HomeMy WebLinkAbout2015-00777 - adv plan review CITY OF ORONO * z 0 1 5 - 0 0 7 7 7 *
2750 KELLEY PARKWAY DATE [SSUED: 06/16/2015
. � ORONO, MN 55356-
952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2655 COUNTRYSIDE DR W
PIN : 04-117-23-13-0006
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 006 BLOCK 003
PERMIT TYPE : ADVANCED PLAN REV[EW
PROPERTY TYPE : RESIDENT[AL
COIYSTRUCTION TYPE : ADVANCED PLAN REV[EW
VALUATION : $ 15,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ I5,000.00
TYPE OF PERMIT THIS PAYMF,NT[S FOR: IN-GROUND POOL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00776
APPLICANT ADVANCED PLAN REV[EW 181.23
TOTAL 181.23
PERFORMANCE POOL& SPA Payment(s)
2405 ANNAPOLIS CHECK 1351 181.23
PLYMOUTH, MN 55441-
(763)270-1180
Ci ty ��T Urona
OWNER 275U Kelley Parkway
Orono MN 55356 952-249-4600
VOSSEN, MICHAEL& KATHLEEN Receipt No: 3.013G28 Jun 16, �U15
2655 COUNTRYSIDE DR W
LONG LAKE, MN 55356- Performance Pool & Spa
Frevious Balance: .00
Fermits
2015-0077i 1655 1ti1.23
AGREEMENT AND SWORN STATEMEIVT Countryside Di W
The work for which this ermit is issued shall be erformed accordin to 101-34410
p p g Plar� Check/Site Fxam Fees
the approved plans and specifications,applicable City approvals,and the ---..----- ------
State Buiiding Code. This permit is for only the work described and does Tot81: 181.�3
not grant permission for additional or related work which requires separate =------------=-
permits. All provisions of laws and ordinances goveming this type of work Cheok
shall be compied with whether or not specified herein.This permit will Check No: 1351 l Y 1.23
expire and become null and void if construction authorized is not Payor:
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 respo suring all required inspections are
req ted in co €ortfiance t+tith the at�Building Code.This permit may be �
re ok d at any time for d caus ' � , �' �
, ; l �
n �� n !�
�
��, � ; � �,� i� �� � �,,� ���e�.'�� . ��� ° � ��- , / �, i�
�
icant Perm te igna e Date [ssued By Signature �l Date
�----�.<�
.
City of Orono
Buildir�g Permit Application
_-__
for a Svvimm ing Pooi
� '��N� Mailing Address: �� C�b D-7�
O PO Box 66 Permit number.
Crystal Bay, MN 55323-0066 Date received: � / (� �
� , ` Received b
Street Address: Y
; ,� i .� 2750 Kelley Parkway �f�f (
,,!.��� ;��,` Orono, MN 55356 `^'� � �an review fee: . Z�� C1C�
,�i�
- --- ' Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete appfications wil) be returned. (Please prinf)
GENERAL INFORMATtON:
JobSiteAddress: z(oss �oun�'�ySi�c. ��i✓e- 1.�Q3� � ��onv � MN SS3S'(o
CONTRACTOR 1 LtCANT INFO ON: , , ' `
Name: ���'��y�1n(K�����iDk- �� MS�1�
State License# � Expiration Date:
Phone: G Fax: 1-$3 2
Address: C� :
Z ZIP:
Contact Person: � � .,r Contact's phone number � �j
Email: A licant i ontractor omeowner {Circle One)
PROPERTY OWNER INFORMATION: ' I
Name: 1�'lic,haC� o►nd ��a'�'►'UeCn Vosj'?^
Phone(day): 2 - p
Mailing Address: o �+ 'd c, 0 ri�t W prp rto M ZIP: (o
Email and/or Fax: m VOSSP/1 nA q r'► M�22 CoM
ENGINEER INFORMATION:
Name:
Phone:
Address:
Email: City: ZIP�
Fax:
PROJECT INFORMATION: �Q� �� -- �j�Ll.�
1. Pool Dimensions: 4.Accessory to: 5. Poot Type: 7. Retaining Walls?
Z� X�_feet �Single Famify ❑Above ground [�yes ❑ no Height�
2. Heated? ❑ Muitiple 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: ❑ Commercia! bottom of the footing to the top
❑ Industrial of the wall: even if it replaces
❑ removed from site 6. Sewage Disposal& an existing wall.
�used on site ❑Other: (specify) Water Supply Tiered wa11s are considered
Other: (specffy) ❑Public Sewer one wall unless they are
separated by twice the height
�Private Sewer of the higher wall.
Total Cubic Yards � Public Water
Private Wel
Estimated Construction Value $ ���,('�
Packet Lasi Updafed: 03/29/13
Page J9 of 21