HomeMy WebLinkAbout2011-01127 - adv plan review CITY OF ORONO PERMIT NO.: 20��-0��2�
� • 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �SsuEn: 09/27/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 3380 GRAHAM HILL RD
PIN : OS-117-23-11-0013
LEGAL DESC : GRAHAM HILL PRESERVE 2
: LOT 5 BLOCK 2
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 40,000.00
APPLICANT ADVANCED PLAN REVIEW 373.26
DOLPHIN POOL& SPA, INC. TOTAL 373.26
3405 N HWY 169
PLYMOUTH, MN 55441-
(612)542-9000
Minnesota State License#: 20266452
OWNER
RUDOW, DAVID& LESLIE
3380 GRAHAM H(LL RD
ORONO, MN 55356-
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 E3uilding 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 specitied hcrcin.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days oP the date of issuance,or if construction is
suspcnded for a period of 180 days at any°time atter work has commenced.
"I�he 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 caus . n
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Applicant Permitee Si ature Date Issued By Signature Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE.
� . . City of Orono
Building Permit Application
for a Swimming Pool
,O; Mailing Address: � Q J� -�����
\ PO Box 66 Permit number: , �
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/ Q . Q�� Crystal Bay, MN 55323-0066 Date received: �- �- / /
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I �''` �' � Received b ���
,� '� ��.�.2 a, Street Address:
Y�
�'�,c, �', '" ��' 2750 Kelley Parkway :�?C!!-•�C(!�� Plan review fee: `� �� 7�' . `G'�
� � ���v Orono, MN 55356
�kESHo4
` � 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 applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: ����) `��,.�� ��t� �
c,r?/�
CONTRACTOR/APPLICANT INFORMATION:
Name: 1�i�if�� ..���=J� ..._ -5-i,�i7
State License# �c;.�,��s� Expiration Date: y�� -,/j
Phone: '7�,� ��'� -ioi�:� Fax: '?�3 __�;iJ -�lc�y
Address: -..,i, ,�✓ / t' Cit ����>,�>c�f�✓ ZIP: -�-i
Contact Person: /- _��.,.,- ContacYs phone number
Email Applicant is: Contractor Homeowner (Circ�e One)
PROPERTY OWNER�D�FsORMATION:
Name: __�{1�cft � J�fN�it� �c..�-c�oLv
Phone (day): 9' --��y - 4v
Mailing Address: �3�� �.�,am,f�cC '�� ZIP:
Email and/or Fax
ENGINEER INFORMATION:
Name:
Phone:
Address: City: ZIP:
Email Fax:
PROJECT INFORMATION:
1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal &
��� X y� feet Water Supply
�"5ingle Family ❑ Above ground
❑ Public Sewer
2. Heated? ❑ Multiple Family/Condo (�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
� ❑ Other. (specify) �
❑ used on site
❑ yes �ho
❑ Other: (specify)
Height
Total Cubic Yards
Estimated Construction Valuation $ 7�, �� '
Last Updated: 10/28/2010
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