HomeMy WebLinkAbout2015-00565 - advance plan review fee CITY OF ORONO * Z 0 1 S — 0 0 5 6 5 *
2750 KELLEY PARKWAY DATE ISSUED: OS/1 U2015
. � '` ORONO, MN 55356—
952 249-4600 FAX: 952 249-4616
ADDRESS : 517 FERNDALE RD N
PIN : 36-ll 8-23-14-0007
LEGAL DESC : LJNPLATTED 36 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
COI�TSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 15,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$15,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: IN GROUND POOL
PERMIT#TH[S PRE-PAYMENT IS TIED TO:2015-00564
APPLICA1vT ADVANCED PLAN REVIEW 181.23
TOTAL 181.23
PERFORMANCE POOL& SPA Payment(s)
2405 ANNAPOLIS CHECK 1328 181.23
PLYMOUTH,MN 55441-
(651)731-3940
OWNER i;i ry or Ur�ono
�150 Keiley�Pa�kway g�2-249-4EU0
BURNET, RALPH& PEGGY Orono MN �53�6
392 FERNDALE RD Receipt No: ;3.013364 May 11. 2U15
WAYZATA, MN 55391-
Performance Pool & Spa
Previ�us Balance: •���
AGREEMENT AND SWORN STATEMENT F'ermits 18� �•3
2015-OU565 517 Ferndale
The work for which this permit is issued shall be performed according to Rd N
the approved plans and specifications,applicable City approvals,and the 101-34410
Plan Check/Site Exam Fees _
State Building Code. This permit is for only the work described and does 181.23
not grant permission for additional or related work which requires separate TDta 1: _______________
permits. All provisions of laws and ordinances goveming this type of work � �
shall be com ied with whether or not s ecified herein.This ermit will CheGk ,
expire and become null and void if conPtruction authorized p not Check No: 1328 181.�_3
commenced within 180 da s of the date of issuance,or if construction is Pdyor'
sus ended for a eriod of 80 da s at an time after work has commenced. f'�r f���r�t��O1��� Pool & Spa ��� ��
p p Y Y lotal ApF�lie��l: _
The applicant is cesponsible for assuring all requiced inspections are
requested in conformance with the State Building Code.This permit may be
revok at ime o ue cause. ��
L�
�� �
� S�� 1�� L.�—�.� �`l'V`�-`b � � �- ((� --
Applicant Permitee Signature � Date Issued By Signature Date
..-�----,
-��
� .
. City of Orono
Building Permit Appiication
for �a Swimming Pool
ll�ailing Add�ss: �-�( c-._ S
�O�O PO Box 66 Fermit number. , _
Crystal Bay, MN 55323-0�6 Date received: —j�j
�
StreetAddress: � Received by: � ,,� y `�jZ
y�, � 2750 Kelley Pa y 2�J �5"�%'�(�i Pian review fee: . 2� ��
� � Orono, MN 55356 y
q'�f S H O�'`4• ---- ---=__...._
Totai Fee: -- ___
Main: 952-249-46Q0 Fax: 952-249�616 www.ci.orono.mn.us
7his application form must be completed in full and a11 required information must kre submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: � �-1 �'���L� �+ � L
CONTRACTOR/AP ICANTINFORMATI p
Name: ��.2�F���na���oo� �V�PA
State License# ��,r�5���,L-�� Expiration Date: �
Phone: (�,5 f) �`15- 3 9�1 O Fax: �� 1-$ 7�-
Address: .p Ci : -} ZIP: S
Contact Person: 1 ContacYs phone number 5- 9 c�
Email: � � �"A licant is: n r Homeowner �a►cie or,e
PROPERTY OWNER INFORMATION:
Name: ^h
Phone(day): Z, � -1 I
Mailing Address 1 �p Z�p: � ��
Email and/or Fax:
ENGtNEER INFORMATION:
Name:
Phone:
Address: City: Z1P•
Email: Fax: '
PROJECT lNFORMATION:
1.Pool Dimensions: 4.Accessory to: 5.Pool type: 7.Retaining Walls?
�� X �1 O feet (�Single Family ❑Above r ❑yes [�no Height
2.lieated? ❑Multiple Family/Corido �]o In-groun� *A building pertnit is required
�yes ❑no []public —'� for any wall o�er 4 feet in
fher(specify) height measured from the
3. Excavated materials will be: ❑Commercial 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 ❑�ther:(specify) Water Supply
Tiered walls are considered
❑Other:(specify) ❑Public Sewer one wall unless they are
separated by twice the height
' �Private Sewer of the higher wall.
�_Total Cubic Yards ❑Public Water
�ry�� Private Wetl
Estimated Construction Value $
Packet Las[Updated.� 0329/13
Page 19 of 21 "