HomeMy WebLinkAbout2011-01586 - demo CITY OF ORONO PERMIT NO.: 2011-01586
, " � ` 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE IssuEn: OU05/2012
952 249-4600 FAX: 952 249-4616
ADDRESS : 1200 LOMA LINDA AVE
PIN : 08-117-23-23-0027
LEGAL DESC : SAGA HILL REVISED
: LOT 001 BLOCK 001
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-ACCESSORY STRUCTURE
ACTIVITY : 649-ALL OTHER BUILDING&STRUCTURES
NOTE:
1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. INSPECTIONS DONE BEFORE BACKFILLING.
APPLICANT DEMOLITION-ACCESSORY STRUCTURE 50.00
THN ENTERPRISES STATE SURCHARGE DEMO 5.00
500 WEST LAKE ST.
EXCELSIOR,MN 55331- MISC FEE 0.00
(952)4749454 TOTAL 55.00
OWNER
ETAL, EDMUND GRIFFIN
1210 LOMA LINDA AVE
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 dces
not grant permission for additional or related work which requires separate
permiu. 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 c ance with the State Building Code.This permit may be
revoke t' e for due ca .
� � � �� /z � ���/�--
icant Permit ' ature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� ^
�' �:t�� City of Orono FO CIT LISE ONLY p /�
��O`�`�y, P.O.Box 66 CS/
� Date Received: Z ( Pennit# o��/�"` U !�
��+�;�,�„ i 2750 Kelley Parkway
��� '����� � Crystal Bay,MN 55323 Amount $ ��AC Credit
����s;�yc,�� (952)249-4600
`\�!?r",isao!f
_ ,. _ Homeowner(s)Signed: ❑Yes
Resolutions(if any)Signed: ❑Yes ❑None Required
Zonin Disclosure Si ned: ❑Yes ❑None Required
CITY OF ORONO - DEMOLITION PERMIT
(All pennits must be approved by the Building Offieial and/or Zoning Department)
Jc�I���';C`��r InfOrmation: �
Type: [� Residential Commercial
Site Address: / �C��� ���G� ����� �
Ownef�: ��J� � � ��-4� Mailing Address: r�.�U �Q�C� � 1�/t���
City: �C��C� Zip: ,J`���b ��
Home Phone: /� � ���14 �� d��d Alternate Phone: (;�.(X(��lW,����t ��"' "
�-��� .m� z�♦��1����`�� � atian: V�+�`��� �
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Contractor/App.: 1 !��� �11c1�t���►'�5 Contact Person: ld�1, l 1l�GG'lf W�,
Address: ��� W�' � ���� �� State !.icense #:
City: ����► dt Zip: ���}���� / Expiration Date:
Phone: /`��z- � 7�� ( - yY�'� Alternate Phone: �/ �`-���^ '��� �
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General Instructions:
1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc.
2. Work must not begin unless the permit card is available on the job site.
3. fi 24-48 nour notice is required ior aii inspections. Caii ��i5�j :49-46G0.
4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued.
Demolition by means of: ❑ Manual Disassembly [�Heavy Equipment ❑ Other
Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandonment #
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to:
l. Submit a survey, aerial photo or sketch showing all structures on the property. Note which
structures are to be demolished.
2. Submit a survey, aerial photo or sketch showing pi-oposed erosion control measures in
accordance with Chcrpte�� 79, Construclion Site Runoff Control.
3. Submit a $2,000 escrow and an escrow agreement signed by the property owner.
4. Keep all structure(s) enclosed and/or secured until such time as demolition is complete.
. , , .
5. Keep all demolition debris off adjoining property and/or the public rights-of way unless speciftc
prior approval is obtained in writing for temporary use thereof.
6. Completely remove foundation(s) from the ground.
7. Completely dispose of all demolition debris off site in accordance with all applicable PCA
requirements.
8. Abandon water wells in accordance with State Health Department regulations.
9. Call for an inspection when all debris has been removed, before backfilling.
10. Within 5 working days of superstructure removal, a final inspection shal! be requested. The site
shall be left clean and clear of all debris, with any excavation filled with earth level with the
adjacent ground elevation (except when such excavation is to be used as part of a new building
and such new building is actually under construction).
1 l. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped,
crushed and filled with native soils. An inspection is required after the tanks are pumped and
before the tanks are crushed and filled.
12. The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its
agents, employees �nd assigns from aizd against all �laims, damages, ,osses ar �xpenses,
including attorney fees, against the City, its agents, employees and assigns arising out of or
resulting from the demolition described herein as performed by the property owner, his
employees, agents, subcontractors or assigns.
PERMIT TYPE AND FEE CALCULATION
❑ $75.00-Principal Structure $
� $50.00-Accessory Structure x (how many)
1. Subtotal of above permit requested � $
2. State Surcharge 5.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $
The undersigned herby app(ies to the City of Orono for issuance of a Demolition Permit, agrees to do all
the work in a strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and correct.
--��/
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�pplacant's Signature: � " Jate:
� �
Owner's Signature: � Date: /��°`//
Approved By: �, 2u�---- Date: � - ;3 - Z�► Z.
(Building Offtcial)
* Zoning Disclosure Required? ❑ YES �NO
*This must be filled out by Zoning Department—For either nswer,a Zoning Official must sign all applications.
* Approved By: Date: DI D � ` �
(Zoning Of� ' I)
Hennepin County Property Map Print A Page 1 of 1
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� p� y p y p - Tax Year: 2011 � �
. !The daW contained on this �
���. pa9e is deriveC from a compila[ion of records and maps and may contain discrepancies that can only be disclosed by an aaurate survey peRormed by a Ilcensed � �
land surveyor The perfineter and area(square fooWge anA acres)are approximates and may contain discrepanoes The informa[bn on tbis paqe should be used for reference purposes only.
� ; Mennepin County dces rw[guarantee the accurecy of material herem contained and is not responsible for any misuse or misrepresentatlon o/this informatlon or its derivatives.
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Selected Parcel Data nate Printed: io/a/2osi s:s2:15 PM �
� i Parcel ID:08-117-23-23-0027 Current Parcel Date:9/6/2011 (
Owner Name:EDMUND GRIFFIN ET AL
Parcel Address: 1200 LOMA LINDA AVE,ORONO,MN 55364 E
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p rty Type:RESIDENTIAL LAK Sale Price:$0.00 #
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� ; Homestead:NON-HOMESTEAD Sale Date: / i
' ' Area s ft . 21210 �
j ; � 4 )' Sale Code: a
� ; Area(acres]:0.49 �
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A-T-B:TORRENS �
� Market Total:$838,000.00 ; �
� ; Tax ToW1:;8,701.10 � €
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http://gis.co.hennepin.mn.us/HCPropertyMap/Locator.aspx 10/4/2011
DATE TIME V
CITY OF ORONO CALLED IN
INSPECTION NOTICE ��. SCHEDULED � /
PERMIT NO�L' �� � �� `-�r. COMPLETED '�7 'I�'��
ADDRESS � � �' �- �"� '� ���� -
OWNER TELEPHONE NO.�� j '- '���
CONTRACTOR
>; DESCRIPTION �o't'� n � ����` � ���� (=SC ici�
�
� ❑ FOOTING ❑ PLUMBING FINAL �EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
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
J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL �FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED ��ROJECT COMPIETE
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W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W4LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnerlContractor on site: �
Inspector.
White Copy/lnspector's File Canary CopylSite Notice
� DA TIME �
CITY OF ORONO CALLED IN �
INSPECTION NOTICE SCHEDULED �� a���
PERMIT NO.v2U��d���� COMPLETED
ADDRESS ��d� ���� � ���
OWNER TELEPHONE NO. ��-�� ����
CONTRACTOR �,��� � �Q�'Y1 /v��G��'r""''"
�: DESCRIPTION
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
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 INSTALI ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW ❑WORK SATISFACTORY:PROCEED �ROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46��
Owner/Contractor on s' e: -
Inspector. '� � ' �
White Copyllnspector's File Canary CopylSite Notice
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emo
To: Finance Department
From: Christine Mattson, Planning Assistan��
CC: Street File
Date: 5/8/2012
G/L: 101-22205
Re: Demolition Permit Escrow Refund
Demolition Permit #2011-01586 pertaining to 1200 Loma Linda Avenue is complete. The
Applicant, Donald 8�Carolyn Udell, has requested a refund of their$2,000 escrow.
7he following is attached:
• Escrow Refund Request
• Email from Bonestroo indicating no unbilled WIP on this project
• 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: Donald &Carolyn Udell
1210 Loma Linda Avenue
Mound, MN 55364
w:�,street filesUoma linda ave\1200�escrow refund memo 2011-01586.doc
Christine Mattson
From: Carolyn Udell [ceudell@hotmail.com]
Sent: Tuesday, April 24, 2012 7:28 AM
To: Christine Mattson
Subject: Udell, Return of escrow for 1200 1/2 Loma Linda
Christine Mattson,
RE: Demolition permit 2011-01586
I am requesting the return of the escrow money, $2,000.00, that was deposited for the demolition of 1200 1/2 Loma
Linda Ave in January 2012.
The property was inspected and passed the inspection.
Please let me know if there is anything else we need to do to get the money returned.
Thank You for your attention to this matter.
Carolyn &Don Udell
1210 Loma Linda Ave
Mound MN 55364
Phone: 952-471-8688
�
Christine Mattson
From: Sherry Charboneau [SCharboneau@ck-law.com]
Sent: Monday, May 07, 2012 12:23 PM
To: Christine Mattson
Subject: RE: Unbilled WIP
Christine:
Nothing for Campbell Knutson.
Sherry
Sherry 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(c�ck-law.com•www.ck-law.com
From: Christine Mattson jmailto:CMattsonCa�ci.orono.mn.usl
Sent: Monday, May 07, 2012 8:42 AM
To: Darren Amundsen (darren.AmundsenCa�bonestroo.com); Sherry Charboneau
Subject: Unbilled WIP
Good Morning,
Any unbilled WIP for the following?
Buildin Permit# Address
2011-00318 115 Creek Rid e Pass And & Marnie Pfeifer/Charles Cudd
2011-00075 3215 Graham Hill Rd Kei h &Am Korsi/ Charles Cudd
2012-00038 4050 Ba side Road Danielle Steele
2012-00205 1390 Cher Place Te & Gretchen Blount
2011-01586 1200 Loma Linda Ave Donald & Carol n Udell
Thank you!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway � Orono � MN � 55356(physical address)
PO Box 66 � Crystal Bay � MN � 55323-0066(mailing addressJ
'� 952.249.4620 � 8 952.249.4616
�cmattson@ci.orono.mn.us � �]www.ci.orono.mn.us
Office Hours: Monday-Friday 8 am to 4:30 pm
Summer Office Hours begin Monday, May 21,2012
Monday-Thursday: 7:30 am to 5 pm/Friday 7:30 am to 11:30 am
�
Christine Mattson
From: Schlegel, Kellie[Kellie.Schlegel@stantec.com]
Sent: Monday, May 07, 2012 3:54 PM
To: Christine Mattson
Subject: RE: Unbilled WIP
We do not have any WIP on the projects listed below.
Kellie Schlegel
Engineer
Stantec
2335 Highway 36 West
St. Paul MN 55113
Ph:(651)604-4734
Keflie.Schle�elCcastantec.com
stantec.com
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 intended recipient,please delete all copies and notify us
immediately.
�Please consider the environment before printing this email.
_ .. ____ _
From: Christine Mattson jmailto:CMattson ci.orono.mn.usl
Sent: Monday, May 07, 2012 11:35 AM
To: Schlegel, Kellie
Subject: RE: Unbilled WIP
Yes, that would work. Tomorrow at the latest please. O
Thanks so much!
From: Schlegel, Kellie jmailto:Kellie.Schlegel@stantec.coml
Sent: Monday, May 07, 2012 11:21 AM
To: Christine Mattson
Subject: RE: Unbilled WIP
I should be able to get this info to you soon (hopefully today or tomorrow). Does this work?
Kellie Schlegel
Engineer
Stantec
2335 Highway 36 West
St. Paul MN 55113
Ph: (651)6044734
Kell ie.SchlegelCcDstantec.com
stantec.com
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 intended recipient, please delete all copies and notify us
immediately.
�Please consider the environment before printing this email.
� 1
' From: Christine Mattson jmailto:CMattson@ci.orono.mn.usl
Sent: Monday, May 07, 2012 8:55 AM
To: Schlegel, Keliie
Subject: FVN: Unbilled WIP
Hi Kellie,
I received Darren's out of office replay. I unfortunately need to know if there is any unbilled WIP on the below
projects before DaRen retums. Are you able to research? Or can you direct me to who can do this in Darren's
absence?
Thanks!
From: Christine Mattson
Sent: Monday, May 07, 2012 8:42 AM
To: Darren Amundsen (darren.Amundsen@bonestroo.com); 'Sherry Charboneau'
Subject: Unbilled WIP
Good Morning,
Any unbilled WIP for the following?
Buildin Permit# Address
2011-00318 115 Creek Rid e Pass And & Marnie Pfeifer/Charles Cudd
2011-00075 3215 Graham Hill Rd Kei h &Am Korsi / Charles Cudd
2012-00038 4050 Ba side Road Danielle Steele
2012-00205 1390 Cher Place Te & Gretchen Blount
2011-01586 1200 Loma Linda Ave Donald & Carol n Udell
Thank you!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway e Orono � MN � 55356(physical addressJ
PO Box 66 � Crystal Bay � MN � 55323-0066(mailing addressJ
S 952.249.4620 I 8 952.249.4616
�cmattson@ci.orono.mn.us ( � www.ci.orono.mn.us
Office Hours: Monday- Friday 8 am to 4:30 pm
Summer Office Hours begin Monday, May 21,2012
Monday-Thursday: 7:30 am to 5 pm/Friday 7:30 am to 11:30 am
OUR OFFlCE WILL BE CLOSED: Monday, May 28,2012(Memorial DayJ
2
DEMOLITION PERMIT 2011-01S8f
ESCROW AGREEMENT
A{3REEMENT made this,,�,�'day of � 2U,L, by and between the CITY OF ORONO, a
Minnesota municipal corporation("City"j and Oonald&Caroiyn Udeil{"Owners").
Recitals
1. An application for a demolition permit ttas been filed for an accessory structure located at
1200 Loma Lfnda Avenue (°Subject Prapert�')legally desaibed on attached Exhibit"A".
2. �n con)unction wlth the demolition erosion c�ntro� measures a�e required as shown on attac��ed
Exhibit"B'.
NOW,THEREOFRE,THE PARTIES AGREE AS FOLLOWS:
1. DEPOSI'f OF ESCROW FUNDS. Contemparaneousiy with the execution of this Escrvw Agreement,
the Owne�s shall deposit $2,OOQ with the Ctty. Ali accrued Interest, if any, shall be paid to fhe City to reimburse the
City for Its cost in administerfng the escrow account.
2. PURPQSE OF ESCROW. The purpose of the escrow is to guara�ee reimbursement to the City for
all out-of-pocket costs(including planning, engineering, or legal consultant revfew)the City has incurred to assure that
the erosion corrtrof ineasures are installed and maintained so the property complies with the provisfons of Orono City
Code Chapter 79, The financial security may also be used by the City ta eliminate any hazardous conditfons
assoclated with the work and to repair any damage to public property or infrastructure that is caused by the work. If
complfance with the approved Land Disturbance Permit is not accampfished within the allowable�me period,the City
may b�ing the project inta compliance by use of the sacu�ity.
3. RIGHT OF EN7RY. The Owners hereby grant the City, its ager�ts, employees, officere and
contractors the right to enter the property to perForm all work and inspectfons deemed apprvpriate 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 shouid the Ovmers' contractor not complete those Improvements by the date
spectfied herein.
3. MONTWLY BILLING. As the City receives consultant bills for incurred costs, the City wil! in turn
send a bill to the Uwners, Owners shalt be responsible far payment to the City within 30 days of the Owners' receipt
of bilL
4. DISBURSEMENT FROM ESCRAW ACCOUNT. In the event that the Owners do not make psyment
to the City withln the timeframe outlined in#3 above, shali issue a Stop Work Order until the Owners pay all expenses
Invoiced pursuarrt to #3. The Gity may draw from the escrow account witt�out further approval of the Owne�s to
refmbutse the Cfty for eligible e�►enses the City has incurred.
5. CLOSING ESCRC?W. Any remaining amount of the flnancial secu�ity deposited with the City for
faithful performancs of the plans and specifications and any related remediai work will be releas�d after the
completion and inspection of aii such measures and the establishmeM of final stabilization for the Subject Property.
6, CER71filf UNPAID CHARGE3. If the proJect is abandoned by Owners, or if the eligible expenses
incurred by the Gity exceed the amount in escrow, the Cfty shall have the right to certify the unpafd balance to the
subje pursuant to Minn. Stst. §§415.01 and 366,012.
CITY: CIT 01�5 OVYNERS:
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DEMOLITION PERMIT 2011-01586
ESCROW AGREEMENT
EXHIBIT "A" - LEGAL DESCRIPTION
Lot 1� Block 1� "Sega Hill Reviaed� Hennepin Co. Minn."� and that part of the ad�oining vacated Fbrtland Place lying
Easterly of the center line thereof and Northerly of the extension Weat acxoss it of the South line of said Int 1, acoording
to the recoided plat thereof.
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That part of Government Lot 4� 3ection B, Tocroship 117,,�tsng� 23:�e. }+ek��`s� i e�t the West Quarter corner of
said Section 8; thence North along the West line �f ��#dtBeR$ied:�8 a d'�e @ttd� o.�' £�'e�; thence Eest parallel with the Eest-
ti�fest Querter line of said Section 8 to the ahoi�.'io�,'t3'.a�,�dihtl§tot�; �ki�nce 9outherly elong the ahoreline of said lake to ite
intersection with the Eaqt-�7est Quarter line of;,:5e7.t�:5�etiiSfi 8; theliQe Weg�,A;p�.s'a�,d querter line to the poiint of beginning�
accoxxiing to the Covernment Survey thereof. - `
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� �Hennepin County Property�Map y- Tax Year: 2011 �
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� 'The data contained on this paye is Gerived from a compilation of records and maps and may mntain discrepancia that can only be disclosed by an accurote survey pertomied by a Iicensed
i land surveyor.The perimeter antl area(square footage a�d acres)are approximates and may contain discrepancies.The informatlon on thls Dape should be used for reference purposes only.�
:Hennepin Counry dces not guarantee Me aau2cy of materfal hereln contafned and is not responsible for any mfsuse or misrepresentation of this infortnatlon or itr derivatives.
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� : Selected Parcel Data Date Printed: iz/2s/Zoii e:as:os�M
€ Parcel ID:08-117-23-23-0027 Current Parcel Date: 12/3/2011 � �
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Owner Name: EDMUND GRIFFIN ET AL � �
Parcel Address: 1200 LOMA LINDA AVE,ORONO,MN 55364 �
Property Type:RESIDENTIAL LAK Sale Priee:�0.00 �
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' Homestead: NON-HOMESTEAD Sale DaYe: / �
€ � Area(sqft): 21210 Sale Code: �
! � Area(aeres):0.49 � �
� � A-T-B:TORRENS = �
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Markat Total:�838,000.00 :
Tax Total:�8,701.10 � �
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http://gis.co.hennepin:mn.us/HCPropertyMap/Locator.aspx 12/28/2011
� ` . CITY OF ORONO PERMIT NO.: 2011-01590
' � 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1?✓30/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1200 LOMA LINDA AVE
PIN : 08-117-23-23-0027
LEGAL DESC : SAGA HILL REVISED
: LOT 001 BLOCK 001
PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT
NOTE: THIS$2,000 ESCROW IS TIED TO DEMOLITION PERMIT-2011-01586
APPLICANT ESCROW FEE-BUILDING 2,000.00
ETAL,EDMUND GRIFFIN TOTAL 2,000.00
1210 LOMA LINDA AVE
MOUND,MN 55364
OWNER
ETAL,EDMUND GRIFFIN
1210 LOMA LINDA AVE
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 construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� � Checklist for Refunding Buiiding Permit Escrows
Building Permit # ���"��8�
Street Address: � �� �� ��--��
Appiicant Name: ��Y1g,� � (����ul�l
❑ Escrow request received Date: � ` Z''
Permit Type:
�
Are all inspections completed? Yes No '�� �I �'� '�i ��C►iUCJ
If not, list what is outstanding:
Was there a Temporary Certificate of Occupancy issued? 1 e � 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 unbilfed 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