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Home My WebLink About2012-00586 - addn/remodel/repair . - � �-��,-- l3 � , . � f��},��i, . C i ty of O ro n o (��.� '�-` �� .5 1 � Building Permit Application - for New Structures or Additions Mailing Address: Permit number: O�O/a-D�� O.¢,D,�.O PO Box 66 Crystal Bay, MN 55323-0066 Date received: (O-�-/Z � � �, StreetAddress:' Received by: l�-1��5 E, �ti�' 2750 Kelley Parkway Plan review fee: �O 7� � � �9.kE$H�g'�' Orono, MN 55356 �D<o2 - Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ��-� �,(,`C� C� u/ (L�(p0 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: �_3C� C7 �-c:}c��-.c L.i r1c�c ✓� a�t"e7 v�o � s'�� S�� Will this be a Parade of Homes, Remodelers 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 will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �0.SOti ��S �a.L►�'1 State License# Expiration Date: Phone: j L� Z� — � office cell Mailing Address: ' p �r.� � v� Cit : C�dc�c ! ZIP: S 5 3b� Contact Person: �cks o•�. {-�, �.. +� Applicant is: Contractor / Homeowner'� (Circle One) Email and/or Fax: �1ti��s c.�c�,,.r„� W v�+ 1�j� t � �,� PROPERTY OWNER INFORMATION: Name: ,Jcu..So,,� �JeSw.a K "1 Phone (daY)� ��( Z-- Z�`� - �'`f S 7 Address: '3d0 L�� L „c Cit : GVp /1/�,/UZIP: S � (� Email and/or Fax ; l� ��S��.� �J U,h,o o s[o+� ARCHITECT/ 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) f�- ��t ��S}I<� ❑ Multiple Family/Condo ❑Warehouse C{c � A.�c1 �'�` ❑ Public ❑ Storage ❑ Public Water **Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. Industrial �,Private Well , Minnehaha Creek Watershed District(MCWD) � Other: (specify) 18202 Minneto�ka Blvd T��L L Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) � �d�� Packet Last Updated: 03-06-2012 -21 - w � STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction � a. Length (ft.)= Number of bedrooms= � ❑Wood/Frame b.Width (ft.)= Number of garage stalls: ❑ Masonry Areas in square feet Attached = ❑ Metal ❑ Pole Bldg. c. Basement= Detached = ❑ ICF d. 15t Story = ❑ On-site Prefab e. 2"d Story= ❑ Off-site Prefab f. '/2 Story = ❑ Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A plicable ❑ Permit A lication ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ Surve meetin all re uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ 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/OWNER 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 governmental 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. Applicant's Signature: - �"�� Date: �p�� Z/ ' /Z :� Owner's Signature: Date: �` Z�� /Z Packet Last Updated: 03-06-2012 -22 - ��.�,� ��'C��,� �I��E�T° C�� 6� T'E��C�'�l�E� � ��L�� Aciciress/Permit f�urr�ber: �� , Descriptiort of�r�r�: �� 1��'✓�`-� �' ��G�l�1 �� Septic review by: �" Date ApprovecE: Zoning review by: f/��I� Date Approved: `�2� � Builciing cevie�bY: - ''3; �'M.�r.�.. D�t��lpproved: y- i - 'z�a �3 � Grading r�view by: ,N �<} Da#e Approvecic Zoning Dis#rict:ti f � Zoning File#: Reso#: Reso Date: �oning:Lot Area:�yv SF/AC 1h'idth: �ot Coverage: SF % Survey Submitted: �Yes � No Date of Survey:��Z?i�Z Revised date(�)� � ��` d'� � Pro osed Setbacks: Eronf(Lake) ��Street) ( � � E � ? �' S � 1 Other Buticiings Wetland ide Side � ' � a� � De�ined Height: Peak H�ight: FFE: FFE miRu�6 fee#= (Existing ContouF Perirneter(lin�ar f�et) = 5D%_ #of StQries Ok� �YES` ' FOR A BUILDiNG WITH A BASEMEf1T OR GRAWL SPAGE: � The diatance between"the Iowest FOR A BUILDING ON A SLAB FOUNIDATI01�lC START WITH prop�ed floor(of tl�e basement or crawl space)and the highest point of the roof: START WITH The distanCe betwee�t the top of slab and if you ha�e a... the highest point of the roof. GABLE OR HIPPED ROOF(no :you have a,. • wlndows): Subtrad half.the GABLE OR HIPPED ROOF(no windows); Subtract haif the distanc distance between the highest point between the highest poirlt of the roc . of the roof to the low point ofi the � to th8low ppinf of the coriespondin� SUBTRACTION corresponding gable or hipped roof 3UBTRACTION ' - gable orhipped rpof. . _ '.(BA�D ON ROOF . GqBLE OR HIPPED ROOF(witA (�AS�D ON . -GABLE OR H1PP6D ROOF(witit; windows): Subtract half the ROOF TYPE) windcws): Subtraet halt the distanc dist8nce between the top of the betNreBn Cre top of tfie highest highest window and the highest window and the highest poiri�of the point of the rocf `:roof. • ALL OTHER ROOF 71"PES{flat, � • ALL OTHER ROOF TYPE¢(flat, mansaM.etc)�No subtraCtion. • man rd;. :No sUbUadion. ' ADDITION Atld tlie tlistai�ce behNeen e top qf slab � Sr�bVact#fie distanoe tietween fMe g g 9rade adjacent tc � SUBTRACTION (BASED ON antl the hi hest8xisiin • basemer�t/crawt spece floor and the, , (BAS�D OW EXISTING highest existing grade adjacEnt fo the ��p S� the fbundation. GRADES) foundation OR 10 feet(whichever is less}. �qUp,Lg Defined buNding heigM : -ECUALS OeRned 6uilding fieigM - __ ' Shoreland District MC�lIfD Permif Received Avera e Lakeshore Sefback Met? 'Biuff , � Yes � I�o � NfA 0 Y�s No �Yes C� No CJ Yes 0 No N/A Permit Number. Setback: � Stormwater O;uality Existing Propo�ed ��ance Requ�red CUP Required Overla Di�trict Tier Hardcover Hardcover �/�� 0 Yes P[o � Yes o . ��' � � TYpe�S): TYPe(S). I�� o �� - Updated: January 2013 v:\formslplan review chedclist 2013.dopc REt�GARKS (in-house): Fees to G�Cha ed YES �Q �� Plan Reviev�e S�e Su4rc�ange Investigation Fes t�i�AG—Nwnber�#'S�►�lfr�its ._ , - '` Other(specffy) S uare Foot� e $ r 5 uare Foota e Basement X - � 1�`Floor X - $ 2�'Floor X - � Garage X = $ oa Estimated Construction Value: : `'�� r Orono Inspections Required Work Requiring Separate Permits Required Stats P$nnits G Site � Plumbing Q Grading/filling O WeN 0 Hardcover Rer�►oval Q Mechanical Q Fire � Elec#rical Footing O Septic [3 Water Connection Cl Poured Wa11 Q �ireplace -- G �ewer Connection � Foundation Survey G Masonry � Lawn`lrrigation t! Radon Rock Bed Q Mf9• �Framing � Other(specify) :G Insulation � As-Built SutYey �Final CI Vlletland Buffer . G Other(specify) REMARKS (in-house); OtherReview: Reviewed by: Date Arpproved: Access: Existing: CI YES Q NO New: ti Y�S Cl NO . OFFIClAL REM�;RKS-TO BE NO'FEII� ORE PER�lflT/�,ND INITt/�LI.ED Updated: January 2013 v:�fom'�s�plan review chedclist 2013.docx i • � DATA PRIVACY ADVISORY In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen waming", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under Minnesota State Statute 13.04 (see following page) to review private data on yourself. 6. Your full name is required to process this application or permit. �V��♦ V i ��C ��a /l � First Middle Last �� o o Low.a L ,�.�1�, �- �Q Address 6✓'ov�b _,/I/j /� �s36y �IZ-z39-L��/s�7 City State Zip Phone I understand my rights as s ed ove. Signature ___._. _. Packet Last Updated: 03-06-2012 - 19- 5� �p� TIME C�TY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED - �� % PERMIT NO��"dOS�� COMPLETED ADDRESS l3DO G�Q �� OWNER �-�� • - • TELEPHONE NO.�Z �� `" CONTRACTOR � D CRIPTION / "d�� FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ OURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WEfLANDS � ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNERlFIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W �, - � a - � � O �. � O � W � Q � W � � W � � J W ❑ ORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑ RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR WFLL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS_ Call for the next inspection 2a hou in advance. (g5 249-4600 OwnerlContractor on site: � Inspector. White Copyflnspector's File Canary CopyfSfte Notice �� V C��'�� v'�'i�"lv�' CITY OF ORONO CALLED IN � INSPECTION I E SCHEDULED � �� PERMIT NO. �a`' COMPLEfED ADDRESS � 3O� �Vh'� � L�.0�2. OWNER TELEPHONE NO��- �� 3� CONTRACTOR ��v� v'�`�W�— `�� DESCRIPTION �'k � D FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVEfLANDS y ❑ FRAMING ❑ MECHANICAL FINAL p TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE � SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP p PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT r O DEMO-SITE O SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEEf YOU:_YES_NO y COMMENTS: � � j X i �O � _ � � ' O � W � Q � W � � l�� J W RKSATISFACTORY:PROCEED ❑PROJECT COMPLETE � CORHECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W 0 O RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOYERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52) � OwnedContractor on site: Inspector. White Copylinspector's File enary CopylSite Notice DATE TIME / ;. CITY OF ORONO CALLED IN �� INSPECTION NOTICE SCHEDULED PERMIT NO COMPLETED _�Q�1�" �'J"a ADDRESS %� �o�n.a L� �c • OWNER TELEPHONE NO. CONTRACTOR � DESCRIPTION %� f i .P� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXC V/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z � INSULATION ❑ WOOD BURNER/FIREPLACE � SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � `NAL O SEWER HOOK-UP ❑ COMPLAINT Q ❑ DEMO-SITE ❑ SEPTIC MAINT. �FOLIOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL 2 OWNER�CONTRACTOR TO MEET YOU:_YES_NO c�i� COMMENTS: DQ.r.a,s� �jlc�v �a.la`,p ��G�� e.- � � 4 ��L I`ISO�GL�a.�. - j O ! � ---� d�e. /t'pN(C _ �O W � �i�s� �Q �ba- �� -4� �s s�.��e q Q 2 fLktL !/lf'sd2��T O tr Gel��, �Gf�'tai�s - � W � J O W� ❑WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE W ❑CORRECT W'ORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT VIfORK,CALL FOR REINSPECTION TEMPORARY V BEFORECdVERING PERMANENT ❑CORRECT UNSAFE CONDITION WRHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WFLL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR �INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: Inspector: ��•�-� '7`�— White Copyllnspector's File Canary CopylSite Notice "��-"� D TE TIME CITY OF ORONO CALLED w J —�—/ INSPECTION OTIC� �,l- SCHEDULED — PERMIT NO.� 3� COMPLETED , ADDRESS �� OWNER PHONE NO�Sa'Z�D-7�� CONTRACTOR � DESCRIPTION �-�� tU ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS h O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � �INAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. �FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL � FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO v�i COMMENTS: F�•w�� ' lG ' LD'L�S � ,d.,f _ a f r.'�rst� ' 7" �b-"�4' Q• S � � ° K� � 0 � W � Q � 2 G�✓,�t ori �� W � W � � � ❑WORKSATISFACTORY:PROCEED PROJECT COMPLEfE w ❑CORRECT WORK&PROCEED ❑ I E CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP OfiDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�0 OwnerlContractor n site: Inspector. ��'" White CopY��nspector's File Canary CopylSite Notice Cn� � �'1 � �i�n0� � r� �c�tn� ncn0� W�Z o; � x � � � c� o ° o a c� o c� •x o O cD � '_''J cD J Q n � C�'� O � v>' � � n� � � � n 4 � n � �� Q � o � ' � � ��' �o � � � c�n �� c�e 3.�� O 4 T ,1- 1' j- �� ,,.,, cD k� J. �Q (n �tp O 00 � Q � �� Q ^- � � O y � � � Q � �` • "''� •� � J�p � � `O � (� �`�° o �° o ��o j 82 Q �o o � tr. \�o� o � o c��n Q Q' a � 00 S? ° Z � \ o �' c o � Q � o v �/ `9S � ° cn � � o` � c� �Y � 3 � 0� 2�O,, � o � �° o. cn ;_ o �''� � O \ 8� � � � y o �. � � \ J) � 3 � � � rn =S i� � �, ! � \ � ��SJ � � rn `v°cN�ctiJ, �c..�vw °'�� No �o�� U �q c„ c„�Vo�cnoc.,coocncb� � � � '� . . � � � i i � i \ ; i � � ooM; -�\ , aJd PaP �� , .o��' � p � �; � p . � � !' i �s ��° ° � \ o Q I Q r (Zj ti o� a�o " V � p � � n � � .O� ---_�i ? 'r� i �a \o �. ��\\ � O "'' � � I � i �/� � . � �� Qcp Q:' Q V I 1 UaM o ° O-�P � p \ Q �• �� \ .} �/ �6 � 0�� ' on� op O � � \� � �°� � .. ._�� \ �o� o � � � � ;� � '� O� �, � � ��.- ��.� o � � � ' � ^' � O c� rt a � N : � `� `� c O� �� ,x �� ° � `�� p ",'" `'. p� � 5B 6 i�—� 1 U �x �D 'S CD � 0 /�v ` � x� � ce � � j p � � ,.�� co��b b� I v L 3 �� ^X�r� �o p O cQp � C !D .fl� �ai �� l cn ,oi � ;� ,� � " c.v ` ~, ^* Q � �Q s�, 4 V '�c� � � � Ql� � � � � � \ ti � � @ (� Q � � . � \ �O�� O«' c.i . . . � � � \ o � r.. � x ; � •�� •3 Q � � � p- . x N �\.� \1�pQ :.! `°c °c / . y� � � O = . � p - \\� � ��\ y . l ' "�' � � �. c� V � � �� 4, V , ss 1�+. � O y � �� \ x o � v 9 O � sr r� � ~' � "'� � � I ^�i x o � ',`flrn� 6 6�0 /``\ Q.+ � c� � 9 � •y �� p �p i � sx � V �/ ---�I cn rn X ,,'""�"� � � X �\ � . � Q' s � : �C � x � � o ;' ca 96' . /�� ^. o d •�v •�a �B �� Q � � x � �\� � � � 01l\._/// .. � _ -S��Y� ��i� � .`i! Civ � � U � . ,. �� / / ��.+ � �P � / CNO�'V� i-r i �' ��` \CC��C�>,� ��_ �a�d FaP��M �� 1 � �ai '_ � �\ `� C'D . i � ' - T- %' / � � i `°' t co•� � o,°. / U � � !��\`� p� .�1 ti � / p , oo � � O N � � � N �2 p�-34„ E Q � ; � , � a � � _��6 � 176 62 � � m .�, n � 0 � � � � ' A � N m � i � � � �.� o m o00 ' � o = u� 0 � / m m �o � '� � \° � � � � ° � � �, � � o ;� = o �� _. � � � � � o Q � < � � `� � � o � � o x � v' m � � � 0 0 0 0 0 o g' �. � tD � � o ° � � � � .o 0 0 • � � � Z ° ,�� o o j, � � � c� � o � k cn o � � � � � �n �' � � � Q � � c�u �. � �' j � � ,�\ � O � � II � v r ! � � o � � � � vV Q !"+' o � a � Q � � � � � � ` � � co � 4 � � Q O � Q [n CQ' � C O � � � O �-�, � J (D � � � � Q � C p o ``� � I � �' o °� 3 c � ' � cD cn � J � � � 3 � -� ? r � Q CN � �/ ` ° v ` � c o Q� 3 � � Q � Job Number: 7393 � SCHOBORG � hereby certify thot fhis cerfificate of survey was � prepared by me o� under my direct supervision and Book/Page: 75/08 thaf l am a duly Registe�ed Land Surveyo� under the p LAD SERVICES �Ows of the State of Minnesota. Survey Date: 4-04-12 � Drawing Nome: huesmann.dwg , 'NC. ________ Drawn by. KLB Paul B Schoborg Revisions: 2-21-13 (�emove proposed 763-972-3221 8997 Co. Rd. 13 SE changes other fhan deck addn. project� www.SchoborgLand.com Delano, MN 55328 Date: ��___ Registration No. 14700 . • , • . • • � • . emo To: Finance Department From: Christine Mattson, Planning Assistant CC: Street File Date: February 13, 2015 Ca/L: 101-22205 Re: Escrow Refund Building Permit#2012-00586 pertaining to 1300 Loma Linda Ave is complete. Please refund $600 to the property owner, Jason Huesmann. The following is attached: • Original signed escrow agreement � Copy of cash register receipt showing escrow amount received Mail to: Jason Huesmann 1300 Loma Linda Ave � Mound, MN 55364 w:�street filesUoma linda ave\1300�escrow refund request 2012-00586.docx _ , _ �_ �'��,¢x ? a li a (_�3 j � a4 i �. � ► ►� �! � =1 �° - � � �.,1 � Q. �1 Psmdt fE: ^r�<;� 2012-005� :T l« `,� r:�%Y'!w r� : P'l�mitAddness: 1300LO�r1aLNWaAve r^ � ��4r��nc� �-�rv:�za��,x (Replace existfng deck arW add on} ' Parcei Issue � Pertnit Issue ce��F� i�t��1�w��c o�u�co o�u; 5eq Inspedion T pe Inspedor [3ale Status H Fee Rec ► � . . s o a � • 2 iFrarr�ng �METD 9/t7/2014 �P iY;O . .......- - -._.._._ _...-- ---- �-- ` ------ � 3 Fin21 METJ __ '9/17l2014 -F ;Y'0 _.._. _._.._______._._ _._._._ ___.,__ . . > _ ;__ ; w q ,Fiit�REINSPECTIQN;MET� ;1t110/2014:P !Y 10 ___, � 5 ;F�t21------- METJ --12/10/2014::P--- IYiO ►• X Add New Defete --- --- _�- _ _ _. ___ --- -- —,: -_ - �_ _.�... � �.: > �-Permi# � ,. . . � „ °1 _.:_:� � P'� � � � � � � .,;e::�: �c�.:e__ ��: 12-00586 ["` �'C::`.t ... ..��R'�?c`E P�mNt Address: 13U0 Loma LtndaAve r -,v..,....� �:. ,,..,_... ' Parcellswe r Perm�t�ssue Ge�rerai�Fees ��Pe��A?�Notes I Mn�kant Deteil(CO Detall! I� ton T 1 ctor Date Status H Fee Rec ► � • 2 !Framin _.__ �' � , , -_ __ . ;. _,._ -- , _ � 3 iFinai _.. .: � ' =-_.' � ►• X Add Nwv Dlls� "" "�• S- '�...OI'`}'' .� <, ��o �'� �„c7 4 F�5�'c '''" �`�'2..� �Tr�G-- ��Ct.lz ��'� �t 'r � ' `" L ` / BUILDING PERMIT ESCROW AGREEMENT Orono Building Permit#2012-00586 AGREEMENT made this�day of � ��-, 20!�;"6y and between the CITY OF ORONO, a Minnesota municipal corporation ("City") and Jason luesmann ("Owners"). Recitals 1. A building permit application has been filed for deck reptacement and addition located at 1300 Loma Linda Avenue the ("Subject Property"), legally described as Lot 1, Block 1, Volk Johnston Addition, 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 Agreemeni, the uwners snalf deposit $6u0 with the City. Hli accrued interest, ifi any, shail be paia 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 #2n��-�^�^" •- �ompliance with the approved building permit is not accomplished. 3. MONTHLY BILLING. As the �� .�i _ the City will in turn send a bill to the Owners. Owners shall be �"" �,JJ� ays of the Owners' receipt of bill. � � � �Z.�p -� � . 4. DISBURSEMENT FROM ESCI /� not make payment to the City within the timeframe outlined in #3 at �,�/ rs pay all expenses invoiced pursuant to #3. The City may draw �� I `CJ� I of the Owners to reimburse the City for eligible expenses the City f �� 5. CLOSING ESCROW. The B� Y�ll`J ' e returned to the C��r1!�ErG �^.�h?!1 the �e��ie�i �??s k�eer. co!�?�!etp� : I �rs reauestinp the funds. 6. CERTIFY UNPAID CHARGES. � � �(� lT ✓ �j �ligible expenses incurred by the City exceed the amount in escro� ��`� id balance to the subject property pursuant to Minn. Stat. §§415.G , CITY: CI OF-�O-i�0 UWNER: By: � ` its: �, tn�rnal llse Oniy: G Origit�l to Pfanning 0 Copy to'Property Owner O Copy to Street Fi1e City of Oror� �750 Kelley ParkNay Orona M�i 553� 952-24�-4644 Heceipt No: 3.007701 5ep 28, 201P JaSon Huesoann Planni�ng ar►d Zoning 2012-OU974 1300 Laaa 600,00 Linda Ave 101-�OS Deferred Rev-Devela�r Deposit Total: � (�,pp Check Check No: 3155 600.00 Payor: Jason Hues�wnn Total Applied: bpp,pp Change Tendered: � ,{�Q 09/28/2012 11:43AlI r ' � ' CITY OF ORONO * Z p� 1 2 - PJ 0 9 7 4 * 2750 KELLEY PARKWAY DATE ISSUED: 09/28/2012 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 1300 LOMA LINDA AVE PIN : 07-117-23-41-0083 LEGAL DESC : VOLK JOHNSTON ADDN : LOT 001 BLOCK 001 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: TIED TO BUILDING PERMIT 2012-00586 APPLICANT ESCROW FEE-BUILDING 600.00 JASON HUESMANN, STEFANIE JOHNSON& TOTAL 600.00 1300 LOMA LINDA AVE MOLJND,MN 55364- OWNER JASON HLTESMANN, STEFANIE JOHNSON& 1300 LOMA LINDA AVE MOUND,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 sepazate permits. All provisions of laws and ordinances goveming this type of work shail be compied with whether or not specified herein.T'his permit will expire and become nuli and void if construction authorized is not commenced within 180 days of the date of issuance,or if consWction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for asswing all required inspections are requested in conform e State Building Code.This permit may be revoked at any ti r du ca e. � l'I � ��'j � � � Applic ermi e ignature Date Issued By nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.