HomeMy WebLinkAbout2016-01059 - addn/remodel/repair , • CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 6 - PJ 1 P1 5 9 *
DATE ISSUED: 09/26/2016
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4640 NORTH ARM DR W
PIN : 06-117-23-23-0005
LEGAL DESC : LJNPLATTED 06 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 28,000.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE)
NOTE: PRIOR TO RELEASE OF ESCROW M EY D SOILS MUST BE ESTABLISHED WITH VEGETATION AND A FINAL
INSPECTION COMPLETED. INITIAL:
APPLICANT PERMIT FEE SCHEDULE 467.54
STATE SURCHARGE(VALUATION) 14.00
A.M.BURNEY EXTERIORS,INC. TOTAL 481.54
14367 78TH STREET NE Payment(s)
OTSEGO,MN 55330- CREDIT CARD 1399 481.54
(952)836-8938
Minnesota State License#: BUIL-BC635734
OWNER
IVERSON,DANIEL&LINDA
4640 NORTH ARM DR W
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 separate
permits. Ail 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.
/ /
A ic t ermitee Signature Date ssued ignature Date
C11�Y OF �RONO ,
1 Y � �, j
�U�LDiNC� PERIVII� 14PPLICi4TIOIV 1��1, ��r
FOR �VEVN �TRIJCTURES OR 14DDITIONS
/�� Mailing Address:
�O` �O PO Box 66 Permit number: p/(�— d/D 5�
Crystal Bay, MN 55323-0066 Date received: O �����o
� Street Address:'
� � Received by:
�'� G� 2750 Kelley Parkway(� � ��i� Plan review fee: / —Q/(�s ,
`qxESH��� Orono, MN 55356 1' ,W ��
Main: 952-249-4600 �� Total Fee: %��� 9v
Fax: 952-249-4616 ��nww.c.i.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please prinf)
GENERAL INFORMATIO[V,• �
Job Site Address: �(� ��U /��• �� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,� No
/f yes, a specia/event permit is required with Police Department and City Council approval 60 days prior fo fhe event. Shuttle bus service wi11 be
required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFOR ATION:
Name: � /2��%, '����2S
State License # '7 3y Expiration Date: ' ;2q ) 7
Phone: cell 6 � 2 - 7 _ C� office �v�
Mailing Address: �3b"7 7S 5i N�% Cit : Dr '� Gv ZIP: S j 3� ±�
Contact Person: �� Applicant is: ontractor / Homeowner (Circle One)
Email and/or Fax: �'N Fv � ,��u/�,N�Y�xc2'-✓Z;�2S ��v�`'�
PROPERTY OWNER INFORMATION:
Name: �� �J�h2-S'�
Phone (day): C�/2 - / - 7�,7
Address: Gf(�Y c� . ,/a,,QM �Z City: ✓�'1���%� ZIP�
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone(day):
Address: City: Z�p•
Email and/or Fax:
PROJECT INFORMATION: Description of pro'ect:
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
❑ ew Construction Water Supply
❑ Single Family with ❑Accessory Bldg./Garage
[Y�Addition attached garage ❑ Deck
❑Accessory Building � Sin le Famil with ❑ Public Sewer
g y ❑ Office/Commercial
❑ Relocation detached garage � Residence ❑ Private Sewer
❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater ❑ Public Water
'*Any earth movement may also require ❑ Commercial ❑ Storage
MCWD review 8� permits. ❑ Industrial ❑Warehouse � Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Othe�(SpeCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682 R E C E I V�:;�
www.minnehahacreek.or
$ � t�<,_ AUG :�' �', `"� :
Estimated Construction Valuation (excluding land) � � QQ
C1TY OF ORONO
Last Updated: January 2015
STRUCTURE INFORMATION:
1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction
a. Length(ft.)= b�� Number of bedrooms= [$��/�lood/Frame
� ; , „
b.Width(ft.)= � �" Number of garage stalls: ❑ Masonry
❑ Metal
Areas in sauare feet Attached=
_ ❑ Pole Bldg.
;'
c. Basement= ^� ��" Detached = � ICF
d. 151 Story = �� ❑ On-site Prefab
e.2nd Story= N i �f ❑ Off-site Prefab
f. Y2 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 licable
❑ ❑ Buildin Permit Escrow A reement and Fees
❑ ❑ Plan Review Fee
❑ � Com leted A lication Form
❑ ❑ Pro osed Buildin Plans—2 fult size sets,to scale and 1 reduced 11 x 17 or 8'/z x 11 set
❑ ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements
❑ ❑ Surve —2 full size,to scale meetin ALL surve re uirements
❑ ❑ Hardcover Calculations
❑ ❑ Se tic S stem Certification
❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or
Documentation from MCWD statin no ermit is re uired
❑ ❑ Landsca e Walls and/or Retainin Wall Plans
❑ ❑ Stormwater Pollution Prevention Plan SWPPP
❑ ❑ Access Permit
❑ ❑ Data Privacy Advisory Form
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 femporary Certificate of Occupancy may be issued upon receipt of a$10,000
escrow to ensure completion of the as-b ' rvey and all site improvements.
� ` oate: �// �// � �ECENED
ApplicanYs Signature: --
Owner's Signature: Date: AI If; �� fl 7ni�
Last Updated: January 2015 -
CITY OF ORONO
. � PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
Address: _ ���/`�lJ IY�1 r► ' rl�l'� ��� w PermitNo.: �d�� - (����1
Description of work: �( 1 I��1' , Date Rec'd: p �� ' � �Q
i
Septic review by: Date Approved: � � �
Zoning review by: Date Approved: ' �'
Building review by: Date Approved: /!
Grading review by: tY � Date Approved:
Zoning District: ' L",� Zoning File#: Reso#: Reso Date:
Zoning: Lot Area: J. SF/�� Width: Lot Coverage: — SF --� %
Survey Submitted: �es � No Date of Survey: �'`7•� � Revised date(?):
Landscape plan submitted? 0 Yes �No Landscaper: � ��'�Q�
�
Pro osed Setbacks:
O
Front(L�) Rear(St�� ( N S W ) ( N S E V ) Other Buildings Wetland
�� � Si� Side
a 14A' ��� ` •— ����
, � . ---�
Defined Height: Peak Height: FFE: s ee = xis ing o
Perimete ' ear feet) _ - L.F. below grade
� No, Stories
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION:
The distance between the lowest proposed ��- Slab at or above grade—
START W ITH floor(of the basement or crawl space)and �-•" measure from highest existin�c
the highest point of the roof. START WITH �fl ade to the highest point of the
roof even if fill was brought in to
If you have a...
elevate home.
SUBTRACTION • GABLE OR HIPPED R F(no Slab b grade—measure
(BASED ON windows): Subtrac alf the distance fro ighest existing grade to the
ROOF TYPE) between the hi est point of the roof hest oint of the roof.
to the low nt of the corresponding If you have a...
gable o ipped roof • GABLE OR HIPPED ROOF
SUBTRACT
• G LE OR HIPPED ROOF(with (BASED (no windows): Subtract half
'ndows): Subtract half the distance ROOF pE) the distance between the
� between the top of the highest highest point of the roof to
the low point of the
window and the highest point of the corresponding gable or
� roof hipped roof
� • ALL OTHER ROOF TYPES(flat, . GABLE OR HIPPED ROOF
mansard,etc):No subtraction. (with windows): Subtract
TRACTION Subtract the distance between the half the distance between
BASED ON basemenUcrawl space floor and the the top of the highest
/ EXISTING highest existing grade adjacent to the window and the highest
GRADES) foundation OR 10 feet(whichever is less). point of the roof
• ALL OTHER ROOF TYPES
(flat,mansard,etc):No
EQUALS Defined building height subtraction.
Defined building height
EQUALS
Updated: May 2016
z:\forms\plan review checklist 5-2016.docx
Shoreland District MCWD Permit Average Lakeshore Setback Bluff
M et?
Permit Number: � � Yes 0 No N/A � Yes
Yes � No No
� N/A—see attached Setback:
Stormwater Quality Existing Proposed
Overlay District Tier Hardcover Hardcover Variance Required CUP Required
circle one � % and sf % and f
0 Yes No 0 Yes o
1 2 � 4 5 �l � Type(s): Type(s):
�
I�C t--� i Yli.1.uL�..�� � ,�l r�v�e�t���,� .
Fees to be Char ed ' YES NO
Permit �
Plan Review �
State Surcharge
Investigation Fee
SAC—Number of SAC Units �
Other(specify)
Square Foota e $ per Square Foota e
Basement X = $
15t Floor X = $
2nd Floor X = $
Garage X = $
Estimated Construction Value: $
Orono Inspections Required Work Requiring Separate Permits
Footing 0 Site �Plumbing � Grading/Filling
Poured Wall ilt Fence/Erosion Control Mechanical � Fire
� Foundation Survey � Hardcover Removal � Fireplace � Water Connection
� Framing � Other(specify) � Masonry � Sewer Connection
� Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation
❑ Foundation Waterproofing 0 Other(specify) � Landscaping
Framing
0 Insulation
0 As-Built Survey
' al
� Lathe Required State Permits
� Other(specify)
� Well Electrical
REMARKS (in-house):
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED:
� See Builder Acknowledgement Form �, ,`,,�
�Prior to release of escrow mone aa-as=b�-si�#e�� '���. �- ���t5r�!( ��
y �b y-��l ►ons-must-be subrxaittgd-and appr ved.
U�'�CN` �+- a_ �1�.- <<i�.S��7(%►�- �l�� °�
Updated: May 2016
z:\formslplan review checklist 5-2016.docx
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City of Orono
� �oNo Hardcover Calculation Worksheet
Property Address: � ' II� Ii ,,,( p
�'�n �� � �� l� V lJ 1 *"� ' �1 il Y ��,! -,�`i
`'KFSHo0.`` Prepared by: � s� %. Date: , - ' '
� � �������� _��� - - �
Stormwater Quality Overlay District Tier: (Circle one) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Step 2: PROPOSED HARDCOVER
In the following table, identify all items of proposed hardcover on the property, keyed by letter to
Certificate of Survey (survey must accompany this form). Include all existing hardcover items that are
intended to remain, as well as all proposed hardcover items that will be added. Use as many lines as
necessary to accurately depict proposed hardcover status of the property. For Tier 1 properties, identify
any features by letter which are split at the 75' setback line and calculate hardcover square footage
separately for each portion.
Key to Hardcover Item (Describe) Length x Width Total
Surve (S uare Feet
Exam le Gara e 24'x 30' 720 S.F.
A ! i ' �.� .� • � '� ��:'`� S.F.
B --- ��� ��t: i� r���� S.F.
C r'� ; j �.� �' , !.__ � � , �g S.F.
p � � �; , � � S.F.
E .> � :: ' S.F.
F �,, c � � ' �lt�.W ' i .�? Y ' 7 ,.� S.F.
G ✓ J Z � � S.F.
H S.F.
I o '::R ' �' i;- `f' ' �C �% S.F.
J .�., Y '�, ` � S.F.
K -� .- Z S.F.
� S.F.
►� - S.F.
N —�""� _ —_-_
— - S.F.
0 ' S.F.
P � � � '� S.F.
Q - .....f, 5.�.
R '�_._
�_.
�� - S.F.
S — ---—---__----------—...__.____ _ _
S.F.
T S.F.
� S.F.
V S.F.
W S.F.
X S.F.
Y S.F.
Z S.F.
1 Total Pro osed Hardcover �
� 6 . ', _ s.F.
Excludable Hardcover See Cit Code Sec 78-1684 :
S.F.
S.F.
S.F.
S.F.
S.F.
2 Total Excludable Hardcover S.F.
3 Net Pro osed Hardcover Subtract line 2 from line 1 S.F.
(4 Total Lot Area � , a- S.F.
Proposed Hardcover Percentage [(3)=(4)] I �� %
\ � ( n���--
��T �l %�- � I��� o ;'�f y'=�v,v�. ��� . �,� 0� � V�
l��Z� Z 7 � ► (f"�� �i �� �� _ T'J� � ��jg ,� �_._,
This is an informafion pack2t regarding Hardcover. Every effort has been made to insure the accuracy of the informafion co,ntained
herein;however,if any information is not consistent with provisions of the City Code, the Code provisions will prevail.
Page 9 of 9
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Christine Mattson
From: Christine Mattson
Sent: Thursday, September 01, 2016 3:39 PM
To: 'info@amburneyexteriors.com'
Subject: 4640 North Arm Drive W/#2016-01059
Hi Alan,
We received the building permit application for a mud room addition and deck and 4640 North Arm Drive W; however
the survey submitted does not reflect the proposed additions. Please stop by and draw to scale on the survey the
additions proposed.
Don't hesitate to contact me if you have any questions.
Christine Mattson
Planning Assistant
City of Orono
2750 Kelley Parkway 0 Orono I MN A 55356(physical address)
PO Box 66 I Crystal Bay I MN I 55323-0066(mailing addressJ
'� 952.249.4620 I 8 952.249.4616
�cmattson@ci.orono.mn.us I � www.ci.orono.mn.us
Summer Office Hours: (Monday,May 23 throuqh Friday,September 2,2016)
Monday-Thursday: 7:30 am to 5 pm
Friday: 7:30 am to 11:30 am
OUR OFF/CE WILL BE CLOSED: Monday,September 5,2016
1
DATA PRIVACY ADVISORY
In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen warning", 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.
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RECEIVED
AUG 3 0 �!,��
Packef Last Updated: August 2015 CITY OF ORONO
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Anthony Forest Products is now offering our popular Power k
Column0 as a Power Preserved ColumnTM'for ground contact
using Hoover Cop-Guard. These columns are treated to the high
retention level of 0.13 PCF,meeting AWPA use category 4A,46,
and 4C(should not be used in direct contact with water).
Suggested Uses: (Exterior Oniy) �
■s�
• Deck Support Columns ��,
• Residential and Commercial exposed structural columns ���
• Raised Coastal Construction supports replacing piling �,�
• Industrial and Farming applications , ���,
• Pedestrian bridges and park shelters Deterioration Zones from AWPA Standards
i�l �
'
�1 Dense SYP 2100 psi 2,100 2,300 1.9 x 106 1700 2300
1�t��i�r` ` E}y8 ` fi�.� #�8` ��i tI�, : : .':#l.�. :
_ __ _.___.---- -.__--- –.,___._ ____�_.—_._______,_��__. _.___—_------ -----_.._ _�_....-----______.
'T!re tabulated va/ues arelormoisGue contenl d Irs.s than 16%.For�t-u�e Ure desi�r►alucs slsl!6emu7iPliad by ffie�ed-Use fador.
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DESIGN,INSTALLATION&CONNECTION NOTES: j
• Allowable axial loading for all Power Preserved ColumnTM'sizes can I
be found on our website. !
• Anthony recommends all columns to be placed on column �
base/blocks and/or embedded i�concrete.
• Should not be used in direct contact with water.
• Installation and connection details can be found at
°v�Jwev.anthonvforest.cam and recommended connections must be i Fx
analyzetl by an engineer antl meet all local code requirements. ;
• Standard non-corrosion resistant fasteners can be used unless I
connections are made to other water borne copper treated wood or �
in the severe deterioration zones(local building codes supersede).
• All Anthony column tables are for preliminary design use only. i �,
Final design should include a complete engineering analysis, � '
. including bearing capacity of the foundation supporting the column. C����n''��'�����` ������ ��� �
7
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Power Presenr� Co�umnTM
Aliowable Auial Losds(Pounid�)for Combi�atfon No.50 alulam Coiumns
Eff�ve
Colucru► Net =�112�. 3 lerns =5-1R in. 4 tams
�� I nat D��t�n Fadar Loe�d D�ioQ Facc�
ft 1. 1.'!5 1.25 1.00 1.15 1.25
,4, ,�, � � ,: { , :.< �
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6 g.p50 5.710 10,090 16.08Q 17,010�L 17.550
{x -,�- :� ���° `i'�. . �i��f
�$10 4.760 4.920 . 5,020, „7.920 8.160 • 8.300
�:`��'"" �� �`�"' ��. "
.,�: �. ,���� �e� .� ... _ g�:
14 2 2 870 � 2 900 4 580 4 670 4 720
Effec�ive
Cdtxrn tret =r112 in. 4 lams Net =6-7/8 k►. 5 latr�s
�� t�mr�o�ralion Facbor L D�u�tion Fador
ft 1,00 1.15 125 1.00 i.15 1 5
_. ,; F � � ,
�� :,. �� . _-
� 8 � 25�T80 27,� 28,960_ z 33,820 � 36.280__. �,_37,880
, 1�k � ' . '� .:���•..,_
12 16,280 17.010 17.430 20,740 __ 21.580 22 070 �
- �{ � � ' �. ,->. `. . ��
16 14.780 11,100 11,280 13,490 13.880 14,100
�$ ' �Y��>.: .��+�' ��
� _.
20 7 510 7 680 T 780 9 9 60t! 9 720
, I II�I �I Eftect�e I I �
E� _&114 k►. S lams
Colwrm Net =�7/81n. 51ams Cotumn Ne�De
�� t�DuraUoo Fador Ler�h a�t��tr,�,Factor
R 1.00 1.15 1.25 ft 1.W 1.15 125
��
�� ->� < - ' :. 540' �585 5fl0 - �.� :;
10 �41,450 44,710 46.$20 10 76, 4 ' �t
'!� > . . � �, �+� _ '� � �> � �>� t
,�
14 *28,750 30,170 31,000� 14 'S�.820 84.910 66,240
� `�;� s ;� �., �, >: , '� �`�� ,.,.�
'[8 S 20,360 21,100 21,530%: �8 44,790 47.970 � 48.330
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22 15.Ot0 15,450 15.700 22 34.060,. 36,150 36.1� .
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Notes:
1. The�WiaMd a�owable loads apPh�Y�►�-P�e 9M+���a made wNh a1 N10141�mins�ot�s(C,omti�Aion 50)
vii@loul apeciel brr�ion�•
2. AOP�eal�s aenioe oondqio�s=cNv
3. The tabu�ted eNowaWe bads ero b�eed on simphr a�iaNY lo�ded CoMnns��jecbd b a mstcilNNn eooerq�icilY
af eitl�er 1J�oohMnn widU�o►4/6�deW1►.wFlfdfaver is worss. For sids loads.otlls►eoCenbiC end iDads.ot OIt1Bt
�ed axki and Asxural ioecls.aes 2005 HD6
4. Tha aolunn is�aM�med b Oe ta�6►sced,e000sPt 8t Ihe ooksrm ends�and fhe e�s ooMsnn bnplh is e�i
b U1e aC01al C011MINt leflQlh. .
5. Desiyn ProPaliss far nomtai losd dustion and d�Y+�M aarvice condiqons:
Comp�aian Pera/si lo Oratn(Fa'2.300 P�for 4 a naro lams.or 1.700 D�i tor 2 or 3 Mans.
ModuMis d el�ity(E)=1.9 x td°pai
Flexual skess whan baded Den/N�o Wde tae�s af�rrona8on(Fbr)�2.900 Pd ta 4 ar moro lems.a 2,100 Od tor 3 tams.
Fb�asal aVesa wF�er►iostNyd perpanticdar e�v�ide faoss af Ismiylion(FeJ=2.100 P�for 2 Wes b 15 in.deeP
Miltiout�psdaF IsneiDn ia�natlo�.
Vduns tsebr 1a F�Is in acoo�danee wNh 20D61�6.S�e�do�for Fq,is(i2/tn"�.wAero d is eq�l b tl�e
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OWNER ' TELEPH E NO ��v - ,..F.
CONTRACTOR �ry� �
� DESCRIPTION a�r� � � � C/
� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
�OURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
41 ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE EPTIC INSTALL
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OwnerlContractor on�ite:
Inspector-"JLL��� �
White CopyMspeetor's FM Canary Copyl3N�Notfee
ru,..... --
ADDRESS �G 5'� ir. r�, ,f s ��--
OWNER TELEPHONE NO.
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�, DESCRIPTION ��� � �
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Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
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� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
¢ ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
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OwmerlContractor on site:
Ins���� r """ �.
wnics covrn��+�Fia C�nary Cop�rfSib Noffee
�'� \••- DATE TIME
CITY OF ORONO cnLLED IN �g--a��-�
INSPECTION OTICE HEDULED ��/-i� �/:�
PERMIT N � �OS�MP EfED �
ADDRESS d �
OWNER TELEP N NO. � `�� � �
CONTRACTO
�' D RIPTION �� �
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Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
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� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
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_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
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INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED
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Owr�JContractor site-
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CITY OF ORONO
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_
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csN to�u�e r�xt�repectlo�2�t no„ra n,edvsnos. (952) 249-4600
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ownerlcoMractor on site:
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ca�Io�u�e next tnspsctio�2�t no�B in a�ra�os. (952) 249-4d00
on site:
Inspecla:
YVhib C�MsP�e1o�'S FlN C�n�ry CapyfaM�I�olle�
f�1•yI /3 a��,eq �o.+s�. ' �.-�c36 - �lI�� :
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INSPECTION NOT10E— /O S� SCHEDULED /O ��7 ,�'�
PERMIT NO. � COM ETED � '- /
ADDRESS � `7 O � " • /�'L!/�-t �iV
OMINER TELEPHONE N �� ' �7 �
CONTRACTOR `
�1 DESCRIPTION �� ��"
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csN ro�u�e�e�t r�spec��z4 no�B�aaranoe. (952) 249-4600
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To: Finance Department
From: Christine Mattson, Planning Assistant �
CC: Street File
Date: January 20, 2017
G/L: 101-22205
Re: Escrow Refund
Building Perm�#2016-01059 pertaining to 4649 North Arm Drive W is complete. Please refund
$2,500 to the property owner, Dan iverson.
The following is attached:
• Original signed escrow agreement
• Copy of cash register receipt showing escrow amount received
Mail to: Dan iverson
4640 North Arm Drive W
Mound, MN 55364
w:�str�eet files�north arm drive w�4640�escrow refund 2016-01059.doac
' ' . BUILDING PERMIT ESCROW AGREEMENT
Orono Building Permit#o��l(p-D�D.s'�!
AGREEMENT made this _3o day o � , 20/6, by and between the CITY OF ORONO, a
Minnesota municipal corporation ("City") and 1F[.y'S07�1 ("Owners").
Recitals
D N bu'ding permit application has been filed for �Grt�jP7? located at
� the ("Subject Property"), legally described as
G�G
2. Owners request the City to review this application which requires City approval and may require
consultant legal and/or engineering review.
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$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 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
# �D!!e 15/AS'9 if compliance with the approved building 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 returned to the Owners
when all requirements related to the project are complete. City Staff shall review the terms 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 return 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 all 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
property pursuant to Minn. Stat. §§415.01 and 366.012.
CITY: CITY OF ORONO OW
By:
its: !
Internal Use Only: G Original to Finance Departmerrt `' O Copy to Strest fi��
Packet Last Updated.• January 2016
Page 23
LEGAL DESCRIPTION OF PREMISES SURVEYED:
The South 435.6 feet of the East 427.86 feet of the Southwest Quarter of the
Northwest Quarter of Section 6, Township 117 North, Range 23 West of the
5th Principal Meridian.
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�: .�•:` �
i - - , . . ---�491� �
City of Orono
2750 Kelley Parkway
Orono MN 55356 952-249-4600
Receipt No: 3.016323 Aug 30. 2016
Dan iverson
Previous Balance: .00
Permits
2016-01059 4640 N Arm Dr 2,500.00
101-22205
Deferred Rev-Developer Deposit
---------------
Total: 2,500.00
_______________
Check
Check No: 6491 2.500.00
Payor:
Dan iverson
Total Applied: 2,500.00
---------------
Change Tendered: .00
---------------
08/30/2016 03:37PM
� � � .� � CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 6 — 0 1 0 6 5 *
DATE ISSUED: 08/30/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 4640 NORTH ARM DR W
p� : 06-117-23-23-0005
LEGAL DESC : UNPLATTED 06 117 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 BUILDING PERMIT 2016-01059
APPLICANT ESCROW FEE-BUILDING 2,500.00
TOTAL 2,500.00
IVERSON,DANIEL&LINDA Payment(s)
4640 NORTH ARM DR W CHECK 6491 2,500.00
MOUND,MN 55364-
OWNER
NERSON,DANIEL&LINDA
4640 NORTH ARM DR W
MOUND,IvIN 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. 'I'his permit is for only the work described and dces
not grant permission for additional or related work which requires separate
pertr►iu. 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 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.
1'he 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 Signatwe Date
SQ.4--
DATE TIME
CITY OF ORONO CALLED IN 1—(D^17
INSPECTION NOTICE SCHEDULED 1-q--17 a,t�M
PERMIT NO. 2-OVn,Ub ' �9 �CCOMPLLEETED f"
ADDRESS 4 -� NO l I V L Are_ TV
OWNER TELEPHONE NO.01 l 44 q -17(47
-Gem-RA-crag OVAL 0,Nkti 'Win iv eriow
• DESCRIPTION Ott,44_ FIt4444 i K y– 4✓ !ick
tV ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL
❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION
IT AF.LIAMING 0 MECHANICAL FINAL 0 RATED WALLS
1, ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
-4 Otitt-
0 WATER HOOK-UP 0 FOLLOW-UP
W❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
v ❑ DEMO-SITE 0 SEPTIC INSTALL
Z OWNER/CONTRACTOR TO MEET YOUR�_YES""_ JNO `
h COMMENTS: e/� , 45 7_ - _ �!"n toot -ft-
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Lai
2i/eCt- 'I4& ,aC✓wA - Ci %4A-1.0 .c_&;(:).r.
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0 v 0? 14st'ei. I'Iv•
ct CI-4..4•445 ve. ..s ,a K
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14.1ccQ
refo AN- p/e6e5 -4- dc4��✓io✓ G.)411.5 —
IQOK - Ins 46, —
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W 0 WORK SATISFACTORY:PROCEED 0 PROJECT COMPLETE
W• T34aRRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY
CO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
✓ BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. El PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contra or on site:
Inspector. ( pi
White Copy/Inspector's File Canary CopylSite Notice