HomeMy WebLinkAbout2017-00156 - adv plan review - pool CITY OF ORONO * Z 0 1 7 — PJ PJ 1 5 6 *
, 2750 KELLEY PARKWAY DATE ISSUED: 02/2U2017
� ORONO, MN 55356-
' (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3188 NORTH SHORE DR
PIIY : 09-117-23-32-0011
LEGAL DESC : CRYSTAL BAY PARK
: LOT 000 BLOCK 004
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REV[EW
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#THIS PRE-PAYMENT IS TIED TO:2017-00155
APPLICANT ADVANCED PLAN REVIEW 18120
TOTAL 1 S 1.20
PERFORMANCE POOL&SPA Payment(s)
2405 ANNAPOLIS CHECK 1559 181.20
PLYMOUTH, MN 55441-
(763)270-1180
OWNER
RUCINSKI, MICHEAL& HOLLY
3188 NORTH SHORE DR
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 separate
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 afrer 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
revok a i for due cause.
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Applicant Permitee Signa re Date Issued By Signature Date
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� City of Orono
Buiiding Permit Application
for Swimming Pools and Hot Tubs
�O� Mailing Address: Permit number. ��7� /
O PO Box 66
Crystal Bay, MN 55323-0066 Date receive8: Z �- /-1
,� � St►Bet Address: �J� Reaeived by: ��Z.Z� \
y�, `� 2750 Kelley Park OC ��y���: �
t,�k�sHo4�, Orono, MN 55356 � ����
o ee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required inf�rmation must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATI�N:
Job Site Address: ������T1-}��-}d(�C/.��
CONTRACTOR PLICANT INFO ATION:
Name: �1`1
State License# � Expiratfon Date:
Phone: 1 � d Fax: (�5� '7 Z,
Address: Cit : ZIP:
Contact Person: U- Contact's phone numbe (��;�-77�,��n
Email: , licant is: � ntra -�lomeowner �ci�a o��
PROPERTY OWNER NFORMATION:
Name: �I� �- � 51�--
Phone(day): ..
Mailing Address: Z�p;
Email andbr Fau:
ENGINEER INFORMATION:
Name:
Phone:
Address: City: ZIP:
Email: Fax:
P CT INFORMATION:
.Pool/ H TXb Di��ons; �t 4.Accessory to; 5.Type: 7.Retaining Walls? �
1►
2.Heated? y�ns no �Single Family ❑Above ground '�yes ❑no Heigh� I� *
3. Excavated maberials will be: ❑Multiple Family/Condo In round 'A buildln
removed from site � '� 9 Pertnit is required
❑Pubfic for any wall 4feet or greater in
used on site ❑Other(specify) height measured from the
Other:(specity) ❑Commercial bottom of the foofing to the top
Total Cubic Yards ❑Industrial of the wall, even if it replaces
6.Sewage Disposal8 an existing wall.
**'My earth movement may require ❑��er:(speciTy) Waber Supply
Tiered walls are considered
MCWD revlew and pennits. one wall unless they are
Minnehaha Creek Watershed District(MCWD) �Public Sewer �parated by twice the height
15320 Minnetonka Blvd
Minnetonka,MN 55345 ❑Private Sewer of the higher wall.
Phone: 952-471-0590 ❑Public Water
Fax: 952-4T1-0682
www.minneh hacreek.o ❑Private Well
Estimated Construction Value S �
Packet Last Updated: April 2016
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