HomeMy WebLinkAbout2005-P09479 - sewer/water connect � ` `= PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P09479
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
12/12/2005
SITE ADDRESS: 669 Sandstone Cir Unit#
Long Lake,MN 55356
P��� 33-118-23-11-0038
DESCRIPTION:
Proposed Use: Residentlal
Pernut Class: General
Pernut Type: Sewer and Water Pemut Pernvt Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC collected with building permit
FEE SUMMARY: Permit Fee: $ 70.00 vatuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water&Sewer OWNER: O.T.Development,LLC
775 Tower Drive 10300 lOth Avenue N#101
Hamel,MN 55340 Plymouth,MN 55441
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
LIC T PE EE SIGNA SUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
,��� City of OrOnO Date Received: Permit# '
O.. O P•O.Box 6G
�;t 27�0 Kelley Parkway ❑in-House SAC Determination Forrrt Completed
,��5�y�;" � Crystal Bay,MN 55323
��^ 'r�,}��r��.�o� (952)249-4600 Approved By(If Required):
�$sao$
CITY OF ORONO—SEWER & WATER/ GENERAL PERMIT
(*Note:Some pennits may require approval by the Building Official and/or Public Works Department*)
(.4LL PERMITS- Mav be subiect to further revie�v and mav not be issued when the lpnlication is reccived)
GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the peinut card is available on the job site.
5. Urility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600, 24+hour notice required.
TYPE OF PERMIT
(Check All That Apply)
esidential(May Require Approval) ❑ Commercial(Approval Required)
�Iew Connection ❑Additional Coimection ❑ Re-Connection ❑ Repairs ❑ Disconnect
Job Site/ Owner Information:
Site Address: � ✓ ��s � �. r 2
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
� r
Contractor: a � Contact Person: `
Address: � ��ta w{���� State License #:
� D 'l
City: �� Zip!;, 7 Expiration Date: / � ?j r (/ �
Phone: �j�,,-g r y l� �--�/� Alternate Phone7` � b 7� �
DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid, a sewer connection permit will not be issued)
�Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size Ir inches; material Schd 40 air tested; cast iron
�Water Conn ction/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pemut.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are, true and correct.
. �
Applican Date: � �
�
� ;
'
��LU� � AT TIME �
CITY OF ORONO CALLED IN 1� ��
INSPECTION NO � SCHEDULED '
PERMIT N0. COMPLETED �Z, '�j ;%'�v
ADDRESS l l/�� d�k�Z�'�/J V u/`� CJV
OWNER CONTR. �`'D�
TELEPHONE NO. � � a � � 9 D � ��
� DESCRIPTION � � �
t� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/G ING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h
Q 03 INSULATION 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z 04 WALL BD. 12�1VATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
�
W
0.
� � • f 1 %`� '��S"T" l� �
o �
a
�
0
�
W
�
Q
�
2
W
�
W
�
�
�
d
� �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CAIL FOR REfNSPECTION TEMPORARY
V BEFORECQVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WFLL RETURN
❑STOP ORDEFi POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on s'te:
Inspector.
White Copyllnspector's File Canary CopylSite Notice