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Home My WebLink About2016-00439-permit voided . ' " � \ City of Orono � � Building Permit Application � for Swimming Pools and Hot Tubs MailingAddress Permitnumber O�('llol� � ��0 PO Box 66 _ Crystal Bay, MN 55323-0066 Date received: �� i ' + � RecQived by: _ Street Address: / :� � � 2750 Kelley Parkway �J/ Plan review fee: Cv� , J�' �� . �" '� Orono, MN 55356 <<� _�.,� � � �"t t ti��`' J _, Main: 952-249-4600 Fax 952-249-4616 cl orona mn us - " This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: � L 'j�; �;-��;`�;��;, � }-l)�i� R�i A(] CONTRACTOR/APPLICANT INFORMATION: Name: � t �?��,7�'.' � � S�-°CrA'TE� State License# X�" ''� .;L� Expiration Date: 3 3l (p Phone: c� . �= t Fax: g'S1.. � . ' 7 Address: r� i2 � •�� ,� 4. -� Cit : ? ZIP: � �.3 � Contact Person: k F� e�► � ContacYs phone number �2 �j(,r �� '� Email: �� - ` �"' Z • , C c licant is: �ontractoT-� Homeowner (Circle One) �_ ___— PROPERTY OWNER NFORMATION: Name: ^�,�A� � �7rt �NC�2 aJA �� j ��u Phone (day): �c"� . �-� r� - Mailing Address: ��y �+ ��L.�. ,f�- N1 , eV ZIP: j��L^ Email and/or Fax: G,').��Z, C�.�, G•�� ' �,yiA�` . Ca.ti� ENGINEER INFORMATION: Name: C�R�-�T�A:� �,c��--t�J�rt'IAorF= _ � �i(:� �TR�--�c.{��- /N�. Phone: , � , �' - � � Address: `-f� C1xJxIA�.:..� �fu� 5�� , `a��-rza '�'� City: ��. l�4�,L ZIP: �ja/c� Email: �t�l ��r�A,vSC ,9��.��5�'Q��c-r��r�.sc Fax: d y. PROJECT INFORMATION: 1. Pool! Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? ��: X �"�Z feet 2. Heated? yes ❑ no ❑Above ground ❑yes �'ino Height ' , �Single Family i 3. Excavated materials will be: ❑ Multiple Family!Condo �In-ground 'A building permit is required ' ❑ removed from site for any wall 4-feet or greater in i ; ❑ Public � used on site ❑ Other(specify) height measured from the � ❑ Other (specify) ❑ Commercial bottom of the footing to the top ' Total Cubic Yards ❑ Industrial of the wall, even if it replaces � 6.Sewage Disposal& an existing wall � ""Any earth movement may require I ❑ Other (specify) Water Supply Tiered walls are considered MCWD review and permits. � ,y one wall unless they are '. Minnehaha Creek Watershed District(MCWD) � LrJ PubliC Sewef 15320 Minnetonka Blvd separated by twice the height Minnetonka. MN 553a5 ❑ Private Sewer of the higher wall Phone: 952-471-0590 ❑ Public Water Fax: 952-471-0682 4w✓v�n�innebahacr2eK.or � Pfivate Well Estimated Construction Value $ ��,��(` Packet Last Updafed: August 2015 Page 22 .i� REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable � ❑ Buildin Permit Escrow A reement and Fees �1 ❑ Plan Review Fee ❑ Com leted A plication Form ❑ Proposed Pool or Hot Tub Plans—2 sets, full-size, to scale � ❑ Survey—2 full size, to scale (meetin ALL survey requirements) ❑ � Hardcover Information ❑ I� Septic S stem Certification �7 ❑ Minnehaha Creek Watershed District (MCWD) Permit or documentation from MCWD statin no ermit is re uired ❑ Landscape Walls and/or Retainin Wall Plans ❑ � Stormwater Pollution Prevention Plan �1 ❑ Data Privac Advisor Form ❑ ❑ APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Planning & Building Departments; i ' • Understands, if applicable, an as-built survey and as-built hardcover cover calculations, are required to be submitted after the project is complete( including final grading and landscaping)prior to refunding the escrow; • 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; ' • 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 permit may not be issued. ApplicanYs Signature: Date: 2/ �Jr(G Owner'sSignature ��,`Z.�()(�� I �r S�/�� Date: �-1/ /��O Packet Last Updated: August 2015 Page 23 7 � � • ♦ � ♦ � � 1 � � • � emo To: Finance Department From: Christine Mattson, Planning Assistant f Jv ` ' CC: Street File ` Date: August 3, 2016 G/L: 101-22205 Re: Escrow Refund Permit#2016-00439 pertaining to 1050 Edgewood Hills has been voided. Please refund the advance plan review of$670.23 to the applicant, Streeter&Associates. The following is attached: • Copy of cash register receipt showing escrow amount received Mail to: Streeter&Associates 18312 Minnetonka Blvd Wayzata, MN 55391 w:�,street files\edgewood hills road�1050�adv plan review refund 2016-00439.docx � '� CITY OF ORONO �kZO 16 - 00438 * 2750 KELLEY PARKWAY DATE ISSUED: OS/02/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1050 EDGEWOOD HILLS RD PIN : 02-117-23-13-0003 LEGAL DESC : REG. LAND SURVEY NO. 1098 : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 90,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$90,000 TYPE OF PERMIT THIS PAYMENT IS FOR: IN GROUND POOL PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00439 APPLICANT ADVANCED PLAN REVIEW 670.23 TOTAL 670.23 STREETER&ASSOCIATES Payment(s) 18312 MINNETONKA BLVD CREDIT CARD 5001 670.23 WAYZATA,MN 55391 (612)449-9448 Minnesota State License#: BUIL-1380 OWNER STEINER, BARBARA 1050 EDGEWOOD HILLS RD WAYZATA,MN 55391- 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 sepazate 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