HomeMy WebLinkAbout2010-00811 - adv plan review CITY OF ORONO PERMIT NO.: 2010-00811
2750 KELLEY PARKWAY
�.
' v ORONO, MN 55356- �ATE ISSUED: 09/08/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 515 FERNDALE RD N
PIN : 36-118-23-14-0006
LEGAL DESC : UNPLATTED 36 1 18 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 15,000.00
NOTG: PLEASE�ILL IN THG POLLOWING:
VAI,UA1'ION OF PERMIT: $ 15,000.00
TYPE OF PERMIT TH1S PAYMENT[S FOR: SWIMMING POOL
PERMIT#THIS YRE-PAYMENT IS TIED TO:20 1 0-008 1 2
APPLICANT ADVANCED PLAN REVIEW 172.58
CUSTOM POOLS TOTAL 172.58
8960 EXCELSIOR BLVD
HOPKINS, MN 55343
(612)933-2255
Minnesota State License#: 5023
OWNER
GR[FFIN, ROBERT
125 CHEVY CHASE DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issucd shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Buildin�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 compicd 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 ot�issuance,or if construction is
suspended lor 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
�evoked at any tipu-fac due cause.
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�A plicant erP mitee SiK+�at e Date Issued By nature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHE AN DESCRIBED A
Crity of Orono q��1� le
Building Permit Appfication
for a Swimming Pool ,�a73°�
Mailing Address: Permit number: 0-����Z-
�,�. PO Box 66
Crystal Bay, MN 55323-0066 Date received: � lD
0 �.��, 0 , �
a ���'�S�y �, Sfreet Address: Received by:
��. `��si�� �ti
\,�,L���`��' 2750 Kelley Parkway Plan reviewfee: /72. S� c?0/0-00 /( rQct
\kEsxo�`'�/ Orono, MN 55356
� � 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.
fncomplete appfications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: ri � �� �
_ � I � �-e�nc�c�.� �� , ,
CONTRACTOR/ARI�LICANT INFORMAT
Name: .�S -�z� �.�.-��C'x.�� �
State License# � ;�- Expiration Date: �' (
Phone: 3- 5 � Fax: ,Z - " � — � � �
Add�2SS: � �� �" " F �✓ �, � ��I Clty: � �v�� ZIP: ,
Contact Person: '� c��.tiv�c:� ContacYs phone n.umb�r_
Email r - - '� �-}�►n �,o �,v�°p�icant is: �Contractor Homeowner (CircleOne)
PROPERTY OWNE INF RMAT ON:
N a m e: �-;, �--'v���r
Phone (day):
Mailing Address: �� �-��r i1 C�. '� '� • ZIP: C�C`�_�-� b
Email and/or Fax
ENGINEER INFORMATION:
Name:
Phone:
Address: City: ZIP:
Email Fax:
PROJECT INFORMATION:
1. Pool Dimensions: 3.Accessory to: 4. Pool Type: 5. Sewage Disposal &
❑Above ground Water Supply
��Single Family
� �-. �,��'`�� i n-ground ❑ Public Sewer
, � X ✓� feet ❑ Multiple Family/Condo
❑ Public ❑ Other(specify) ❑ Private Sewer
2.Heated? ❑ Pubfic Water
❑ Commercial Excavated materiais will be:
��es ❑ Industrial •��
removed from site ❑ Private Well
❑ no ❑ Other: (specify)
❑ used on site
❑ Other: (specify)
� �.
Estimated Construction Valuation � �r ��--J
Last Updated: 9/1/2010
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