HomeMy WebLinkAbout2012-00451 - adv plan review - pool CITY OF OR01�10 * 2 0 1 z -� 4�
2750 KELLEY PARKWAY DATE ISSUED: OS/24/2012
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDREeS : 4355 CHIPPEWA LA
PIN � : 31-118-23-42-0020
LEGAL DESC : N/A
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REV[EW
VALUATION : $ 24,500.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ 24,500
TYPE OF PERMIT THIS PAYMENT IS FOR: INGROUND POOL
PERMIT#THIS PRE-PAYMENT IS TIED TO: 2012-00451
APPLICANT ADVANCED PLAN REV[EW 268.45
JMS HOMES INC. TOTAL 268.45
80 W 78TH ST-#133
CHANHASSEN, MN 55317 PAID WITH CC# 9064
(952)949-3630
Minnesota State License#: 1913
OWNER
YOUNG,JOHN&LYNN
4355 CHIPPEWA LA
MAPLE PLAIN, MN 55359-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according[o
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permi[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 afrer 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
revok any time for due cause. ,� ���'
_ ,S i� i � `��_� i 1��� �'l � .` � � " _
A ica Permi Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
Building Permit Application
� for a Swimming Pool
� �,0,�. Ma��iPO Bo�r66. Permit number: Z�( �"—��-'�{�°�
Crystai Bay, MN 55323-0066 Date received: � Z`� � � Z
,a �� O � i�t f I�
�
���� '°- �, Street Address: Received by: --
'�' ,� i „` � 2750 Kelle Parkw "�.'� � . - � �
�' o y �Z�IZ=C04�( � Plan review fee: ��. y� _ C�c •
��kESH�g� Orono, MN 55356 _ ._ _. _�___ ___�--_____.___
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be compieted in full and all required information must be submitted.
Incomplete applications will be returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: L.�'� S� �- �� �,/3���� L��, �
CONTRACTOR I APPLICANT I FOR�!ATI N:
Name: �R S �Q c�/s ��-
State License# �t..� Expiration Date:
Phone: - (� - ��3 Fax: �; - � �
Address: �/o� Gro'�dd� �"(� `ULL ity: ZIP: S„5�� �_
Contact Person: �� y ContacYs phone r
),.-,�
Email �v�,� Applicant is� Contractor Homeowner (Circle One)
PROPERTY OWNER INFORMATION: /
Name: ��4 c..l( � �-�isva.� �U� n,,� � tl S� C�Lc. - �CZ - (�`� —�� ��
Phone (day): ����
Mailing Address: �f 3 S:S � [,i�► Z�P: :S�
Email and/or Fax ��� �
ENGINEER INFORMATION:
Name: ���-c-� �,L��Gs �J�z��s D � �-7` ���� -���
Phone:
Address: � ���� c� ,�`� Cit : < c,v ZIP: Oc�
Email ' ax:
PROJECT INFORMATION:
1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal &
Water Supply
�X��feet ❑Above ground
(�Single Family
❑ Public Sewer
2. Heated? ❑ Multiple Family/Condo �Q In-ground
(�yes ❑ no �,Private Sewer
❑ Public
❑ Other(specify)
3. Excavated materials will be: ❑ Commercial ❑ Public Water
�..removed from site ❑ Industrial 6. Retaining Walls? �Private Well
❑ used on site ❑ Other: (specify)
'�J yes �no
❑ Other: (specify)
Height��oG�
�'�� Total Cubic Yards fj��� � - l 5 i��
Estimated Construction Valuation $ ��� ���
Last Updated: 10/28/2010
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