HomeMy WebLinkAbout2014-00860 - adv plan review CITY OF ORONO
* 2014 - 00860 *
2750 KELLEY PARKWAY DATE ISSUED: 08/11/2014
ORONO, MN 55356-
(952) 249-4600 FAX: 952) 249-4616
ADDRESS 200 TRUFFULA TR
PIN 33-118-23-44-0039
LEGAL DESC MEADOW WOOD POND
: LOT 005 BLOCK 001
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADVANCED PLAN REVIEW
VALUATION $ 28,500.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ $28,500.00
TYPE OF PERMIT THIS PAYMENT IS FOR: POOL PERMIT
PERMIT#THIS PRE-PAYMENT IS TIED TO:2014-00861
APPLICANT ADVANCED PLAN REVIEW 296.40
ADAMS,MR.&MRS. Payment(s) TOTAL 296.40
200 TRUFFULA TR CHECK 6894 296.40
LONG LAKE, MN 55356-
OWNER
ADAMS,MR.&MRS.
200 TRUFFULA TR
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 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.
Applicant Permitee Signature Date Issued By Signature Date
1r"' II
City of Orono
Building Permit Applications'
for a Swimming Pool
O�r Mailing Address: Permit number: app/V-4,0 48?
VO PO Box 66
Crystal Bay, MN 55323-0066 Date received: ' I
Street Address: Received by: ckv\
y 2750 Kelley Parkway Plan review fee:
t'rk'Ism o�� Orono, MN 55356 apN
Total Fee: i
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us MW
This application form must be completed in full and all required information musf be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: 2 Q Q Lr ", E '�1A TR,g.6
CONTRACTOR/APPLICANT INFORMATION:
Name: :3 K5 /0-00's
State License# A"At Expiration Date:
Phone: "263 – 052 -43U Fax: ( C32 0
Address: ra o'f' ^v Ci ZIP: S 3i
Contact Person: "?`�-otR t ty*t-G4 oeo Contact's phone number / _ &
Email: N oaJ e- Applicant is: o Facto � Homeowner (Circle one)
PROPERTY OWNER INFORMATI N:
Name: �_ jjoU -+ 511 s
Phone (day): 2 12— 633f-, , ���,
Mailing Address: no ;Q,, �/� 7+ tet,
Q IC�a v►1 ZIP: Eff
Email and/or Fax: �—
ENGINEER INFORMATION:
Name: a- Loi S .Ja
XA
Phone: lie
Address: i W City: ZIP:
Email: ' l.. Fax: AJ�
PROJECT INFORMATION:
1.Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls?
X feet .Single Family [IAbove ground [Iyes no Height "
2.Heated? ❑ Multiple Family/Condo %In-ground *A building permit is required
yes ❑ no ❑ Public for any wall over 4 feet in
❑Other(specify) height measured from the
3. Excavated materials will be: ❑ Commercial bottom of the footing to the top
❑ Industrialof the wall, even if it replaces
removed from site 6.Sewage Disposal& an existing wall.
.used on site ❑ Other: (specify) Water Supply Tiered walls are considered
❑Other: (specify) ❑ Public Sewer one wall unless they are
separated by twice the height
(Private Sewer of the higher wall.
13Total Cubic Yards
❑Public Water
Private Well
Estimated Construction Value $ Ey
Packet Last Updated: 03/29/13
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