949�9 � �94��G�-c �!t- � `° '"� `� � ,► � _ � G 1 X,958.2 �� X951./ / _ ,,_--\"� ��Oa � g ,� � rn � � ' � � x - s.F. � cD � �' x s.F. v+ . 952.0 >�� pgE� ` � � d" rn � � � � � � DRII'E�f;iY Misc. X Misc = 1,16� S.F_ Pro sedBimmuiousDrivewav ` 95�.8 :. > �PR�PF�NCE` x 948.2 a' Q' � ,;µ �� C 933.6 ` p° �• � ' �, � s , - �4� � 51�X 949.2 11 t �,,,+ rcF.PC � � i :. � ' �. � 1 .1' Y ►"�i x = s.F. ,,g5a,6 �7� •� �� "' � 1,�4" � �X 94r�.8` ` �36'7 �,�I � 9�.0 , 1� � My SIDE[{;4LK.S 1Sisc X �fisc - 81 S_F_ RevisedFroutConcreteSidewal� Fp R� '� ,' ' 6 5 x�48.3 �, 1 ' � � , � '� Muc X Misc - 66 S.F. Proposed Side Concete Sidewalk _� �� ,'- �� 949.2 '� I 1 � � �` �, � P.4T/O/DECKS Muc. x ',bfisc. - ll3 S.F. EaiscmgRrarConcretePad � �p j ;p � .��, � ' 4 p Rimc. % ;11isc 212 S.F. Eastmg Front Deck � g5g.1 ;T�=k�� o 0 22•Z N ,J-� i ��\ I � �,T R �LE' ` x 933J__ -' � �� I � L.�:tiDSGPI:\'G x _ s.F. 'j ?Jp cM �. , \ I � 4 0 � 0� \I �Qpy� E� � n1Nl, -� f �1 y x - s.F. � 9 ��.-► � ,\ �'� � j v,� j2• 949.4 �948.07 E"��-�rt:� � � 1 � � 1 O RET�I\7�'GW4L4S z = s.F. G (l� �di� 959.6 �;958/ ti_ o N� 0 949.7QF�C:-�..'�'�" x�944`6 , � � ' � � �'` � x = s.F. � �'�AR�A OF `��-�3 .,� .1 '� p� � PAD � t � � I \ � � OTHER x s.F. � �� S�ORAGE� } �. �`` � �'1 -,_ .�O' 1� 949. g49.1 � M� � / W�' � ' � 1 932.1� I '� `1 � " = sf. � Cr► � �i '` 95g 0- W� �G N C WpLl. � a^, / C�•`g4"1,9� � + j X 933.0 � , e.aitnco��m��x i axEa c�rmt i � � � ,�H p� �:�^ � .P n tn 0 �ON 9g2.8� rn �� 48•?� ( � ' � � -�.a .,� .- 15' cn�^ o _SOW.0 w�l i �,�i i 2i?r� x ioo= �4�;�� U� �./� wp�y ! �Ws�g49.'4'� r �f B �94�0 � 1 , ^ �C� N , 1 ^o Z� CA�cr _ _ 1,-�959 6 �c C01'►�' �.31 " ��9 �� W�' � �-� � l, � 'S d. � o, �� SITE AREA EXCAVATION N � Ct� � \� 96�/ WAY �W W 'l��9g 2.9�18'a 9�F8.9g48• 9 ��(9�3'3�\� \' � r`�n '`' Ig3�.3 � + Im ortcd fill:36 c. o CO �' � `'"� 1� ��9�1�� \� N B0�� ' 4 ��' " 2J5 '. _fi �8 ��g�0'� �' � � 6 x 932 � � �L� rcO.� � Exportcd for thc e cavation: 18 c.v. � r' g62.� i-'�' -;•.�;{ � � � �� Q � �942 ` l ool Total area:54 c.y. o� 0 �+ �� . 3� 955.h �. c�,� �' '� :: � ''� \ :: � � �v �W rn r C:�,�5�'-"� �� ` 957. J�`"- \ � .: 933.0 93�.3 < � � � ,� � '`c�t.6� - ,, �� EM ` � , »--�-"" � � �� t� I hereby ceRify that this survcy,plan or report was prepared by me or under my direct �959.6 `_ a� R p O'�'23 W �� \ supervision and that I am a duly Licensed Land Survcyor under thc laws of the State of � �" \ -� - � 958. � .. Sa� , � _6- Minncsota ��i \ �c .� ` � �� ICE-- 61.5 I �_�SR� FENCE��.►� ��_DA8�J"`",.� P?�U��',.'_�. 9622 9 �--� HOL'SE �° � .�:p � �y� ��.P:^;?'�� ,� 964.7� N � Fp 3�4� �F� �g58'2 �e� 1� 1 ~^ ^ � ` Dated this lst day of May,2013. ' � �./ � I 1 SATHRE-BERGQUIST,[NC. 96�.3 _ : _ ' ` z; : , ,. = _ .,: - . , � ` \ ` � Danicl L.Schmidt,Profcssional Land Surveyor Minncsota Liccnsc No.26147 NORTH JOB#:69310-001 REVISIONS 2��as S�R� HARDCOVER SURVEY FIELD CREW:DH MISC.HARDCOVER REVISIONS 05-02-13 JML W �, SATH RE-BE RGQU IST, I NC. PREPARED FOR DRAWN BY:JML ADDED PROPOSED LANDSCAPING 07-30-13 JML JO NATHAN PAU L 30 15 0 15 30 60 m ,,,, ¢ 150 SOUTH BROADWAY WAYZATA,MN.55391 (952)476�000 CHECKED BY:DLS ADDED MISC.LANDSCAPE NOTES 07-31-13 JML `% 2� 3532 IVY PLACE DATE:04-15-13 REVISED EXCAVATION NUMBERS OS-O9-13 JML ��RS °�P� CITY OF ORONO,MINNESOTA SCALE IN FEET 2��3 '��07�! T � � � ♦ � • � � , � � emo To: Finance Department From: Christine Mattson, Planning Assistant !�� " l' \ CC: Street File Date: July 28, 2014 G/L: 101-22205 Re: Escrow Refund Bldg Permit#2013-00781 /3532 Ivy Place Building Permit Application #2013-00781 pertaining to 3532 Ivy Place is complete. Please refund $2,500 to the applicant, Jonathan Paul. The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Jonathan Paul 3532 Ivy Place Wayzata, MN 55391 w:�.street files�ivy place13532 ivy place(paul)�escrow reTund memo 2013-00781.docx , ZONING PERMIT ESCROW AGREEMENT Permit# 2�13—C707k'� AGREEMENT made this 1� day of i , 20�, by and between the CITY OF ORONO, a Minnesota municipal corporation ("City')and ("Owners"). Recitals 1. A building permit application has been filed for a zoning permit for a property located at[ . the ("Subject Property"), legally described as 1�4� C'19 '1-��TQY�OIr �U� I�T�� Hennepin C nty Minnesota. 2. Owner requests the City to review this application. 3. The City will commence its review of the application and incur costs associated with said review only if the Owner establishes an escrow to ensure reimbursement to the City of its costs. NOW THEREFORE,THE PARTIES AGREE AS FOLLOWS: 1. DEPOSIT OF ESCROW FUNDS. Contemporaneously with the execution of this Escrow Agreement, the Owners shall deposit $�with the City. All accrued interest, if any, shall be paid to the City to reimburse the City for its cost in administering the escrow account. 2. PURPOSE OF ESCROW. The purpose of the escrow is to guarantee reimbursement to the City for all out-of-pocket costs the City has incurred (including planning, engineering or legal consultant review) or will incur in reviewing the plan. Eligible expenses shall be consistent with expenses the Owners would be responsible for under a zoning permit application. The escrow will also guarantee reimbursement to the City for all out-of- pocket costs the City has incurred to assure that the work is completed in accordance with the Stormwater Pollution Prevention Plan and the provisions of Orono City Code Chapter 79. The financial security may also be used by the City to eliminate any hazardous conditions associated with the work and to repair any damage to public property or infrastructure that is caused b the work (including planning, engineering, or tegal consultant review) associated with permit # -C� TC if compliance with the approved zoning permit is not accomplished. 3. MONTHLY BILLING. As the City receives consultant bills for incurred costs, the City will in turn send a bill to the Owners. Owners shall be responsible for payment to the City within 30 days of the Owners' receipt of bill. 4. DISBURSEMENT FROM ESCROW ACCOUNT. In the event that the Owners do not make payment to the City within the timeframe outlined in#3 above, shall issue a Stop Work Order until the Owners pay all expenses invoiced pursuant to #3. The City may draw from the escrow account without further approval of the Owners to reimburse the City for eligible expenses the City has incurred. 5. CLOSING ESCROW. The Balance on deposit in the escrow, if any, shall be retumed to the Owners when the review has been completed and written notification is received from the Owners requesting the funds. 6. CERTIFY UNPAID CHARGES. If the project is abandoned by Owners,or if the eligible expenses incurred by the City exceed the amount in escrow, the City shall have the right to certify the unpaid balance to the subject property pursuant to Minn. Stat. §§415.01 and 366.012. CITY•�F� OWNER: I � ` n By: � ItS: t_. - �� a�,Y��. � i ,�.. « ...._ , �� 7��' . .'� Updated: November 30,2012 Ci�t_y of Grono 275t► Kelley Parkway Orana I�I 55356 952-249-4600 Receipt No: 3.0107Si Apr 18, �Q14 Janathan Paul Previoa� Balance: ,pp Peroits �414-OU3U6 3532 Ivy Place 2,50p,0{? 101-�05 Deferred Rev-Developer De�sit , Total: �,5pa.p� Check � (�eck No: 5168 �,5pt�.� Payar: Jonathan Paul Total Applied: 2�gpp,pp Change Tendered: .flQ 44118/�C014 11:PIA1� �� CITY OF ORONO * Z p� 1 4 - 0 0 3 0 6 * 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2014 ORONO, MN 55356- 952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3532 IVY PL PIN : 20-117-23-42-0033 LEGAL DESC : TAYLORS SUBD OF SPRING PARK LO : LOT 000 BLOCK 000 PERMIT TYPE : ESCROW FEE-APPLICANT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-APPLICANT NOTE: THIS$2500 ESCROW IS TIED TO ZONING PERMIT 20 1 3-0078 1 APPLICANT ESCROW FEE-APPLICANT 2,500.00 ESCROW FEE-DEVELOPER 0.00 PAUL,JONATHAN&JULIE TOTAL 2,500.00 3532 IVY PL WAYZATA,MN 55391- Payment(s) CHECK 5168 2,500.00 OWNER PAUL, JONATHAN &JULIE 3532 IVY PL WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this pertnit 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. �� (`v 1 / l A lic ermitee ig ature Date Issued B ignature ate