HomeMy WebLinkAbout2004-P07676 - sewer/water connect PERMIT
C I TY Q� O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07676
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: �i2i2oo4
SITE ADDRESS: 718 Sandstone Cr
Long Lake,MN 55356
PID: 33-118-23-11-0051
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Sub-type(s): Sewer&Water Connections
Pernut Type: Sewer and Water Pernut
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#P07642-06/28/04
FEE SUMMARY: Pernut Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Water&Sewer OWNER: 7ohn Terrance Homes, LLC
6501 County Rd 15 8266 Xene Lane
Mound,MN 55364 Maple Grove,MN 55311
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.
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APPLICANT PERMITEE SIGNATURE ISSUED Y SIGNATURE
Copies: 1-File(Si�nitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
� (Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (27501�elley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORNIATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day
the application is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility comiection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Deparnnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN witl�out express approval of the Public Works Department. Issuance of a pernut 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.
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JOB SITE ADDRESS: �� ��`�� 5���'+P �IJ'G[�
Occupancy Type: Residential Commercial
Owner's Name:��_��/'P��c� ���z+,�� Phone Number:
Mailing Address: City: Zip:
Contractor's Name: ..,;��rov� � S w Phone Number: �'�, �!7-��yrS'r'
Mailing Address: �o( C�7. �' , l5 City: ;,�� Zip: 5�36�
PERMIT TYPE �Connections ❑Repairs ❑Discorulect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge rnust accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material� Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size �? � inches; material � copper; other
WATER METERS must be picked up and paid for at City Hall.
Water metei•s must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pemut must be
included for each well,sewer and water connection pernut requested.
3. Posta�e & Handling (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
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 complete, true orrect.
Signature of Applicant: Date: � O
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DATE TIME
CITY OF ORONO CALLED IN '"�^d
INSPECTION NOTICE SCHEDULED � �� �.
PERMIT NO._�"�.�v 7� COMPLETED
ADDRESS��L ��� K� C`uv
OWNER�l� T��_�u.t l�� CONTR. �11�,1.�21L�c.- GL��r'S
TELEPHONE NO. ���'�' �7� — ��� �
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOO NER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. ATER HOOK-UP 17 SITE INSPECTION
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Q OS FINAL 14 SEWER HOOK- 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTA�L. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINA� 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnerlContractor on '
Inspector.
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