HomeMy WebLinkAbout2011-00803 - addn/remodel/repair � ' CITY OF ORONO PERMIT NO.: 2011-00803
2750 KELLEY PARKWAY
ORONO, MN 5535C- DATE ISSUED: 08/17/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2740 KELLY AVE
PIN : 21-117-23-23-0037
LEGAL DESC : VERN-MAR MANOR
: LOT 012 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 82,000.00
NOTE: SEPERATE PERMITS REQUIR�D: PLUMBING,MECHANICAL, ELECTRICAL(STATE)
GARAGG ADDITION
* EXISTING DRIVEWAY AND SIDEWALK TO BE REMOVED AND ETATED PRIOR TO RELEASE OF ESCROW.��"`"NIT)
* AS BUILT SURVEY REQUIRED PRIOR TO RELEASE OF ESCROW��(INITIAL)
APPLICANT PERMIT FEE SCHEDULE 921.75
AUTUMN RIDGE HOMES INC STATE SURCHARGE(VALUATION) 41.00
P O BOX 375 TOTAL 962.75
DELANO, MN 55328-
(763)269-2697
Minnesota State License#: 20637701
OWNER
O'MALLEY,PHYLLIS
2740 KELLY AVE
EXCELSIOR, MN 55331-
AGREEMENT AND SWORN STATEMENT
Thc work for which this pennit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and [he
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[his type of work
shall be compied with whether or not specified herein.This permit will
expirc and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if constr�ction is
suspended for a period of l80 days at any time atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in confonnance wi[h the State Building Code.This permit may be
revoked at or due cause.
� , � , > �', 17, 1
�cant P ee Si tu Date Iss y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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' � ��I � Cit of Orono i\
Y I �
� �� n �
Buildin Permit A lication �' � �
J pp "t�
for New Structures or Additions
�
Mailing Address: �
O�, ,�.Q PO Box 66 Permit number: —
Crystal Bay, MN 55323-0066 Date received: � ;,1
,� ��\���` � Received b
� :,`+ �, Street Address:' y�
�'.F, ��� oti 2750 Kelley Parkway Plan review fee: J� � . �
t�kESHOg'� Orono, MN 55356
Total Fee: a�l��Ud�
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must.be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: T'L'7�� k�� ! v �•���
Will this be a Parade of Homes, Remodele�s Showcase Home or other Display Home? ❑ Yes ❑ No
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: '{�v�v r►�r� �i�c�C�� �►-rr.�-� �-✓)�.
State License# '�p�3��`7 �j Expiration Date: '3—�I-�^?S71 Z
Phone: '��3 —'�.i.w�q�'Zca.�'� (office) (cell)
Mailing Address: �o �,� '37'� City:���r,o ZIP: �_
Contact Person: ° � Applicant is: r o�acfo� / Homeowner (Circle One)
Email and/or Fax: � Q�,� ,.Y,h r i c �,rru��M n . �m
.—�- _ � ,
PROPERTY OWNER INFORMATION:
Name: �m�
Phone (day):
Address: City: ZIP:
Email and/or Fax
ARCHITECT I ENGINEER INFORMATION:
Name: ���
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION:
1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
Water Supply
❑ New Construction -�] Single Family with ❑ Residence
�]Addition attached garage .� Garage/Accessory Bldg. �] Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family!Condo ❑Warehouse
❑ Public ❑ Storage � Public Water
"'Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review 8� permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify)
18202 Minnetonka Blvd
Deephaven, MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.or
Estimated Construction Valuation (excluding land) $ �:��
Last Updated: 4/26/2011
- 19 -
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City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Qermit number: p�:r �
g,�,�. PO Box 66 : �
0 � Crystal Bay, MN 55323-0066 �Date received: � .
a �, Street Address:' Received by
�'�c, � ��`S' 2750 Kelley Parkway Plan review fee: �,� , /��
��'k'E3H�4� Orono, MN 55356 ; ����y
"fotal Fee: ��� ,
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: �'L7�� k2� �y �Q��,
Will this be a Parade of Homes, Remodele�s Showcase Home or other Display Home? ❑ Yes ❑ No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil/be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION: \ '
Name: �v�'v mr� ��c�G� T�r�r��, ZYJ�.
State License# '�pU,'3'�� �) � Expiration Date: 3-�31-2s�12
Phone: ��3-2.t�q-'Zc�►q"� office (cell)
Mailing Address: }�o � '3�5 City:�.�,�o„o ZIP: j�_
Contact Person: ° Applicant is: �'fo"� / Homeowner (Circle One)
Email and/or Fax: � 5� ,�� ���m n . C,�n-�
PROPERTY OWNER INFORMATION:
Name: �m�
Phone(day):
Address: City: ZIP:
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name: �n-�
Phone (day):
Address: City: ZIP:
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 .�Garage/Accessory Bldg. � Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other:(specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public . ❑ Storage � Public Water
*"Any earth movement may require ❑ Commercial ❑Other(specify)
MCWD review 8�permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other.(specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m i nnehahacreek.or
Estimated Construction Valuation(excluding land) $ �Z,�
.
Last Updated: 4/26/2011
- 19- Srg
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STRUCTURE INFORMATION:
1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction
a.Length(ft.)= �� Number of bedrooms= �]Wood/Frame
c..i ❑ Masonry
b.Width(ft.)= z 1 Number of ya�rage stails: ❑ Metal
Attached= L ❑ Pole Bldg.
Areas in sauare feet Detached= ❑ ICF
❑ On-site Prefab
c. Basement= ❑ Off-site Prefab
d. 15�Story =
❑ Other(please specify):
e.2nd StOry=
f. '/2 Story =
g.Total Area=
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
;Nof
Enclosed : A licable
-� ❑ Permit A lication
$7 ❑ Pro osed Buildin Plans
❑ '� MN State Ene Code Calculations and Mechanical Code Re uirements Form
� ❑ Surve meetin all re uirements
.� Stormwater Pollution Prevention Plan
❑ Nardcover Calculation s
❑ ,BI Se tic S stem Site Evaluation Re ort
❑ Access Permit
❑ � Wetland Buffer Im rovement Plan
❑ �? En ineered Plans for Retainin Walls 4 feet or above
❑ Plan Review Fee
❑ ❑ Other
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Agrees to pay the City of Orono for engineering consultant review costs in excess of�500;
• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they
are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative
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 to ensure completion of the as-built survey and all site improvements.
P
ApplicanYs Signature: Date:
Last Updated: 4/26/2011
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CITY OF ORONO CALLED IN � 3� /
INSPECTION NO ICE b � SCHEDULED �� �L�
PERMIT NO. l COMP o
ADDRESS
OWNER TELE � NO. �����`3`5��
CONTRACTOR �%��
� DESCRIPTION G�Z�/�.� �/�G2N`—
� ❑ FOOTING ❑ PLUMBING FINAL � EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
c�., COMMENTS:
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� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFOREC�/ERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (g52) 249-46��
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� � <\��� q, E TIME ✓
I CITY OF ORONO CALLED IN t� I I
INSPECTION NOTICE SCHEDULED �
PERMIT NO.oZ��(��iY.��� COMPLETED
ADDRESS � ��
OWNER TELEPH NE NO. ���3 a�'r-�`��
CONTRACTOR t1�-�f LLPYIft�'l (���►N►C
�; DESCRIPTION ���Q t ?��� Y� r�4'1�1C� (
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� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y 0 FRAMING ❑ MECHANICAL FINAL
❑ TFEE 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 ❑ SEP I FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO ME'OU:�YES_NO
� COMMENTS:
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To: Finance Department
From: Christine Mattson, Planning Assistant
CC: Street File �1
�\ n,V
Date: 2/21/2012 �I
G/L: 101-22205
Re: Building Permit Escrow Refund
Building Permit #2011-00803 pertaining to 2740 Kelly Avenue is complete. The Applicant,
Timothy Dunn, has requested a refund of his$2,500 escrow.
The following is attached:
• Escrow Refund Request
• Email from Bonestroo indicating unbilled WIP on this project. Confirmation with the
Finance Department that the unbilled WIP will not exceed the$500 credit.
• Email from Campbell Knutson indicating no unbilled WIP on this project
• Original signed escrow agreement
• Copy of cash register receipt showing escrow amount received
Mail to: Timothy Dunn
3010 Brooks Lane
Wayzata, MN 55391
w:�street filesUcelly avenue�2740�escrow refund memo 2011-00803.doc
Christine Mattson
From: Tim Dunn [timd179@gmail.com]
Sent: Tuesday, February 07, 2012 11:43 AM
To: Christine Mattson
Subject: Escrow for 2740 Kelly Avenue
Ms. Mattson
Please release the balance of$2,500 of the escrow account for 2740 Kelly Avenue and advise when I can pick
up a check.
Thanks in advance,
Tim Dunn
3010 Brooks Lane
Wayzata, MN. 55391
612 986-6999
i
Christine Mattson
From: Peter Zimmerman
Sent: Wednesday, February 08, 2012 2:03 PM
To: Christine Mattson
Subject: RE: 2011-00803/2740 Kelly Ave
They have a bill from August for$164,so when you add in the alleged$82,they would still be under the$500 credit
amount.
_ _ _ . _ _ _ . _ . . _
_.
From: Christine Mattson
Sent: Wednesday, February 08, 2012 1:49 PM
To: Peter Zimmerman
Subject: 2011-00803/ 2740 Kefly Ave
We have an escrow refund request for the above. I don't see a 'tab' started for this project yet. Bonestroo has
$82 in unbilled WIP. Will that amount put this project over the $500 credit?
Thanks!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway f Orono F MN ! 55356(physical addressJ
PO Box 66 � Crystal Bay � MN � 55323-0066(mailing addressJ
S' 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 20,2012(in observance of Presidents DayJ
1
Christine Mattson
From: Darren Amundsen [Darren.Amundsen@bonestroo.com]
Sent: Wednesday, February 08, 2012 1:35 PM
To: Christine Mattson
Subject: RE: Unbilled WIP
$82 coming on December Biil
Darren Amundsen, PE
Associate
Stantec
Tel 651-604-4894
Cell 651-775-5623
darren.am undsenC�stantec.com
stantec.com
Bonestroo has joined Stantec. a professional services consulting fi►m recognized forits leadership in
sustainability, depth and diversity of talent, and technical expertise.
The content of this email is the confidential property of Stantec and should not be copied, modified,
retransmitted,or used for any purpose except with Stantec's written authorization. If you are not the
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�Please consider the environment before printing this email.
From: Christine Mattson [mailto:CMattson@ci.orono.mn.usl
Sent: Wednesday, February 08, 2012 11:06 AM
To: Darren Amundsen; 'Sherry Charboneau'
Subject: Unbilled WIP
Good Morning,
Any unbilled WIP for building permit 2011-00803 pertaining to 2740 Kelly Avenue?
Thanks!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway j Orono ; MN � 55356(physica/addressJ
PO Box 66 I Crystal Bay i MN i 55323-0066 (mailing addressJ
'� 952.249.4620 C 8 952.249.4616
�cmattson@ci.orono.mn.us a �] www.ci.orono.mn.us
Office Hours: Monday-Friday 8 am to 4:30 pm
OUR OFFICE WILL BE CLOSED: Monday, February 20,2012(in observance of Presidents Day)
1
Christine Mattson
From: Sherry Charboneau [SCharboneau@ck-law.com]
Sent: Wednesday, February 08, 2012 12:29 PM
To: Christine Mattson
Subject: RE: Unbilled WIP
Good Afternoon Christine!
Nothing for Campbell Knutson.
Sherry
Sheny L. Charboneau
Legal Assistant
CAMPBELL KNUTSON P.A.
1380 Corporate Center Curve•Suite 317•Eagan,MN 55121
"�"(651)234-6230• Fax:(651)452-5550
�scharboneau@ck-law.com•www.ck-law.com
From: Christine Mattson jmailto:CMattson@ci.orono.mn.usl
Sent: Wednesday, February 08, 2012 11:06 AM
To: Darren Amundsen (darren.AmundsenCa�bonestroo.com); Sherry Charboneau
Subject: Unbilled WIP
Good Morning,
Any unbilled WIP for building permit 2011-00803 pertaining to 2740 Kelly Avenue?
Thanks!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway ', Orono � MN � 55356 (physical addressJ
PO Box 66 j Crystal Bay ; MN ; 55323-0066 (mailinq addressJ
'�' 952.249.4620 � 6 952.249.4616
�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 20, 2012(in observance of Presidents Day)
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BUILDING PERMIT ESCROW AGREEMENT
Orono Building Permlt#2011-$@3�
�
AGREEMENT made this�day of ��_, 20�, by and between the CITY OF ORONO,
a Minnesota municipal corporation("Cit�')and T�1Nf)TJ�l�'J :�. ��("Owners").
Recitals
1. A buiiding permit application has been filed for a building permit located at 2740 Kelly Avenue,
the ("Subject Property'), legally described as Lot 12, Vem-Mar Manor according to the recorded plat thereof,
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-podcet costs the City has incuRed (induding planning, engineering, in excess of $500, or legal
consuttant 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 #2011-00803 if compliance with the
approved building permit is not accomplished.
� 3. MONTHLY BILLING. As the City receives consultant bills for incurced 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�e 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 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
subject property pursuant to Minn. Stat.§§415.01 and 366.012.
CITY: OF RONO OWN .
By: �
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� � • CITY OF ORONO PERMIT NO.: 2011-00833
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 08/10/2011
952 249-4600 FAX: 952 249-4616
REPRINTED ON 8/10/2011
ADDRESS : 2740 KELLY AVE
PIN : 21-117-23-23-0037
LEGAL DESC : VERN-MAR MANOR
: LOT 012 BLOCK 000
PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT
NOTE: THIS$2500.00 ESCROW IS TIED TO BUILDING PERMIT#2011-00803-PAID FOR BY TIMOTHY DUNN
APPLICANT ESCROW FEE-BUILDING 2,500.00
O'MALLEY,PHYLLIS TOTAL 2,500.00
2740 KELLY AVE
EXCELSIOR,MN 55331-
OWNER
O'MALLEY,PHYLLIS
2740 KELLY AVE
EXCELSIOR,MN 55331-
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
sha(l 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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Checkfist for Refunding Building Permit Escrows
Building Permit # ���—64�
Street Address: �-�� �Ce��� i�i'�
Name: �IV'Vl ���1�'�
���.-�St�SY�.�.�
�'' Escrow request received Date: � 7 ��2-
Permit Type: �" �
Are all inspections completed? Yes No
If not, list what is outstanding:
Was there a Temporary Certificate of Occupancy issued? Yes No Date:
�
Was there a Final Certificate of Occupancy issued? Yes No Date:
As-built survey required? Yes, approved on � � � ! ` �� ' NO NA
Email CK & Bonestroo to see if there is any unbilled WIP. Date email sent: ��� ' �`�
� Prepare memo for Finance Department
z:\forms�zoning standard forms\checklist for refunding building permit escrows.doc
Last Updated: 10-31-2011
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C�TY OF ORONO�� � DATE TIME
INSPECTION NOTICE CALLED IN i
PERMIT NO. SCHEDULED 2-��Z �
COMPLETED �� �— ;
ADDRESS_ Z7g,Q ���� �f��— —'-- �
OWN ER ;
TELEPHONE NO. ;
CONTRACTOR i
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� DESCRIPTION c.�� V��a-
� ❑ FOOTING ❑ PLUMBING FINAL
Q O POURED WALL ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING i
Zy ❑ FRAMING ❑ LAKESHORE/WETLqNDS
O INSULATION � MECHANICAL FINAL ❑ TREE REMOVAL �
❑ WOOD BURNER/FIREPLqCE
�Q ❑ RADON SLAB ❑ WATER HOOK-UP � SITE INSPECTION
� FINAL O SEWER HOOK-UP � PROGRESS
v O DEMO-SITE ❑ COMPLqWT
�Q ❑ SEPTIC MAINT. j
❑ DEMO-FINAL ❑ SEPTIC INSTALL � FOLLOW-UP
v ❑ PLUMBING RI ❑ SEPTIC FINAL � WARD COVER REMOVAL
� OWNER/CONTRqCTOR TO MEET YOU:_y�_NO � FOUNDATIOWREMOVAL
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� ❑WORK SATISFACTORY:PROCEED
❑CARRECT WORK&PRpCEED �PROJECT COMPLETE
0 ❑W ❑ ISSUE CERTIFICATE OF OCCUPANCY
CORRECT WORK,CALL FOR REINSPECTION
V BEFORECOVERING TEMPORARY
❑CORRECT UNSqFE CONDITION WITHIN ----PERMANENT
INSPECTOR WILL RETURN HOURS. �HOTO TAKEN
❑STOP ORDER POSTED.CALL fNSPECTOR D CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.
Owner/Contractor site: �952) 249-4600
Inspector.
White Copyllnspector's File
Canary Copy/Site Notice
.�---= � CITY OF ORONO PERMIT NO.: 2011-oogo3
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 08/17/2011
952 249-4600 FAX: 952 249-4616
ADDRESS , : 2740 KELLY AVE
PIN � : 21-117-23-23-0037
LEGAL DESC : VERN-MAR MANOR
: LOT 012 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL :
VALUATION : $ 82,000.00
NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STAT'E)
GARAGE ADDITION
* EXISTING DRIVEWAY AND SIDEWALK TO BE REMOVED AND ETATED PRIOR TO RELEASE OF ESCROW.���T)
* AS BUILT SURVEY REQUIRED PRIOR TO RELEASE OF ESCROW��INITIAL)
APPLICANT pERMIT FEE SCHEDULE 921.75
AUTUMN RIDGE HOMES INC STATE SURCHARGE(VALUATIOI� 41.00
P O BOX 375
DELANO,MN 55328- TOTAL 962.75
(763)269-2697
Minnesota State License#:20637701
OWNER
O'MALLEY,PHYLLIS
2740 KELLY AVE
EXCELSIOR,MN 55331-
AGREEMENT AND SWORN 5TATEMENT
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 oniy 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 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 or due cause.
� , � , > �`, l 7, 1
icant ee Si tu Date Iss y Signature Date
SEPA�ATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.