The URL can be used to link to this page

Home My WebLink About2016-01333 � � CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 3 3 3 * DATE ISSUED: 10/19/2016 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 225 OLD CRYSTAL BAY RD N PIN : 33-118-23-31-0007 LEGAL DESC : LJNPLATTED 33 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : DEMOLITION PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE NOTE: 1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS. 2. WELLS MUST BE ABANDONED. 3. INSPECTIONS DONE BEFORE BACKFILLING. NOTE: A 24-48 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600. SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUALIFIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. CHECK TO MAKE SURE THIS PERMIT HAS BEEN PULLED BEFORE ISSUING THIS PERMIT. APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 75.00 STATE SURCHARGE DEMO 1.00 Pali Holdings LTD DEMOLITION-ACCESSORY STRUCTURE 50.00 CAMERON,PAUL 11578 CHAMBERLAIN CT TOTAL 126.00 EDEN PRAIRIE,MN 55346- Payment(s) CHECK 3456 126.00 OWNER Pali Holdings LTD CAMERON,PAUL 11578 CHAMBERLAIN CT EDEN PRAIRIE,MN 55346- 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 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 I80 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 ing all required inspections are requested in conform with the te Building Code.This permit may be revoke t an ti for du � / ��/�J/� P-er S-o /� � �9� /.� Appli itee Signature Date Issued B gnature Date S '� � ( � / 4 �O�T City of Orono sE oxi,Y��/�33 �V P.O.Box 66 Date Received• ermit# � 2750 Kelley Parkway �, Crystal Bay,MN 55323 Amount: $� SAC Credit: (952)249-4600 � ,� Homeowner(s)Signed: ❑Yes d�, �,� Resoludons(if any)Signed:�]Yes ❑None Required l�k£SHO�� Zonin Disciosure Si ed: ❑Yes ❑None R uired CITY OF ORONO - DEMOLITION PERMIT (All permits must be approved by the Building Official and/or Zoning Department) RECEIVED ,�e� /�r�1� ' �:. OCT 1 9 2016 Type: (`�Residential ❑ Commercial c�nr oF oRONo Site Address°�� C� � � � �� C ��G� l a� Owner: C�.�vt,}�e�'/ci`� Mailing Address: � �� G � ��+��r�e,i-� � ~�- c�ty: �� t��a`re z�p: S�3 y�/ Phone: �� 7� - � l�� Email: �o��t (1 e`'�C'�✓�► �� a� ►'� CaP. Gv�-. ��t�a�i`J " . ��t�~= ., t�r� � : Cont�actor/App.: � �a� �'��011 � Contact Person: �Gbl J��-SWPo�h��' Address: I I S 7� C�Us•rr► ,��c�-• State License#: 13C ° (v(o �y�C� City: �� Y��r1� Zip: ��3�/�/ Expiration Date: ��3 �� (J��7"0 ��oZ Email: k�ob�(� �+r-► Phone: C �/'�a�� cc�,0•�d� . . ; � ,. �► �►�: ��.�:� �. .. � ��►� ��fi= x � General Instructions: 1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc. 2. Worlc must not begin unless the permit card is available on the job site. 3. A 24-48 hour notice is required for all inspections. Call (952)249-4600. 4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued. Demolition by means of: ❑ Manual Disassembly �}-Fieavy Equipment ❑ Other Permit(s) Issued: ❑ Sewer Disconnection ❑Well Abandonment# In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to: 1. 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 proposed erosion control measures in accordance with Chapter 79, Construction Site Runoff Control. 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating permit(s) are not required. Form Last Updated: July 2015 150784 ~ d �. � t 1 1 4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached). 5. Keep all structure(s)enclosed and/or secured until such time as demolition is complete. 6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific prior approval is obtained in writing for temporary use thereof. 7. Completely remove foundation(s)from the ground. 8. Completely dispose of all demolition debris off site in accordance with all applicable PCA requirements. 9. Abandon water wells in accordance with State Health Department regulations. 10. Call for an inspection when all debris has been removed, before backfilling. 11. Within 5 working days of superstructure removal, a final inspection shall 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). 12. 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. 13. The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its agents, employees and assigns from and against all claims, damages, losses or expenses, including attorney fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition described herein as pertormed 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) ��B • � 1. Subtotal of above permit requested $ 2. State Surcharge 1.00 3. TOTAL PERMIT FEE (add lines 1-2 above) $ ` � �� The undersigned herby applies to the City of Orono for issuance of a Demolition Permit, agrees to do all the work in a strict accordance wit rdinances of the City and the regulations of the State of Minnesota, and certifies that all statements ade on this application are complete, true and correct. % Applicant's Signature: Date: ��1`�� Owner's Signature: Date: Approved By: Date: uil ing fficial) * Zoning Disclosure Required? ❑ YES � O *This must be filled out by Zoning De artment-For eit nswer, a Zoning Official must sign al appl' tions. * Approved By: Date: l� (Zon' fficial) Form Last Updated: July 2015 150784 � w a � , � ' I I � � � �� SYMBOL LEGEND �'�� ----" � �,` �— —� . �� LOT LINE � � ' / � , - BUILDING SETBACK BOUNDARY �� r 1� � - ��` � / � PARGEIBOUNDARYLINE � � , � � fIWNER � p �. / � � — 'y 'I I�� ` � � Weis�F g a k REMOVE EX . � . •�� -I DRAINAGEANDUTILIlYEP3EMENTS �'� .g f'� \. I I ` � 3 Orono �rJt 5>956 a RIGHT-0f.WAY � � �� , ! REMO E '� P�o 3�s.� o��z,�" CUt,bERT AND - � i F�amE�oeE�o�W��P� I �' � � ` ' � � APPROX. 32d SY�� ' � STORMSNCTURELPBEL i o ' �' . � , F�E�f2ADE DITCH TO � , � �a ' � i � EX. GRAVEL � �" IwiATCH EXISTING �` � � �� '� W�" � � � i _ _ .�I SEPTIC SITE � �,. � i ` �. i � i ', .e \ �_I �� I EMERGENCYOVERFLOWS'NFLE � .��' � � � ri �� _. � — —————jxoLF SILTFENCE—— T.. —__ i � SOIL BOfLNG LOCATION � , ' REMOV 2 EX. , ' ,. ' {�� ,a 1 C:t 1 �,..�_ � �_ � BENCNMP.RKfFWNDIP .. 1� .. ' BL S � � �*�'�+x- , �'�'-�a= I �� .>NOBUFFERMONUMENT � � ]Z8.': � ; ' /� �I PRE CANSTRUCTION SILT FENCE ' . �-}��` �"+�S � � m `�� .'�i � `i .� POSTCANSTRUCTiON51LTFENCE ———— .. �/E,EX. , , � � � � � _ -——- Y T�M��. �-" ?. 9Fp�s7T<�� i li li SEPfICPRO7ECTIONFENCING '�� -- � .4 � � � . � �hc�"�'F 4,� + �I \�'� I' TREE PROTECTON FENGNG �'I � _ r F � �' � �' � _� 1 � il vnuTvvo�e ,. ,-^ �� \ � � `t ��,�.,� �''c�..�, ^../ o;� � ' _ . �. . '� !-� I � !, r�esnveo _',— --Q�! �•� � 1� � �S� � ,4 � � .'. TREEREMOVED O+ � �� r � , <>>�, � _;,, d�� ,t, - � t �� '— _ — , . , , ; � � , � � �� , 1 � , - �� `� � I n z�� `�, �� `-y � { 'TREE FF1yCE k I .�n". ♦ T` . � : . "- �` " '-�a� — S(TE°6 , i� , __ r,- '� r _ � ah � , � � �� / w _ � ��— __ �� _ , � ^ _:,; -�� , � � � � F��. P P � '-. �� - �� = �� °�� }�L. 2'E�.� ' �� - . � �4�� ' � � ,�a °� �� ''- � ��J{/I �� ' " �b �e,,d � i ete a F ��, ,� 'l�� EF�E I \ � I ` � . lG. � � .� � NpRt� opo�2�� ,. � �F� �.�� "_ ' ��-,i � �� ,1� o � - ` z �. ` , RE� V E q'� +�..�d .i,� `e� .> � � � 50 25 0 25 50 100 � ��Q�G� � �o�;o�L , `�� . o \ �SEP I�� S,�EM '�� i , V >� �-. d I �� +� v I � v � o�. •>V 4 �� . � " SCALE IN FEET � a�'a ��i� a �o.� . c 6 p _. _� n� �` _ ��-��.1 .�{ I � o � o v�c'�✓�n �c� � ,�:� '_� � �� . m �.� o ��t _.�� .��o�o� dF � ''� I - p�'••J�'.ji b�– ` �I`��,��1r a�,-� ��r�°� a _ �� _ '_�,o�`V�� :,�It u � �_, 6� � .. o�P g o� 1 .s� � � i< � _ � 0 0 / _—�-� � �\ \ � / �- ' � �'�. � P d° � � � � ��--�«'"� -�--a' � _ �- _ oi �� .. -�� , � � � - - �> �'�f�EMOifE 6 EX. �'� ��` �o��d` � � ' . __. � . a\ eA o� C, �^ �. �_� � ''� --__ �� .BLDGS �� , —��- -�->, � , ---- - �� `��:� � � �'�� `�-- ��-. - " � ��. _..__� . � �,,� , ��J � � �'�� , ��.,v y .,- �'� � �� , � ; � �, � / �� i � , "� �` \ ; i �� i� � � ', I ! i � �' �� °�� ------------ T---�---� � � ' , ., i �.� � � ! . ' _,.,, �.r � ' i� ' ��I . . � . �� ` __ _ — _ �� .r_' � � . !: r:> � ' --_ _"_— ' , � ' �.� / . • . .. �. . . . - .0'AF ER. . ,_ � `_ f � t�& Ber � � l 4 0 va a e d , �i � �OKNrER. � ' 'J o.bf^1 SJ 56 /^ I� � � /�c�tt PrrleY I � PD" sF.�. �. � � �'/� � � . . .. I . >, .s '_. � � . � 4 I N 'gnM 4ddross �' i = � ' . / '� i 0 0.!AN 55:55 . � .. i ... 1 . i / 1 � �. .. F'�0 i!II$�j•d�tio • " /� -� , � ' / ,- r . i �. � _. . .. /�{� � 1 , � i � _.. _�. . I , J , � . � L I ' i L � � ( � f w J�^ L ( , .f..., �. . � � / � i ` : � � �/ ' � � \ �1 , 1� l. � � '� � / I 't � i� � i' � I ' � �� , � �� 1 � �� ::.�� ' � ` I � � � �_i ' I _ � i. � �� V � ` "� � � � I . I � :L�._ . � ' �� .� � h � � ' i � ! �. �; i � �1 � / t \� / �� _ ��'�_�- --� _� `�, �' � � �� ,_ __-�`��, ��, � REC�Ii/�D AUQ 0 �:2016 � ?, 8 5� �; ci�nr oF oRONo ?��"5" B�R�P c�#;�°�49TNO EXISTING CONDITIONS AND FILENO. �� DEMOLITION PLAN 3786�� _ ;��.. } SATHRE-BERGQUIST, INC. pRONO, o �w T�?�— 750 SOUT}1 BROADWAY WqY7ATA,MN.5.5391 ,�z,<,� CRYSTAL BAY ESTATES 2 °' � _`'� MINNESOTA �F"S'°`'`� CHAMBERLAIN CAPITAL, LLC. 7 � � V DATE TIME CITY OF ORONO ED IN INSPECTION NOTIC scHEnuLED ��0 PERMR NO. ��3'3 COMPLETED ADDRES.S � � � � � O'WNER T EPHONE NO. " �SF�Z � CONTRACTOR � : �' / � DESCRIPTION �� rl h�-r ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAVlGRADING/FIL,�IN(3 O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION � ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � ❑ FINAL ❑ WATER HOOK-UP � FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SE ER HOOK-UP �OUNDATION/REMOVAL v ❑ DEMO-SITE PTIC INSTALL i dIMN64COKTRAC�'OR TO MEET YES_NO � COMMENT� f � �� - �c �c n, f�e i.vta �— � ' � r�� l!S G�,o,O _ o , ^ � � .S G��'t G �4 rt�f. G��i 1'Y.'"�.. � ' G �Y.�b r•c. d��6.a h�t,e e�� W � Q 2 �e h�to -� �rtiC � �i.�✓wt•� �i�iu�� o w�K snnsF�croAr:�oce� ��Ecr coM�re W o oo�cr wo�c a PAoce� ❑issue coin�►�oF oca�r►Ncr 0 O OORRECT W'OF�(,CALL FOR F�INSPECTION TEMPORARY V BEFORECdVERINO PEq�AANBdT ❑OORRECT UNSAFE CONDITION WITHIN HOURS• ❑pHpTO TAKEN INSPECTORIMLLRETURN ❑STOP OROEA P08TED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRAN(iE ACCESS. caM ra n�e next tnspection u nours M sdvanoe. (952) 249-4600 ownerlcontractor on site: ( a 6 y ��: c��-. -�- WMN CoPYM�eCM�'S FlN C�nary CoprI81M Noliq t � • ♦ • • � • � � • • I emo To: Finance Department Frorn: Christine Mattson, Planning Assistant ('� � CC: Street File Date: November 3, 2016 G/L: 101-22205 Re: Escrow Refund Demolition Permit#2016-01333 pertaining to 225 Old Crystal Bay Road N is complete. Please refund $2,500 to the property owner, Chamberlain Fine Custom Homes The following is attached: • Original signed escrow agreement • Copy of cash register receipt showing escrow amount received Mail to: Chamberlain Fine Custom Homes 11578 Chamberlain Ct Eden Prairie, MN 55344 w:\street files�old crystal bay road north�225�escrow refund form 201('r01333.doac _ DEMOLITION PERMIT o3DI�O-D J �J33 ESCROW AGREEMENT AGREEMENT made this J�day of �(�7�1�' , 20T by and between the CITY OF ORONO, a Minnesota municipal corporation("City°) andd�ar►� lcur1 �►-Fa,� ("Owners"). Recitals • 1�t /1,An� application for demolition permit has been filed for OYl located at �rj U� u�.b�'A..p �!lU �c� � ("S4bject Prope ") , I gally described as cd �S _ io 2. In conjunction with the demolition, erosion control measures are required as shown on attached Exhibit"B°. NOW,THEREOFRE,THE PARTIES AGREE AS FOLLOWS: 1. DEPOSIT OF ESCROW FUNDS. Contemporaneously with the execution of this Escrow Agreement, the Owners shall deposit$2,500 with the City. All accrued interest, if any, shall be paid to the City to reimburse the City for its cost in administering the escrow account. 2. PURPOSE OF ESCROW. The purpose of the escrow is to guarantee reimbursement to the City for ail out-of-pocket costs(inGading planning, engineering, or legal consultant review)the City has incurred to assure that the erosion controi measures are installed and maintained so the property complies with the provisions of Orono City Code Chapter 79. The financial security may also be used by the City to eliminate any hazardous conditions associated with the work and to repair any damage to public property or infrastructure that is caused by the woric. If compliance with the approved Land Disturbance Permit is not accomplished within the allowable time period, the City may bring the project into compliance by use of the security. 3. RIGHT OF ENTRY. The Owners hereby grant the City, its agents, employees, officers and contractors the right to enter the property to perforrn all wo�lc and inspections deemed appropriate by the City in conjunction with the required erosion control measures, including but not limited to constructing or completing any and all of the agreed upon improvements should the Owners' contractor not complete those improvements by the date specified herein. 3. MONTHLY BI�LING. As the City receives consultant bills for incurred costs, the City will in tum send a bill to the Owners. Owners shall be responsible for payment to the City within 30 days of the Owners' receipt of bill. 4. DISBURSEMENT FROM ESCROW ACCOUNT. In the event that the Owners do not make payment to the City within the timeframe outlined in#3 above, shall issue a Stop Work Order until the Owners pay all expenses invoiced pursuant to #3. The City may draw from the escrow account without further approval of the Owners to reimburse the City for eligible expenses the City has incurred. 5. CLOSING ESCROW. Any remaining amount of the financial security deposited with the City for faithful performance of the plans and specifications and any related remedial work will be released after the compietion and inspection of all such measures and the establishment of final stabiiization for the Subject Property. City Staff shall review the teRns of this escrow agreement two times per year to determine whether the requirements of the project have been successfully completed and whether it is appropriate to retum the funds. Owner may also request the release of the funds, and such funds shall be released upon City Staff receiving the appropriate verification that aii requirements of the project have been successfully completed. 6. CERTIFY UNPAID CHARGES. If the project is abandoned by Owners, or if the eligible expenses incurred by the City exceed the amount in escrow, the City shall have the right to certify the unpaid balance to the subject pPoperty pursuant to Minn. Stat. §§415.01 and 366.012. CITY: CITY OF RONO OWN . By: �ts: ��,�J/t,l�l'L : �o� . ' a � n e�� Form Last Updated: January 2015 150784 � ��;iF��tstg�,r �a�a�,�""� _ �r k a,„��, � �,�s� �� :' '�'F !C��' ��' e ' � E�,.c1'��, ` �,/� �- i�ds� _:: a : � : �. ., aA3� '�k'4 p P .J'� li�. y �� S � �� Q � ��f��af�"�iv},p � R'. ks tr � ` �: �4��d 1 . � x•` tt� }+s 4 � #e ��f k�� 2.�- �. J r�t��jr,��y� }�f� h . . x �� t ��;�ss,�.��,k„`.�.r 't,', � '�;;' �� f��: ��.� ; ,.� `� ° �� i�1• R � 4�y;�- �y� �.;4 �`F"��? �t�� , �k - '�, , ' ,�la!;" �.o '.�1�r' _� ��+�`a f,3� . t � � Y�. ��r�$ • t ky (g�e '\ `i i�`. -,.�. . ,e 41yy,. 1 . �' f't � n . � �' �� ' i11� lY . � ':: � x : 4 (� ':/��L�� ! { .C'1� . J,� ��Sr: ` '� . . . ,�;e��+� i 4��h�ti ��g1 :�,. � £t,,' ,�„� x r z�'y�'��A�-= # f;h. _ ... 4�4`�`E,i `�,,��s `x 4it.. #�t • y� t �� :�t�'4��:,.�' {��c - ��kr�ti�� s ��t��`��4 � -..�, , �'!'�7.` . '•-'`5 k.N�< t . t`�¢ . $ . P, -� �r ��>c t _ r � 1��k � • + t �4if ".. � ' �t.�. t.,ft .. O}n �, i �i�� 1 ��S pyF�i�r '�i�'+� r � s �r�„ ' Y'dY�i��.`..: , Yt �� R �Q 4 . 1 �#�� a+ ,9 , . ) :i¢�r4fN,�' �'o-ti�� .7u y�(�C�� .i t T ; " .,;'�t v,_7�- �i+h 4 ,b; 9 �:;� � . J ( � i;a� ,,�� ., 'l� �{,d :�� i-� . . Tn�6� Y$* � -o .ei" � . P 6� "��r'K�$,�s-:. - .� -( ;-k��`,��,f�„�� r City of Orono ��`�� ` 2750 Kel ley Parkway � ."-L'T K !`+`�:. `,� ;.u�'.� �' �:£ d y� �` . Orono MN 55356 952-249-4600 �'A�3!m r� 6°z > ,'�:� . , � ':; "� Receipt No: 3.016740 Oct 19, 2016 i+' r _, ;:j ��r, f .. f �� a.. .f� ` ' �� ` .' `r ` "' `� Chamberlain Fine Custom Homes ; 4" , "r _p,f' ;.�q r �'^w 4 �, t' "�'�k �{ �,.�;; �' � - Previous Balance: .00 � =�� r f.; ,p - . �"�{ K`�.�,�a' � .�; t � •. Permits �� '��y�Y ��. .� � (.�,e �, . �t��',�� ,� � �. h t,; 2016-01334 225 Old 2,500.00 .�� 4 �. � ,, � Crystal Bay Rd N � �• ��q �� e`., 101-32510 ,�,.�, �' �;� . � ; k �� ,� : Y Building Permits �� 1'°�'�: � .��s� 'i ��'E � k �'�- �� --------------- «.; r �s;: ;., �;r-�: ��,'t ��a��F` e � TOt811 L��.S��.�� • - n ' �t�� .��R.�x ��t � _______________ � �� Check � . e��-�, �,��.�.t� , b -; a. ' � " 1 '4�' .'{ 1 "4 r ..'�� f�' �s, ;��:� � s, Check No: 3456 2.500.00 -�.,� ��'� '�. �a��"��`��'��'� Payor: , .� �4� ��.�.�"�' � ``: Chamberlain Fine Custom Homes � ��"� � ��'^�` � Total Applied: 2,500.00 �gh�+... ,M 'q��,,�x," � �� k�,�� ; --------------- ' ��i ,��,��,��; Change Tendered: .00 �� W LL _ �� i�!'�"� .j��. ________�______ �� , t�'� "�E•! � P ��s1 �' o� rt� {�4 °r' . 10/19/2016 11:53AM .�� oW �� t��: } ,�,� �: � . ��*r+t '�' ¢a�O �s`AE �{.: M1 f /V .,"� f��p 't- K �f�i. �f � � � y CITY OF ORONO " � 2750 KELLEY PARKWAY * � 0 1 6 — 0 1 3 3 4 * DATE ISSUED: 10/19/2016 ORONO,MN 55356- (952 249-4600 FAX: 952)249-4616 ADDRESS : 225 OLD CRYSTAL BAY RD N PIN : 33-118-23-31-0007 LEGAL DESC : UNPLATTED 33 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: THIS$2500 ESCROW IS TIED TO DEMOLITION PERMIT 2016-01333 APPLICANT ESCROW FEE-BUILDING 2,500.00 Pali Holdings LTD Pa ment s TOTAL 2,500.00 CAMERON,PAUL y � � 11578 CHAMBERLAIN CT CHECK 3456 2,500.00 EDEN PRAIRIE,MN 55346- OWNER Pali Holdings LTD CAMERON,PAUL 11578 CHAMBERLAIN CT EDEN PRAIRIE,MN 55346- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued sha11 be performed according to the approved plans and specifications,applicable Ciry 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 permits. All provisions of taws 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 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 required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. ��4,� /D /�`� //.� Applicant Permitee Signature Date Issued By ature Date