HomeMy WebLinkAbout2004-P07675 - sewer/water connect ITIr� � R N PERMIT
C O O O O Permit Number:
2750 Kelley Parkway - PO Box 66 Po�6�s
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: ��2�2004
SITE ADDRESS: 720 Sandstone Cr
I,ong I,a1ce,MN 55356
PID: 33-118-23-11-0052
DESCRIPTION:
Proposed Use: Residential
Pernrit Class: General
Permit T}�pe: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: �'estonka Water&Sewer OWNER: John 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 SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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PLICANT PERMITEE SIGNAT E ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
(Updated 1/5/04)
CITY OF�ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley 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 retum 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 pernut card is available on the job site.
5. Utility comiection pernuts 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 Deparnnent. 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.
JOB SITE ADDRESS: �`��S�0� C—�✓��`P
Occupancy Type: �Residential Commercial
Owner's Name:�^�.��P�r�.t�x� /{�,.t�S Phone Number:
Mailing Address: City: Zip:
Contractor's Name: �GS1�'n1Ec S `,J Phone Number: �i5�� �'7,� - y�t�'`�
Mailiug Address: 65'a c'�- �� rz City: ,. Zip: �s 3�y
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Re�air ($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 inust be picked up and paid for at City Hall.
Water meters 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 pernut must be
included for each well,sewer and water connection pernut requested.
3. Postage &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.
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Signature of Applicant: Date: �
DATE TIME
CITY OF ORONO ca�/���iN �] -b-��
INSPECTION N TICE SCWEDULED Z� �.�
PERMIT NO. ?��S COMPLETED
ADDRESS � Ld /����� C�C-�
OWNER�Z��l u•����u �ru� CONTR.,�'.Le.��z���� G�'��S
TELEPHONE NO. f-��� `f7L— ��/G �
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� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 RNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP � 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 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 CI PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED c ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR '-�CITATION ISSUED
❑ INSPECTfON REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContrac on ite:
Inspector_
White Copyllnspector's File Canary Copy/Site Notice