HomeMy WebLinkAbout2014-00656 - demo . , CITY OF ORONO * 2 0 1 4 — 0 (d 6 5 6 *
2750 KF,LLEY PARKWAY DATE ISSUED: 07/03/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2560 KEI.I,Y AVE
PIN : 20-117-23-11-0007
LEGAL DESC : REG. LAND SURVEY NO. 0088
: LOT 000 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE . R�tt6�AF�6-- I'�cj`-t �<-l � � l cc `
CONSTRUCTION TYPF. : DEMO- PRINCIPAL STRUCTURE
lo�� ��1 p��� 8�-e�
NO'1'L: DEMO(1)PRINCINAL S�RUC"I�URE AND(1)�10ESSORY BUILDING
APPLICANT DEMOLITION - PRINCIPAL STRUCTURE 75.00
STATE SURCHARGE DEMO 5.00
TAYLOR WEST DEMOLITION-ACCESSORY STRUCTURE 50.00
P O BOX 190
CIRCLE PINES, MN 55014- TOTAL 130.00
(612)248-3132 Payment(s)
CHECK 5424 130.00
OWNER
INTN'L MINISTERIAL PELLOWSHIP
2560 KELLY AVE
EXCELSIOR, MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shali be perli�rmed according to
the approved plans and specitications,applicable Citp approvals,and the
State[�uildino Code. l�his permit is for only the work described and does
not grant permission for additional or rclated work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not speciYied herein.'I�his pennit will
expirc 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 alter work has commenced.
I'he 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.
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Applicant � mitee Signaturo 1�atc Issu� l3y Signature Date
Jun 27 14 09:41 a TaylorWest 6515288351 p.2
Jun 26 14 i028a Taylo�'�1'lest u�35288351 P 2
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�Alf pe�niLs mu�!br.approved 6y the Build'ing O�F�ciai andior?onng Gepar:menij
( Job�ife/ Owner Information: -----^1
Type: �Residentia9 ❑Commercia!
site Address- O��Y1� 3`-�C�� �� r`��C-� ��(�1'117.�; l"I��IJ .� ���f
�-•rr�rnCt�-�'!O CA-J o5`7 ��� �d� �
Owner: f�i'I in r ��-�'iG /Fr%/�SG,�Nailing Rddress: �f f,��QC KL�C�tG�
C�ry_ �c n��_ z�P: �s�3 r
Phon�:������i"7� "`,-�-y�D� Email: b�L�.��� �.1,-'�'d1 -�� C{yJ
Cantractor 1�lpplicant irformation: J
Contractnr/App :���f ���� �L� ContactPerson: ��S$�"1L��'`�
�ddress: � (�• LY>� � �� D St�te License#:
City: (�1'tG��. �I't'1C� Zip: � )�'�" Expirati�n Date:
Phone: Cf�1�� _�y,��f 3�. Ernail: ri�1StT�L� OtL'�5�"�'''�' � C6�'��
�'_ -`__ _ _�
SPEClAL�QNDITI4NS & HOLD HARMLESS AGREE�VIEt�T _ __
Ge r�e ral Inst�uctians:
9_ You may ne required to abtain other permits, i.e.:evell abando /^ ,- '_ � ,�.rr ��t��
2. UL'ork m�st npt begin unl�ss the oermil card is ava�labJe On thE �.nw� (�
3. A 2448 hournotice is required for a!I inspections. Cati (952):
4. Sewer must be d�scontinued at ihe City senrice b}� quaEifiEd co ��Z, 2�� q333 (,G)
issued.
Dernolition by means of_ ❑ 1Uanual Disassembiy �Neavy Equiprn
PeYmit(s) fssuP.d.- ❑ 5ewer Disconnection ❑WeH Abandonment#
!n return�far issuance of said Demolition Pertnit, the untfersign�d
1. Submit a suruey, aerial pho�o or ske#c� shawing all structu�
str�ciures a�e to he demofished_
2. Subrnii a survey, aeriaf phoio or sketch showing prop�s�
accordance with Chapter 79, Construcfion Site Runoff�r,nfr•ol.
3, Submit a capy of�errrrit approval frorrE th� M=nnehaha �reek �
City v��tl no# issue a demolition permit without a copy of tF
documen�tian stating permit(s)are not r�quired,
/�� PRINCIPAL STRUCTURE DEMOLITION PERMIT
� ZONING DISCLOSURE $ DECLARATION
y � To the property owner: Demolition of the principal dwelling structure on a property may
` �.,,^� �� automatically terminate certain rights which may have accrued to the property by virtue of the
'� continued existence of that building. This means you may give up some or all of the zoning rights
currently associated with the principal structure (setbacks, hardcover, size of building, etc)with its removal.
• Rebuilding on a substandard lot of record (i.e. a lot that does not meet the zoning district required lot area or width
standards) may, with few exceptions, require variance approval by the City Council, and such approval is neither
automatic nor guaranteed but requires that a practical difficulty be demonstrated.
• Additionally, all current zoning standards will have to be met by the new principal dwelling including setbacks, and
building footprint, hardcover(impervious surface), &height limitations, etc.
• Where municipal sewer is not available, provision of two (2) conforming on-site septic treatment sites is mandatory
for a new dwelling.
• Unless specifically approved by the City, all seasonal and permanent docks must be removed at the time of
principal dwelling demolition. They may not be re-installed until a new principal dwelling has reached the
framing stage.
The following information is presented for the purposes of advising the properly owner of the implications of removal of
the rinci al dwellin on the ro e
1. Property Address: 2560 Kelly Avenue PID# 20-117-23-1i-0007
2. Zoning District: LR-1B Required Lot Area: 1 acre Required Lot Width: 140'
Shoreland? Y N Actual Lot Area: 2.31 acres* Actual Lot Width: 250'
*According to Hennepin County
Lot area variance i i no equired. Lot width variance is i no r quired.
3. Required Setbacks: Front 35' Rear 30' Side 10' Side Street 35'
Lakeshore Lot: Lake (Front) Street(Rear)
Average Lakeshore Setback: mu t be m i n licabl .
4. Massing & Lot Coverage by Structures: limited to 15% of lot are does not a I lot rea > 2 acres
5. Hardcover limitations: Are NOT applicable—or -Are applicable.
Stormwater Quality Overlay District Tier: 1 � 3 )4 5
Tier 3 hardcover limit = 35%of gross lot area �
6. Municipal sewer is available.
7. Wetland is present; a 35-foot setback is required. If the wetland is within 150 feet of the project a wetland delineation
may be required for setback determination. Minnehaha Creek Watershed District approval is required prior to issuance of
permits from the City of Orono. **Contact Planning Department Staff for additional information.
�The ndersign d property owner hereby acknowledges receipt of the above information. Staff Initials
�..,,._��� r�-�--�=-�-�.-b.Q r--���,,,,�.,�►
�Y � G ° � . �� ��dM
Pr perty Owner's Signature Date
(Original: Street File; Copy: Properly Owner)
Created: Apri12013
Jun 271409:42a TaylorWest 6515288351 p.3
J�.in 2G 1�11�2P�� TaylorWest 6v152883F1 P�
4, Submit a �2,�00 escrow ar:d an escrow agreement signed by the properiy owner.
5. Keep al�struct�re(s}e:iclosed andlor secured until sueh time as�+emol3tion is complete.
6. Keep al! dert�olition debris ofF adjoining prdpert7l and/or the public rights-of way unless specrf�ic
�riQr app►'ova!�s obtained in writing tor temporary use thereo�.
7. Compietely remove founda6on(s)from the ground.
B. Compteteiy dispose af a!I dem�iition debr�s oFf site in accordance with aEl applicable PCA
requirements.
g. Abandon water welEs in accordance with State HealFh Depar�ment regufatians.
1 d.Call for an inspection when all debris has been remav�d,before back�tling.
11.W�hin 5 working days af superstnacture removal, a fnal inspection shalf be requested. The site
shall be lefi de� and clear of all debris, w:ih any excavation filled wlth earth teve! with the
adjacent gr�und elevation{except when such excavation is to be used as part of a new bu�lding
and such new bu�lding is aatual{y under construction).
12.Abandcn septic systems per Minnesota RuEes Chapter 7pB�. A11 septic t.anks must be pum�ed,
crushed and filled with native soils. An inspectnon is required after the tanks are pumped and
before the tanks are a'ushed and filled.
13.The undersigned own�r shall and hereby does indemnify and hold ha��nless the City ot Orono,
its egents. errrp9oyees and assigns#rarr antl against a!! ctaims, d�mages, losses or expenses,
including attorney fees, against the Ciry, its agents, ernployees ar�d assigns arising out of or
resulting from the demo�ition described herein as performed by the property owner, his
ernployees,agents, subcontractors or assigns.
PERM[T TYPE AhtD FF..�GALCi3LATtdN
� �75.00—Principal Structure � ��' a �
�, $50.Ot"3—Accessory Stsucture x 6 (how many} J�� " � �-
1. Subtofal dfi above permit requested $_�� � Q �
2. State Surcharge 5.00
3. TdTAL PERMIT FEE (add lines 1-2 above) $ �.��� �
i he undersigned herby app�ies to the City of Orono far issuance of a Derr�olition Permit, agrees to do
all the work in a strict aceordance with the ordinances of the City and the regt�lation�s of the State of
Minreesota,and certifies lhat aO statements made on this appl;cation are complete,true and correc�.
I • � ��.- �2t�: ��' i_7�Ci' /1 1
A�alicant's Signature: •
__�_-�l�r�� fv �a(o� �4'
� Own�r's Signature: � . �r e�-.���_ �_.,�.`�..,�_..,,-. Date:
° ��Y
Ap�roved$y: _ D�ate:
uilding Officiai)
I
"Zoning Disclosure Required? YES ❑ �O
'This must be filled out hy Zoning D artment—Far either answer,a Zoning Of�icial rnust sign all aflplicat.ons.
"APProveai By_ Date: �'f �� 1
(Zoning O�cia1)
.,.
Christine Mattson
From: Christine Mattson
Sent: Tuesday, July 01, 2014 11:10 AM
To: 'Chet Masserano'; 'rusty@taylorwestcorp.com'
Cc: Melanie Curtis
Subject: 2560 Kelly Ave/#2014-00656
Attachments: Zoning Disclosure Form 2014-00656.pdf; Escrow Agreement- Demolition Permit
2014-00656.pdf
Chet,
Thank you for speaking with me this morning. Per our conversation attached are the Zoning Disclosure Form and the
Demolition Escrow agreement. Please review and sign the Zoning Disclosure Form and return to us. Also, please review
and sign the Demolition Escrow agreement and return with a check for$2,500.
Rusty,
This project may trigger the Minnehaha Creek Watershed District's (MCWD) permitting requirements; please contact
the MCWD directly at 952-471-0590 regarding the project. Please note, the City of Orono will not issue the demolition
permit without a copy of MCWD permits or documentation from the MCWD stating the proposed project does not
trigger any of their permitting requirements.
The above information is required in order for the review to 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.
Christine Mattson
Planning Assistant
City of Orono
2750 Kelley Parkway Orono MN 55356 (physica/addressJ
PO Box 66 Crystal Bay MN 55323-0066 (mailing addressJ
S' 952.249.4620 g 952.249.4616
� cmattson@ci.orono.mn.us � www.ci.orono.mn.us
Summer Office Hours: (Monday, May 19 through Friday,August 29,2014)
Monday-Thursday: 7:30 am to 5 pm
Friday: 7:30 am to 11:30 am
OUR OFFICE WILL BE CLOSED: Friday,July 4, 2014
1
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Parcel 20-117-23-11-0007 A-T-B: Torrens Map Scale: 1"= 100 ft. N
ID: �
Print Date: 7/1/2014
Owner Market �
Name: Intrnatl Ministerial Felship Total: $233,000
Parcel 2560 Kelly Ave Tax $2,501.30 i
Address: Orono, MN 55331 Total: (Payable: 2014) �
Property Residential Sale �400,000
Type: P�ICe: This map is a compilation of data from various
`sources and is furnished"AS IS"with no
Home- S81e representation or warranty expressed or �
Homestead 10/2013 implied,including fitness of any particular '
stead: Date:
purpose,merchantability,or the accuracy and
completeness of the information shown.
Parcel 2.31acres Sale COPYRIGHTOOHENNEPINCOUNTY2014 ;
Area: 100,581 sq ft Code:
�, Think Green:
http://gis.co.hennepin.mn.us/Property/print/default.aspx?C=452105.2532117474,4975574.8... 7/1/2014
Jun 271409:42a TaylorWest 6515288351 p.4
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Jun 271409:41a TaylorWest 6515288351 p,1
Taylor West LtC
P.O.Box Z90
[Phone numberj(fi51)248-3132� [Fax number](651)52&8351
TO: City of Orono FRQM: Taylar West LLC
FAX: �952)249,4616 PAGES: �
PFfO N E: DATE: 6/2i/2014
RE: Demolition Permit CC:
❑Urgent �For Review ❑Please Comment �lease Reply ❑Please Recycle
Commenu: To Whom it may concern,please review and contact ituss 7hole with any question(651J248-313Z
ThankYou,PattyThole
a�� DATE TIME (/
CITY OF ORO O (z�(2S(� CALLED IN
{�
INSPECTION NOTICE SCHEDULED
PERMIT NO. COMPLEfED -� '�
ADDRESS 2 5 Ga ����y �G 2 -
OWNER TELEPHONE NO.
CONTRACTOR la�lO✓ W�ct�
� DESCRIPTION a��
W ❑ 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 ,�OLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
Z OWNERlCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: l�✓wc�t `tc/L.Q�✓ �� /4O �3 Ca�r' ,�.,�-
a li �'r.�t�L e� S�ccGi�d.�
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W� ❑WORKSATISFACTORY:PROCEED �PR6dECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
Owner/Contractor on site:
Inspector: � �``�� �
White Copyllnapector's File Canary CopylSite Notice
� ��� i DATE TIME
CITY OF ORONO CA LE8'T�_--
INSPECTION NOTICE SCHEDULED
PERMIT NO. ��,..� l�- c��i COMPLETED
ADDRESS � JC� �� C' ( - �
OWNER��'iff-�i'Ci7�`.'CI"��...�.i.�.�TELE H . =3/3
CONTRACTOR ~ �- P �
` �'` ��$
�; DESCRIPTION
ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC F
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXC /GRADING/FILLING
y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
kJ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE ❑ S TIC INSTALL ❑ FOUNDATION/REMOVAL
2 OW NERICONTRACTOR TO MEET YOU:�ES_NO
� C,�MMENTS:
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W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRE�T WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CO�ECT WORK,CALL FOR REINSPECTION TEMPORARY
V . �FORE CWERING PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
� �, INSPECTOR W{LL REfURN ❑CITATION ISSUED
❑ STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO AflRANGE ACCESS.
Call for the next inspection 24 hours in advance.�g�2) 249-46�0
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To: Finance Department
From: Christine Mattson, Planning Assistant (^ ��n
�,�
CC: Street File
Date: November 17, 2015
G/L: 101-22205
Re: Escrow Refund
Demolition Permit#2014-00656 pertaining to 2560 Kelly Avenue is complete. Please refund
$2,500 to the property owner, International Ministerial Fellowship.
The following is attached:
• Original signed escrow agreement
• Copy of cash register receipt showing escrow amount received
Mail to: International Ministerial Fellowship
2477 Shadywood Road
Excelsior, MN 55331
w:�street filesUcelly avenue�2560�escrow refund 2014-00656 demo.docx
. �
DEMOLITION PERMIT 2014-00656
ESCROW AGREEMENT
AGREEMENT made this �.��day of , 20� by and between the CITY OF ORONO, a
Minnesota municipal corporation ("City")and Internat' al Ministeri I Fellowship ("Owners").
Recitals
1. An application for a demolition permit has been filed for the principai structure and one (1)accessory
structure located at 2560 Kelly Avenue("Subject Property")legally described on attached Exhibit"A".
2. In conjunction with the demolition, erosion control measures are required as shown on attached
Exhibit"B".
NOW,THEREOFRE,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 (including planning, engineering, or legal consultant review)the City has incurred to assure that
the erosion control measures are installed and maintained so the property complies with 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. If
compliance with the approved Land Disturbance Permit is not accomplished within the allowable time period, the City
may bring the project into compliance by use of the security.
3. RIGHT OF ENTRY. The Owners hereby grant the City, its agents, employees, officers and
contractors the right to enter the property to pertorm all work and inspections deemed appropriate by the City in
conjunction with the required erosion control measures, including but not limited to constructing or completing any and
all of the agreed upon improvements should the Owners' contractor not complete those improvements by the date
specified herein.
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. Any remaining amount of the financial security deposited with the City for
faithful performance of the plans and specifications and any related remedial work will be released after the
completion and inspection of all such measures and the establishment of final stabilization for the Subject Property.
City Staff shall review the terms of this escrow agreement two times per year to determine whether the requirements
of the project have been successfully completed and whether it is appropriate to retum the funds. Owner may also
request the release of the funds, and such funds shall be released upon City Staff receiving the appropriate
verification that all requirements of the project have been successfully completed.
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 OWNERS:
�� �� fw��\,�.� `^ `` � u � `
By: �
�ts: c�"' �' � 5 4 �
ST 3�
In�ernr�l Llse On}y: G Ur1��to Fina�ee Hepart�n�t '�Cepry ta�r�eet File
iso�sa �''I Sr'�' 3�f 6 ' ��f 6�f
DEMOLITION PERMIT 2014-00656
ESCROW AGREEMENT
EXHIBIT "A" —LEGAL DESCRIPTION
County: Hennepin
City/Township: Orono
Parcel ID and/or Address: 2560 Kelly Ave (PID #2011723110007)
Legal Description (Section, Township, Range):
Reg. Land Survey No. 0088, Tract C, Part of the NE 1/4 NE 1/4
Section 20, T117N, R23W, City of Orono, Hennepin County,
Minnesota
�so�sa
, CITY OF ORONO *� 4 _ 0 0 6 9 1 *
2750 KELLEY PARKWAY DATE ISSUED: 07/02/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2560 KELLY AVE
PIN ; 20-117-23-11-0007
LEGAL DESC : REG. LAND SURVEY NO. 0088
: LOT 000 BLOCK 000
PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT
PROPERTY TYPE : -RE�JS r�-�"s � �-1 c ��-i �� (
CONSTRUCTION TYPE : ESCROW FEE -TIED TO BUILDING PERMIT
NOTE: ESCROW FOR DEMOLITION PERMIT 201400656
APPLICANT ESCROW FEE-BUILDING 2,500.00
TOTAL 2,500.00
INTN'L MINISTERIAL FELLOWSHIP Payment(s)
2560 KELLY AVE CHECK 35574 2,500.00
EXCELSIOR,MN 55331-
Ci�y of Gror�c
2750 Kelley Parkway
Orono MN 55356 y52-�t49--4bU0
OWNER Receipt Na: 3.011241 Jul Z, 2U14
INTN'L MINISTERIAL FELLOWSHIP
2560 KELLY AVE IntriI Ministerial F�]lowshiH�
EXCELSIOR,MN 55331-
Plar�niny a�.tl Zoning
2014-U0691 z560 Kelly Ave 2,500.�Ju
lU1-22205
AGREEMENT AND SWORN STATEMENT Defei r�d RF.v-[)eveloper Deposi t
The work for which this permit is issued shall be performed according to Tp��l: 2,��00 00
the approved plans and specifications,applicable Ciry 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 Cheek
permits. All provisions of laws and ordinances goveming this type of work ChPC�: No: 35574 2,.50iJ.0U
shall be compied with whether or not specified herein.This permit will Psyor:
expire and become null and void ifconstruction authorized is not InTnl Ministerial Fel l ows!�iE�
commenced within 180 days of the date of issuance,or if construction is Tot�,l A ]ied: 2,500.UO
suspended for a period of]80 days at any time afrer work has commenced. p�
The applicant is responsible for assuring all required inspections aze --- '---'�'-'---
requested in conformance with the State Building Code.This permit may be Chanye Tendered: .00
revoked at any time for due cause. ________________
p7/p��� � � r�1;COPM
�7'�- / /
Applicant Permitee Signature Date lssued By � nature � Date