HomeMy WebLinkAbout2004-P07811 - sewer/water connect 'IT OF OR N PERMIT
Y O O
0 Kelley Parkway- PO Box 66 Permit Number: Po�si i
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: si9�2ooa
SITE ADDRESS: 2484 Sandstone La
Long Lake,MN 55356
PID: 33-118-23-11-0024
DESCRIPTION:
Proposed Use: Residenrial
Permit Class: General
Pemut Type: Sewer and Water Pernut
Pemut Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Water&Sewer OWNER: Dahlstrom Development LLC
6501 County Rd 15 7745 Polaris 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 ED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Anplicant 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
(Updated 1/5/04)
C�rY OF ORONO APPLICATION FOR UTILITY PERMITS
Bc�66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORMATION
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 pernut card is available on the job site.
5. Utility coruiection pernuts may be issued to licensed contractors only.
G. 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 without express approval of the Public Works Department. Issuance of a pemut 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: ��� C (� S�'I_dn �� ,
Occupancy Type: Residential Commercial
Owner's Name: �'��,,� "r�rr�„�� ��f��M►z� Phone Number:
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Mailing Add►•ess: City: Zip:
Contractor's Name: �,}P s��l/� S�� Phone Number: S� � -<<ys`"�
Mailiug Address: �SJ� ��,?. r�c�. i� City: �pw� _ Zip: �,�-3�<�
PERMIT TYPE [.�Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge inust 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
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WATER METERS must 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 minimuin 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 Surcharee $ .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 an ,c ect.
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Signature of Applicant: � � Date: � ✓ �� �
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� DATE TIME �
CITY OF ORONO CALLED IN
INSPECTION N TICE SCHEDULED 'LD-�� �
PERMIT NO. ��/ COMPLETED
ADDRESS ZTtS�7 � �-�
OWNER CONTR.`��� -S�
TELEPHONENO. p$2' ���- �lo�o
� DESCRIPTION. ���� ��r�-r�C �� �
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
� 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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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WlLL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContracto e:
Inspector.
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