HomeMy WebLinkAbout2015-00449 - land alteration CITY OF ORONO * Z 0 1 5 - 0 0 4 4 9 *
, 2750 KELLEY PARKWAY DATE ISSUED: 04/28/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 1485 LONG LAKE BLVD
PIN : 35-118-23-22-0001
LEGAL DESC : LJNPLATTED 35 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ZONING PERMIT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : LAND ALTERATION(0-500 CU YDS)
NOTE: $2,000 IN ESCROW MUST BE COLLECTED PRIOR TO ISSUING ZONING PERMIT.
ESCROW FEE FOR EROSION CONTROL&ENGINEERING REVIEW COSTS
NOTE: PRIOR TO RELEASE OF ESCROW MONEY,A FINAL INSPECTIN MUST BE CALLED FOR AN�APPROVED. INITIAL:���
/
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APPLICANT MINOR LAND ALTERATION 50.00
ENGINEERING REVIEW COSTS
GREENLEY,KURTIS TOTAL 50.00
1485 LONG LAKE BLVD Payment(s)
LONG LAKE,MN 55356- CHECK 1179 50.00
OWNER
GREENLEY,KURTIS
1485 LONG LAKE BLVD
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if consVuction authorized is not
commenced within l80 days of the date of issuance,or if construction is
suspended for a period of I80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked a any 'me for du ause.
_ �8� � �_ ,z�--, /�.5
p cant ermitee Signature Date Issued y Signature Date
City of Orono
� Zoning Permit Application
Mailing Address: Permit number. � � �J"'Y G��-+'�vJ
�-O� PO Box 66 Date received: ��l� ��
0 Crystal Bay, MN 55323-0066
Escrow#and
StreetAddress: amount: � 21,�.�'�,7�
� ,>, 2750 Kelley Parkway Permit Fee: �GJ�
y�r G` Orono, MN 55356
l,y �, Approved by:
'�ES H�� Fax: 952-249-4616
Notes:
Main: 952-249-4600 `^�^�W ci.orono.mn.us
This application form must be completed in full and all required information must be submitted. (P/ease print)
Job Site Address: �G�$� �(o (�((,� ��� - LO�� L��� �� �3��
CONTRACTOR/APPLICANT INFORMATION:
Name: NORLING'S LAKE MINNETONKA
Phone: . LANDSCAPES,INC.
Address: '��� P.O.BOX 361,SPRING PARK, MN 55384
y 952-471-0255-www.norliqgs.net Z�P:
Contact Person: �Ep G- 1�(Dl�l I2•�
Email aQowqQahdrl�Kus �.�a.t- mer (CircleOne)
Con+��
PROPERTY OWNER INFORMATION:
►vame: Ir�URTI S (� G2�€/VC �1(
Phone (day): � 1 - 1 /
MailingAddress �y g,r �pµ(, �paC ��,,�� �� � LIE9J�l���� 1V ZIP� S�3S
Email and/or Fax
Overall Project Description: j„�DSe►4DtIlfG
�goXk TYPE OF PERMIT COST*
Dock, Commercial $50+engineering review costs
Escrow for erosion control and en ineerin review costs $2,000
Dock, Residential—Permanent dock on any lake or initial seasonal dock not $50 +engineering review costs
on Lake Minnetonka ermanent dock re uires CUP)
Hardcover Permit: Driveway, Patio, Sidewalk, Etc. (New or Replacement) No charge
Also requires is a Minor or Major
Land Alteration Permit
Land Alteration, Major(grading, filling, or excavating) more 500 cubic yards $50
or more than 10 cubic yards in lakeshore setback (also requires CUP)
Escrow for erosion control and engineering review costs As determined b CUP
Land Alteration, Minor(grading,filling or excavating)—500 or less cubic $50+engineering review costs
1r• yards outside of lakeshore setback or less than 10 yards in lakeshore setback
Escrow for erosion control and en ineerin review costs $2,000
Retaining Wall measuring under four feet require a zoning permit. $50+engineering review costs
Retaining walls measuring more than four feet(from bottom of footings to top
of wall) require a building permit. (Tiered retaining walls are considered one
wall unless the walls are separated by twice the height of the lower wall.)
Escrow for erosion control and en ineerin review costs $2,500
Stairway or Lifts to Lake(New or Replacement) $50+engineering review costs
Escrow for erosion control and engineering review costs $2,000
Structure Permit for other structures not requiring a building permit but $50+engineering review costs
regulated by the zoning code(including, but not limited to accessory building
of less than 120 square feet, detached deck or platform and sport court)
Escrow for erosion control and en ineerin review costs $2,500
Tree Removal or other vegetation removal in 0 to 75 foot zone No char e. Pre-inspection required.
Temporary Construction Office/Trailer(associated with building ermit) $30
(over)
*Permit fee will be collected when the permit is issued.
Updated: January 2014
APPLICANT/OWNER ACKNOWLEDGEMENT: '
. App!:icanUOwner agrees to provide all information required or requested by the Planning Department;
• Owner agrees to pay the City of Orono for engineering consultant review costs where applicable;
. ApplicanUOwner certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes
that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no
alternative but to reject it until it is complete;
. Applicant acknowledges the attached Escrow Agreement is completed and signed by Owner;
• Applicant/Owner understands their project may require an initial and as-built survey per City Code Section 86-68.
• Some or all of the information that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data.
Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and
intended use of this information is to annually date our records and records of other governmental agencies required by law. If
ou refuse to su I the information,the a ' ation a not be issued.
The undersigned certify that the inf atio uppli is true and correct to the best of their knowl ge.
Applicant's Signature: ' Date: � �l�
Property Owner's Signature: Date:
SUBMISSION REQUIREMENTS: Except for tree removal permits, all permits require a completed
TYPE OF PERMIT: application form, escrow agreement (signed by the property owner) and escrow check from owner,
two copies of all plans,and three copies of all grading plans or surveyslsite plans
DOCk,Commet'Cial 1. Structural plans for the dock
2. Survey showing the proposed location of the dock
3. Copy of LMCD permit
DoCk,Residential Seasonal Dock—survey showing proposed dock
Permanent Dock—plans as approved by CUP and copy of LMCD permit(if applicable)
Hardcover Permit 1. All Minor or Major Land Alteration Permit requirements apply as appropriate
2. Hardcover calculations,existing and proposed
3. Survey
Land Alteration,Major 1. Survey/grading plan including existing and proposed contours as approved by Conditional Use Permit
2. Erosion control plan.
3. A copy of Minnehaha Creek Watershed District(MCWD)permits or documentation from the MCWD stating the
proposed project does not trigger any of their permitting requirements. Please note,the City will not issue a
buildin ermit without information from the MCWD.
Land Alteration,Minor 1. Survey/grading plan including existing and proposed contours
(Less than 10 Cu.yds. 2. Amount of fill to be imported and/or exported and haul route
within 75'of lake or less 3. Amount of earth to be moved around on site
than 501 Cu.yds 4. Erosion control plan.
elsewhere. 5. A copy of Minnehaha Creek Watershed District(MCWD)permits or documentation from the MCWD stating the
� proposed project does not trigger any of their permitting requirements. Please note,the City will not issue a
buildin permit without information from the MCWD.
Retaining Wall 1. Plans for wall(s)
2. Unless repair or exact replacement of existing wall,submit an updated survey with grading plan including existing and
proposed contours
3. Hardcover calculation worksheets if in shoreland district
4. Erosion control plan
5. A copy of Minnehaha Creek Watershed District(MCWD)permits or documentation from the MCWD stating the
proposed project does not trigger any of their permitting requirements. Please note,the City will not issue a
buildin ermit without information from the MCWD.
Stairway or Lifts to 1. Construction plans for stairway or lift,including footings
Lake 2. Topographical survey of property with proposed stairs or lift shown
3. Erosion control plan
4. A copy of Minnehaha Creek Watershed District(MCWD)permits or documentation from the MCWD stating the
proposed project does not trigger any of their permitting requirements. Please note,the City will not issue a
buildin ermit without information from the MCWD.
StruCture Permit 1. Construction plans.
2. Survey of property with proposed structure shown and with setbacks to property lines,other structures on property
and the septic system indicated.The general location of any sewer and water services should be shown if applicable.
3. Grading plan if grading is proposed.
4. Hardcover calculation worksheets
5. Erosion control plan.
6. A copy of Minnehaha Creek Watershed District(MCWD)permits or documentation from the MCWD stating the
proposed project does not trigger any of their permitting requirements. Please note,the City will not issue a
buildin permit without information from the MCWD.
Tree Removal Call: 952-249-4600 to schedule a single tree removal inspection. A re-planting plan/erosion control/management plan
re uired for clear cuttin , buckthorn or other intensive ve etation removal.
Updated: January 2014
� , PLAN REVIEW CHECKLIST FOR ZONING PERMIT APPLICATIONS
Address: -��
Description of work: r •��
Type of permit:
Zoning review by: _ Date Approved:_ 'T' �'�
Grading review by: �� Date Approved: 71/!�-/2/�
Other Review, Reviewed by: Date Approved:
Zonin Information:
Zoning File#: Resolution#: Resolution Date:
Lot Area: SF/AC Width: Depth:
Survey Submitted? Yes � No Date o�Survey: � Revision date:
Existin Setbacks:
Front(Lake) Rear(Street) � N Side W � ( N Side W � Other Buildings Wetland
Pro osed Setbacks:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) pther Buildings Wetland
Side Side
Shoreland District MCWD Permit Received Average Lakeshore Setback Met? Bluff
/ Yes 0 No � N/A � Yes O No
�Yes � No 0 Yes � No G N/A
Permit Number: ' _ Z Setback:
Stormwater Quality Existing Proposed Variance Required CUP Required
Overla District Tier Hardcover Hardcover
� Yes q No � Yes 0 No
TYPe�S): Type(S):
File# File#
Updated:January 2013
z:\fortns\old stuft�plan review checklist for zoning permit applications 2013.docx
Earth Movement-Cubic Yards
�n Out Total
Haul Route? ? � Yes � No
Explain haul route in detail:
Fees to be Char ed Amount Orono Inspections Required
fermitfee Amount
�� � Site
Escrow Amount � Hardcover Removal
�Z� � Footing
� Poured Wall
Escrpw Agreement received? p As-Buiit Survey
0 Yes � No � Planting Plan
� Wetland Buffer
Escrow Money received? Final
0 Yes 0 No � Other(specify)
:�r�9lneer�r��rev�ew��ede�cl?
�3 X+es fl Ho`
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
REMARKS TO BE NOTED ON PE MIT AND INITIALLED BY PER ON PULLING PERMIT
�1'1�r �0 �,ULQ�S�c-- �S V�- i I�, t�fA�`--
YY� �QJ�. `�—
Updated:January 2013
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City of Orono -
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� � ��E�� ❑APPROVED WITH �;EVISI P.1 a s Y
KURTIS A. GREENLEY ��;��:,��, ❑DENl�p S (see notes) ��o�
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IN GOV'T LOT 1, SEC. 35-118-23 �., ���� �� ���-- �o;<
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I. Tf11S CUT/FILL PROJECT IS TO ACIIIEVE A MAINTAINABLE AREA OF TURF INLAND 'oo'a�q� p�%y-. _ %s�
OF 5'TO 6' BETWEEN TF1E EXISTING RIPRAP AND EXISTING LAWN Tf1AT 11AS BEEN 'T`"F, „"�"
DISTURBED BY ICE FIEAVE. ��op'��, _
2. LONG LAKE I 00 YEAR FLOODPLAIN IS AT ELEVATION 94G.4 ACCORDING TO �`�`qTi �T, �
LORA POFiTILLA OF TI1E MINNEIIAIIA CREEK WATER511ED DISTRICT. �QI o�9Qs i "
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3. ELEVATION 946.4 WAS INTERPOLATED FROM CONTOUR DATA ON TI11S SURVEY. G� s � o $��
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4. LOCATION A-CUT ICE 11EAVE AREA-4'X I 26'X 6" (b.4 CUBIC YARDS), �•9� Fti� Q ���� €
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INCREASIN6 7CY CAPACITY TO I 00 YR FLOODPLAIN
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5. LOCATION B- FILL TO REDUCE SLOPE-4'X I 26' (DECREASING 8.4 CUBIC � eg�s
YARDS CAPACITY TO 100 YR FLOODPLAIN). - - 8"`�
�.....__............._.... a�.� <
6. LOCATION C 4'X 2 I'REMOVES I.5 CUBIC YARD, ADDING i.5 CUBIC YARD ��
CAPACITY TO TI1E I 00 YEAR FLOODPIAIN - BALANCING TF1E ORIGINAL FLOODPLAIN `-.------------------ - �
STORA6E OF Th1E SITE. VITY OF ORONO �
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7. FINISIIED GRADES St1ALL BE SMOOTFi BETWEEN CUT/FILL AND EXISTING AND \\ �
511ALL NOT EXCEED 3:I SLOPE. SITE PLAN �GRqDING PLqN \� Z y
�PROVED `
8. ALL DISTURBED AREAS 511ALL BE RESTORED WITI1 SODlfURF. � w�
❑ APPROVED WITH REVISIONS �
9. SILT FENCE SHALL BE INSTALLED AS St10WN ON DRAWING PRIOR TO O DISAPPROVED
CONSTRUCTION AND REMOVED AFTER TURF ESTABLISIIMENT.
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DA.TE ZY �',2 is
PROPOSED WORK BY NOf�LING LA APES
LAKEShORE ICE hEAVE / LAWN f�EPLACEMENT
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Parcei 35-118-23-22-0001 A-T-B: Torrens Map Scale: 1"= 100 ft. N
ID: Print Date:4/16/2015 �
Owner Kurtis A Greenley&Wife Market $623,000
Name: Total:
Parcel 1485 Long Lake Blvd Tax $7,639.56
Address: Orono, MN 55356 Total: (Payable: 2015)
P rtY '
Pro e Residential Lake Shore Sale
Typ@: P�IC@: This map is a compilation of data from various
sources and is furnished"AS IS"with no
Home- Sale representation or warranty expressed or
Homestead implied,including fitness of any particular
stead: Date:
purpose,merchantability,or the accuracy and
completeness of the information shown.
Parcel 1.02 acres Sale
Area: 44,514 sq ft COde: COPYRIGHT OO HENNEPIN COUNTY 2015
,�, Think Green:
_—
http://gi s.hennepin.us/Property/print/default.aspx?C=45 5 794.743 65223 664,4982175.28445... 4/16/2015
DATE TIME v
' � CITY'(3F ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. �-C��5 -�� coMP�ErE� ���Z �l,5
ADDRESS ��'� �►�-� �'�' c�V�1
OWNER TELEPHONE NO.
CONTRACTOR
� DESCRIPTION " � ��� ���'�' �l � � �1���
ll� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FfNAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE
❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
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� ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WIIL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 forthe next inspection 24 hours in advance. (952) 249-46��
OwnerlContra on site:
Inspector.
W ite Copyllnspector's File Canary CopyiSite Notice
�
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REVISIONS DESIGNED Iherebycerti(ylhatthissurvey,plan,orreport o"T'
waspreparedbymeorundermydirectsupervision 12383 GRONBERG & ASSOCIATES� '��.
DATE BY REMARKS DRAWN and that I am a duly Licensed Land Surveyor under s��
Ihe laws ofthe State of Minnesola.
���'��� CIVIL ENGINEERS,LAND SURVEYORS,LAND PLANNERS
CHECKED
12383 445 N.WILLOW DRIVE LONG LAKE,MN 55356
onre MINN.�ICENSENUMBER PHONE:952-473-4141 FAX:952-473-4435
• � ,
. � � � ' �
� • ,
emo
To: Finance Department
From: Christine Mattson, Planning Assistar�t r/��
l/'. ,
CC: Street File
Date: November 3, 2015
G/L• 101-22205
Re: Escrow Refund
Zoning Permit #2015-00449 pertaining to 1485 Long Lake Boulevard is complete. Please
refund $2,000 to the property owner, Kurtis Greenley.
The following is attached:
• Original signed escrow agreement
• Copy of cash register receipt showing escrow amount received
Mail to: Kurtis Greenley
1485 Long Lake Blvd
Long Lake, MN 55356
w:�.street filesUong lake blvd�1485\escx�ow reiund 2015-00449.doac
` .
� ' ✓
I,AMD US�ApPLICATION Ap EENA
AppHcatian`#��- ��� ,
. AOREEMENT made thfs�day of ,�'- ,� 20 ��� by end b n the CITY OF �
ORONO,a MMnesota municipa�corporation(°Cif�')and �
(a cwporation—optlonelj("Owners'�. i
Rec�ls �
1. Ownere hav fl n Use App p����yqf8rtnally requeetin�the City to review plans �
for the property addressed: the '3ubject Property") IepaUy
described as SGt j
2. Owners roqueat the Clty to revfew sald plans which requfres City approvel and may re�ire
conaulHng fegal and/or en�inaering review.
S. The CUy is wllling to c�mmence tts revlew of the appNca�on and Incur costs aasociated wRh seid
revlew only�the Owners esteblfsh an escrow to ensure refmburaemotrt to tha City of fts aosts. �
NOW THEREFOR�,THE PAR71E8 AGREE AS FOLLOW8: ;
1, DEP081T OF ESCRO FUND Cor�temporeneousty with the execution of this Escrow I
,48r�ment,the Ownete ehsll deposit �ith the Clty. All axrued irrterest,ff a�ry,shafl be paid to the ;
City to relmburse the Clty for it�coat in a ministering the eacrow account. i
2. PURP08E OF ESCROW. 7he purpo�of the esarow is to guarentae relmburserr�ent to the Ct�r '
for all out-of-pock�costs the City hes fncutred(Inciuding planning,enginee�lr�,or legal consulfant review)or uvAl �
incur in m�ting wlth the Owne reviewin the pi�ns, and pr+ep�ing agenda padcet materiel fbr Cl�r Councll
revlew.of Land Usa AppUcallon �I�q�le axpensea shall be consistent with expenses the Owners
would be responsible for under a land uae appl aatlon.
8. MONTHLY BII.LfNO. Ae the City receivea conaultant b(Ils for incurred coats,the City wi11 in turn
send a bilf to the Owners. Owners ehell be responaibie for peyment to the CKy wRhin 30 deys of the Owners'
reoelpt o#bill. '
4. DISSURSEMENT FROM E8CROW ACCOUNT. In the everit that the Ownars do not make �
payment ta the City within the timefreme outiined in #3 above, shali cease afl reviews ut�tB the Ownera pay all ,
axpenses.invoiced pursuant to#3, 7he Cky mey dcew from the escrow ecx�nt wfthout further approval of the
Owners to�elmburse the City for eligible expens�the CHy h�a incurred. '
�
8. CLOSING ESCROW. Tfie Baler� on de�sit In the escrow, if any, shatl be returnod to the
Owners when all requirements related to the proJeat are compl�a. City Staff shaN review the terms of this escrow �
a8reoment trvo dmea per year to determine whet�e� �e requiremer�ts of the prro�t have been succeasfuliy
oompleted and whether it ts appropriat�to retum the funda. Owner may aleo request the release of the funds, �
and aur.h funds ahetl be released upon Cfty Steii reoeiving the approprlato veMftcation that aii requlremerds of the
project have been sucoeeafully completed. �
6. C�RTIFY UNPAID CHAROES. Ittl�e proJeat is abar�loned by Owners,vr if the eligible expenaes
Inaurred by the Cfty exceed the amourrt in escrow,the Cit�+shail have the right to cerHfy the unpaid balance to the
$ubjed property pu�suant to Minn.S�t.§§816,01 and 368.092.
C�TY: CITY OF ORONO OWNE� �
t3 By; i;,Ei. ''� � '
V
ItS: � �e�- lls:
��F� ._ .���. _�� _k������l�l��:_._ ,�s����iiing':�'ill�.z_.��AY�.�:.�.�a'Ue '
I�1#��!���e�Oqly���.%' � ON' �T:bo'F
Updated: January 2014
F
KUAns nu►M o�N�.�r 1179
1485 LONCi LAKf BLW
tONG LAI�,MN 55356-9508 , � ���
�O�g/�
DATE
PAY TO THE J � �
����`�
..-
%B oo�was . ;,�,
. �
� TCF:National Bank
tcltie�k.corn
� "" ,
�` � ,�
�: �' Oii79
' �
�
City of Orono '
2750 Kelley Parkway
Orono MN 55356
952-249-4600
Receipt No; 3.01327g
� APr 28. 2015
Kurtis Greeley
. Previous Balance:
Permits .00
2015-00449 1485 Long
Lake Blvd 2,000.00
, 101-22205
Deferred Rev-Developer Deposit
Permits
2015-00449 1485 Long
Lake Blvd 50.00
101-32520
Z0�i�9 Permit
Total: ---------------
Check ______2_050_00
Check No: �179 --
Payor: 2,050.00
Kurtis Greeley
Total Applied:
Change Tendered: -----_2_�50_00
.00
04/28/2015 03:35PM --=-__=_=__
CITYOFORONO * 2015 - 0050PJ *
" � ' 2750 KELLEY PARKWAY DATE ISSUED: 04/28/2015
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 1485 LONG LAKE BLVD
PIN : 35-118-23-22-0001
LEGAL DESC : UNPLATTED 35 118 23
: LOT 000 BLOCK 000
PERMTT TYPE : ESCROW FEE-APPLICANT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ESCROW FEE-APPLICANT
NOTE: THIS$2000.00 ESCROW IS TIED TO ZONING PERMIT 2015-00449
APPLICANT ESCROW FEE-APPLICANT 2,000.00
ESCROW FEE-DEVELOPER 0.00
GREENLEY,KURTIS TOTAL 2,000.00
1485 LONG LAKE BLVD Payment(s)
LONG LAKE,MN 55356- CHECK 1179 2,000.00
OWNER
GREENLEY,KURTIS
1485 LONG LAKE BLVD
LONG LAKE,MN 55356-
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 pem►it is for only the work described and dces
not grant permission for additional or related work which requires separate
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 suthorized 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 reyuirod inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ /
Applicant Permitee Signatwe Date Issued By Signature Date