HomeMy WebLinkAbout2012-00198 - stairway to lake . CITY OF ORONO * 2 0 1 z - 0 0 1 9 B *
2750 KELLEY PARKWAY DATE ISSUED: 04/10/2012
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 679 MINNETONKA HGLD LA
PIN : 06-117-23-44-0008
LEGAL DESC : MINNETONKA HIGHLANDS ESTATES
: LOT 004 BLOCK 002
PERMIT TYPE : ZONING PERMIT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : STAIRWAY TO LAKE
NOTE: $2,000 SB COLLECTED IN ESCROW FEE
ACTUAL ESCROW FEE AMOUNT COLLECTED $2,000.00
HOW DID THEY PAY? CK#6030 & WHO PAID?ROBERT NELSON
ESCROW PERMIT#:(DON'T FORGET TO ENTER) 2012-00199
ESCROW FEE FOR: EROSION CONTROL&ENGINEERING REVIEW COSTS
*APPROPRIATE EROSION CONTROL MEASURES MUST BE TAKEN DURING CONSTRUCTION. ;.2(� (INITIAL)
* SINCE NEW STAIRS ARE SLIGHTLY SMALLER THAN EXISTING,EROSION CONTROL MUST BE MAI�TAINED UNTIL VEGETATION
IS ESTABLISHED. �(INITLAL)
APPLICANT STAIRWAY TO LAKE 50.00
NELSON,ROBERT&VICKY ENGINEERING REVIEW COSTS
679 MINNETONKA HGLD LA TOTAL 50.00
LONG LAKE,MN 55356-
OWNER
NELSON,ROBERT&VICKY
679 MINNETONKA HGLD LA
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 does
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 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.
`���.� K� �_ G�l /o l 1��. � lD � a---
Ap ip cant Permitee Signature Date Issued y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
. City of Orono �� � � � ��
Zoning Permit Application
Mailing Address: Permit number: � " ��..� l `'�;,.�;''�
�Q_J�,, PO Box 66 Date received: � � ��.•'"' "� � ����-�
O `rO Crystal Bay, MN 55323-0066
Escrow#and
Street Address: amount: �Z'C��Qq �.,,�
� 2750 Kelley Parkway Permit Fee: �
��t � G�� Orono, MN 55356
y 'w Approved by:
x�H�4 Fax: 952-249-4616
Notes:
Main: 952-249-4600 "^^^^�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: V����i►�r)�`FC f� ci �l�-�� �i Ct ��
��1`'1 k i� � �ct�� � C`�r-C��G,� y 1'1/11 .S S�S�j
CONTRACTOR/APPL�,CANT INFORMATION:
Name: �'�.��+�►^ fi- /J ���.���
Phone: - - Fax:
Address: - c' yr ' ` ,� ri � � Cit : • ��C, ZIP: _$` ,
Contact Person: E . F � ontacYs phone number -- �$-- "
Email ���m t����� . ti� ,�,,,,�qpplicant is: Contractor Homeowner �'��c���ieo�e�
PROPERTY OWNER INFORMATION:
Name: _Qc�-e r t" /�Q���
Phone (day): �$Z,-4 Z�"—1+(5Z
Mailing Address: �yJ; � ZIP:
Email and/or Fax � ��� �—��p, � ��' s,�i . Cc��t;1
Overall Project Description: {�F� (ry«�,� i��-5ny �-�-�+r w�� -t� L:Y 1�� �
Check TYpE OF PERMIT
Box COST*
Dock, Residential— Permanent dock on any lake or initial seasonal dock not on $50 + engineering review costs
Lake Minnetonka ermanent dock re uires CUP
Dock, Commercial $50+ engineering review costs
Escrow for erosion control and en ineerin review costs $2,000
Driveway Permit(New or Replacement) No charge
Also re uired is a Minor or Ma�or Land Alteration Permit
Land Alteration, Major(grading, filling, or excavating) more 500 cubic yards or $50
more than 10 cubic yards in lakeshore setback (also requires CUP)
Escrow for erosion control and en ineerin review costs As determined b CUP
Land Alteration, Minor(grading, filling or excavating)—500 or less cubic yards $50+ engineering review costs
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 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 cou�t)
Escrow for erosion control and en ineerin review costs $2,500
Tree Removal or other ve etation removal in 0 to 75 foot zone No char e.
(over)
*Permit fee will be collected at
the time the permit is issued.
Updated: December 30, 2011
APPLICANT/OWNER ACKNOWLEDGEMENT:
• Applicant 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;
• Applicant 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;
• 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.
The undersigned certify that the information supplied is true and correct to the best of their knowledge.
Applicant's Signature: ��,c �r�,��'l�Y���_ Date: II C[� I l�
Property OwnePs Signature: j��jJ����,,.,� Date: ,�j��r,
SUBMISSION REQUIREMENTS: Except for tree removal permits, all permits
TYPE OF PERMIT: require a completed 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 surveys/site plans
Dock, Residential Seasonal Dock—survey showing proposed dock
Permanent Dock-plans as approved by CUP and copy of LMCD permit
Dock, Commercial 1. Structural plans for the dock
2. Survey showing the proposed location of the dock
3. Copy of LMCD permit
Driveway Permit 1. All Minor or Major Land Alteration Permit requirements
2. Hardcover calculations, existing and proposed
3. Driveway plans
Land Alteration, Major 1. Plans as approved by Conditional Use Permit
2. Erosion control plan or copy of MCWD Erosion Control Permit
Land Alteration, Minor 1. Grading plan including existing and proposed contours
(Less than 10 cu.yds. within 75' of 2. Amount of fill to be imported and/or exported and haul route
lake or less than 501 cu.yds 3. Amount of earth to be moved around on site
elsewhere.) 4. Erosion control plan or copy of MCWD Erosion Control Permit
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 lan or co of MCWD Erosion Control Permit
Stairway to Lake 1. Construction plans for stairway, including footings
2. Topographical survey of property with proposed stairs shown
3. Erosion control plan or copy of MCWD Erosion Control Permit
Structure Permit 1. Plans for structure.
2. Sunrey 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 required
4. Hardcover calculation worksheets if in shoreland district
5. Erosion control lan or co of MCWD Erosion Control Permit
Tree Removal Call: 952-249-4600 to schedule a single tree removal inspection. A re-planting plaN
mana ement lan re uired for clear cuttin , buckthom or other intensive ve etation removal.
Updated: December 30,2011
1 ':�.! ___ ' - YI' N � f 'G'.5�. �'�#.� x.-K \ � v�'c*RP'g fes`AS ..
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� , Plan Review Checklist for Zoning Permit Applications
Address: V/1 "1 r`�\��n��n�, � ��.�
Description of work: ��,(,l'S �
Type of permit: �I� IV�Q�
��
Zoning review by: ��}��� Date Approved: � L
��C��mg r view by: .J �� Date Approved: 4�{��-.
Other Review, Reviewed by: ,��— Date Approved: T/t� -- i Z
Zonin :
Zoning File#: � r � Resolution#: Resolution Date:
�V
Lot Area: SF/AC Width: 1 �� 1 Depth:
� 1.�� N 5td�-�
Survey Submitted? es 0 No Date of Survey: 2 2� _I� �1�� � S�
✓
Existin Setbacks:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland
Side Side
Pro osed Setbacks:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland
Side Side
Shoreland District MCWD Permit Received Average Lakeshore Setback Met? Bluff
� Yes � No ��V/A 0 Yes � No
�Yes 0 No 0 Yes � No /A `
Permit Number: � Setback:
Hardcover Zones Existin Pro osed Variance Re uired CUP Require
0-75' ❑ Yes 0 0 Yes No
75-250' Type(s): Type(s):
250-500' _ Zoning File#: Zoning File#:
500-1000' Resolution#: Resolution#:
Created: March 29,2011
z:\forms\plan review checklist for zoning permit applications.docx
Planning Review Checklist for Zoning Permit Applications
Page 2 of2
Cubic Yards
In Out Total
Haul Route? ? � Yes 0 No
Explain haul route in detaii:
Fees to be Charged Amount Orono Inspections Required
Permit Amount ��
� Site
Escrow Amount L _� � Hardcover Removal
��j`� � Footing
Signed escrow received? � Poured Wall
� As-Built Survey
�es � No 0 Planting Plan
0 Wetland
Escrow amount received? Final
Yes � No
0 Other(specify)
Engineering review needed?
�es � No
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT)
� l � ��� �x- �
� Cs� P�V S ' SI i � ! 1
. �, ��
Created: March 29,2011
z:\forms\plan review checklist for zoning permit applications.docx
Christine Mattson
From: Mary Hammes [MHammes@minnehahacreek.org]
Sent: Friday, March 16, 2012 12:21 PM
To: Christine Mattson
Subject: 679 Minnetonka Highland Ln
Hi Christine,
I just spoke with Bob Nelson about the set of stairs he is proposing on his property in Orono.The work is all above the
floodplain and isn't big enough to trigger our Erosion Control Rule. He is good to start working pending any of your
permits.
Best,
Mary
Mary Hammes
District Representative
Minnehaha Creek Watershed District
18202 Minnetonka Boulevard
Deephaven, MN 55391
Direct: (952) 641-4518
Main Office: (952) 471-0590
Fax: 952-471-0682
www.minnehahacreek.or�
�
MINHEHAHA C�tEEK
WAtERS�tER RISTRlCT
�Think Green - please do not print this email unless necessary
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From: "Jeremy Bickner"<je►�emyb�borgertproduds.00m>
Date: Tuesday,April 03,2012 7:16 AM
To: "Bob Nelson"<bnikmtka�mchsi.corrU
A#tach: scan_�df
Subject: Step Layout _
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� \ � 977.7 - 4"spruce � �,� c+.6
\\ \ \\ gv�ac� 0977 j \ ��� °i5 p oe Area of conc swale = 186 sq ft
� \� � -' -\� j/ , Area o f driveway is 2 2 8 0 sq.f t
\ \ \ 972 B ", 7„birch�� \\ ' ;�' /
\ \ 9�4 �e ;'� ' �z.� � 972 19 ', e�a.�; \, att�59'o11"s r c �� B7 Area of building is 4305 sq.ft
-' ' 'bircH ;� \ '. 9� 9n.B'u /�. 0�.
� \� \ \� -'�- � os�s.s �� • • , p�n � ves.sz Area of conc patio is 1194 sq.ft
� -__'__"9t \ 976? J�,1 � Oi ���
e e 2 9,•birch 97J 1 •,o„btrc � , foP s>/l �
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� � 969.0 too� 981�2! / %`\1e. Areo of abbreviated Lot is 24543+- sq.ft
� \ \ \ ep�A (�T p6"pine B 77 c�� . . 973 1 fl75/9 �\ p Pine
\\ \ \ `��� � e�ss�.00 sca e g6�'-,--- '�....a �2.so �� \ ' 9�Pjne\ Percentage of Hardcover = 32.5+- percent
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\ � �� , ;, ' , ' ¢6tre.e � s 973.t2 �� 2�'• �
� � , , � ,•� , 9 :�0 2"pme ¢, o5..t,.¢e �P � 90,. ri,..: , Hardcover calculations based on an area of the lot
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S��I�W� '�V � `� ` / � \ iP � ORIGINAL DATE: 9-16-OS
� °te"oax � `�4- � I HEREBY cER71FY 7HAT TFHS PLAT, PLAN, PREPARED BY: BOUNDARY AND TOPOGRAPHICAL SURVEY
� � \ � � DES�CNED Bv: SPECIFICATION OR REPORT WAS PREPARED LOT SURVEYS ��OMPANY, �NC.
\� '�, \ � F � DRAWN 9Y: DE BY ME OR UNDER MY DIRECT SUPERVISION -
• � �s � CHECKED Bv: �p AND THAT I AM A D'JlY REGISTERED LAND LAND SURVEYORS ICO LANDSCAPE
� �o � - SURVEYOR UNDER THE LAWS OF THE
� REViSiONS: STATE OF MIN SOTA. 7GO� 73RD AVE. N0.
�\ ��'r,� �\ e-2s-os wou BROOKLYN PARK, MN 55428
� �� �� � �z-os-cs na,d�o�e� /=(*-(^ Ph. ?63 560-3093
�����) ���� � Fx. �763� 560-357_2
� � � Signed
� 1� \ � Charles F. Anderson, Minn. Re No.21753 or
\ 1� � ti�hea-21nv7zaoo .scJ Gregory R. Prasch, Minn. Reg.9No24992 F.B. No 10tt-25 Inv. No �2406
��� / DATE TIME ` /
CITY OF ORONO�(;���. � cAC N � �Z(o 1:3- v
INSPECTION NOTICE / SCHEDULED �: ' ri�1
PERMITNO. �� �U`�� COMPLETED
ADDRESS �� �1 I � � ` � Ol'� � � � L c� L-N
OWNER r'�C�I�'i�fi �e �S�nTELEPHONE NO. � C�� 5"� ��-
CONTRACTOR -
� DESCRIPTION �I �'1�� )`� f'��`� � � �i�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q p RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. � FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SE I¢FINAL ❑ FOUNDATION/REMOVAL
� _O��RICONTRACTOR TO MEET YOU: �YES_NO
� COMMENTS: ✓
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W� ❑WORK SATISFACTORY:PROCEED �hFiG1�ECT COMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (J52� 249-4600
OwnerlContractor on site: �
Inspector.
White Copyllnspector's File Canary CopylSite Notice
. •
, • . • •
� • ,
emo
To: Finance Department
From: Christine Mattson, Planning Assistant ( uV\
�J
CC: Street File
Date: 5/9/2012
GIL: 101-22205
Re: Zoning Permit Escrow Refund
Zoning Permit #2012-00198 pertaining to 679 Minnetonka Highlands is complete. The
Applicant, Bob Nelson, has requested a refund of his$2,000 escrow.
The following is attached:
• Escrow request
• Original signed escrow agreement
• Copy of cash register receipt showing escrow amount received
Mail check to: Robert P. Nelson
679 Minnetonka Highlands
Long Lake, MN 55356
w:�.street filesMinnetonka highland lane�679�escrow refund merno 2012-00198.doc
, , � .
Christine Mattson �� � �� 11�
From: Bob Nelson[bnikmtka@mchsi.com] �Of Z -����
Sent: Tuesday, May 08, 2012 10:47 AM
To: Christine Mattson
Subject: Re: Escrow Refund
Christine,
My lake steps were completed on 4/26/12. Final inspection was done by W. Gibbs on 4/30/12. A photo is
attached.
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I am requesting a refund of the$2,000.00 escrow fee.
Thank you.
Robert Nelson
From: Christine Mattson
Sent:Tuesday, May 08, 2012 10:16 AM
To: 'bnikmtka@mchsi.com'
Subject: Escrow Refund
Hi Robert,
Please send me an email stating your project is complete and you are requesting the City to refund your
escrow money. If you have any pictures of your final project, I would love to see them.
Thanks!
Christine Mattson
Planning Assistant
City of Orono
2750 Kelly Parkway � Orono � MN � 55356(physical address)
PO Box 66 i Crystal Bay I MN f 55323-0066 (mailing addressJ
'� 952.249.4620 ! 8 952.249.4616
�cmattson@ci.orono.mn.us I �l www.ci.orono.mn.us
Office Hours: Monday-Friday 8 am to 4:30 pm
Summer Office Hours begin Monday, May 21,2012
i
Monday-Thursday: 7:30 am to 5 pm/ Friday 7:30 am to 11:30 am
OUR OFFICE WILL BE CLOSED: Monday, May 28,2012 (Memoriaf Day)
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ZONING PERMIT ESCROW AGREEMENT
Permit#2012-00198
AGREEMENT made this � � day of �'l�-c�c� , 20�?�by and between the CITY OF ORONO,
a Minnesota municipal corporation ("City") and Robert P. Nelson ("Owners").
Recitals
1. A zoning permit application has been filed for a property located at 679 Minnetonka Highlands the
("Subject Property"), legally described as Lot 4, Block 2 Minnetonka Highlands Estates, Hennepin Caunty
Minnesota.
2. Owner requests 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$2000 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-pocket costs the City has incurred (including planning, engineering 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 zoning 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 permit#2012-00198 if compliance with the approved zoning permit is not accomplished.
3. MONTHLY BILLING. As the City receives consultant bills for incurred 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 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. The Balance on deposit in the escrow, if any, shall be retumed to the
Owners when the review has been completed and written notification 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: I OF N OWNER:
By. 7� 1 1 w �� Y/JiIM
- a�r
Its: � d
�.��.....�..�..,..���._.:� �.. ...� � .
n.,,ss,o �
ROBERT P. NELSON 6 O 3 0
VICKY A. NELSON �
952-475-1452 �
679 MINNETONKA HIGHLANDS W. � " f��_Zp,1�
ORONO, MN 55356
Pay To �''
„ The Order Of t�r �1/ C3 � D �'"'��� � $�a�,
a
$�� �; / `` f ,p �
� �1 l.t �a 1 `"F-C�U���F� � ���1 C �� Dollars IJ �.�•
�
M � I MARSHALL & tLSl.EY BANK
For '��:�C.�'+� � � �, �
���:09100 L L57i: 00 250��� 29444��' 06030 �
C�i�ty of Orono
P750 Kelley Parkway
Orono MN 5535b 95�2-249,4600
Receipt I�: 3.406539 Mar 1b, 2012
2012-06198 / 679 Mtka Highlar►ds
Planning and Zoning
2412-�i98 / b79 I�tka 2,4Q4.OU
Highlands Escrow
iQi-�Q5
Deferred Rev-Develo{�^ Deposit
Total: 2,OOii.00
Check
Check No: 6430 �,�.00
Papor:
Cti12-�198 ! b79 Mtka Highlarrcfs
Total Rpplied: 2,40Q.�4
Change Tendered: .QD
43/16l2012 02:27PM1
' �� ' � CITY OF ORONO * 2 B 1 2 - 0 0 1 9 9 *
2750 KELLEY PARKWAY DATE ISSUED: 03/16/2012
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 679 MINNETONKA HGLD LA
PIN : 06-117-23-44-0008
LEGAL DESC : MINNETONKA HIGHLANDS ESTATES
: LOT 004 BLOCK 002
PERMIT TYPE : ESCROW FEE-APPLICANT
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ESCROW FEE-APPLICANT
NOTE: ESCROW FOR STAIRWAY TO LAKE-PERMIT#2012-00198
APPLICANT ESCROW FEE-APPLICANT 2,000.00
NELSON,ROBERT&VICKY TOTAL 2,000.00
6'79 MINNETONKA HGLD LA
LONG LAKE,MN 55356-
OWNER
NELSON,ROBERT&VICKY
679 MINNETONKA HGLD LA
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 does
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 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time aRer work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.T'his permit may be
revoked at any time for due cause.
' ./��..�. 3 i �� i � � �,c.�-c �' i .3—,/�—/a-
Applicant Permitee Signature �c Date Issued B Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
, . , l�-lJ1 1 •
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Checkiist for Refunding ermit Escrows
Building Permit # ��2-"� �Q b
Street Address: �D� �LY1 2, Yl
Appficant Name: � N el�c�
❑ Escrow request received Date: � !�� � 2'
rermit Type: I �
�;�.rs
Are all inspections completed? es No �fL �
�
If not, list what is outstanding:
Was there a Temporary Certificate of Occupancy issued? Yes No Date: ' Y�
Was there a Final Certificate of Occupancy issued? Yes No Date: _
O As-built survey required? Yes, approved on NO NA
❑ Email CK & Bonestroo to see if there i ny unbill d IP D t email sen
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N W�
❑ Prepare memo for Finance Depa ment
z:\formslzoning standard formslchecklist for refunding building permit escrows.doc
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