HomeMy WebLinkAbout2004-P08065 - sewer/water connect CITY OF ORONO PERMIT
2750 K�i,ley'`�'arkway - PO Box 66 Permit Number: Poso6s
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: ioi12i2oo4
SITE ADDRESS: 2510 Sandstone La
Long I.alce,MN 55356 �
PID: 33-118-23-11-0021
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connecrions
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
SAC Paid-P07603 -08/09/04
FEE SUMMARY: Permit Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: John Terrance Homes,LLC OWNER: Dahlstrom Development LLC
8266 Xene Lane 7745 Polaris Lane
Maple Grove,MN 55311 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 BUILDIN REQUIREMENTS.
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LICANT PERMITEE SI ATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Reouired). 1-Applicant, 1-Monthlv Reoorts, 1-Assessing, 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 pemuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown belo�v. Pernut cards will be sent by rehtrn 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 pemut 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)forutility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without e�:press approval of the Public Works Departinent. 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: �` � �� �����'� �� '
Occupancy Type: �( Residential Commercial
Owner's Name: Phone Number:
Mailing Address: City: Zip:
Cont►-actor's Name: '�(�I�.v�,�-�✓VC�v`C�e t�tl�S Phone Number: '�
Mailing Address: ���UV�.b City: (��(��(� Zip: �G
PERMIT TYPE Comlections ❑Re airs �
� p ❑Discomiect (Check One) `p
SAC Charge (2003 rate $1,350.00) $ (Set Rate) b�
Sac Charge must accompany all sewer pennit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued) ��
. ,JL
Municip�tl Sewer Connection/Disconnect/Repair ($35.00 per stub) $ �
pipe size L���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 tanlcs = 75'
REQUIRED setback from sewer line =20'
PERMIT FEE CALCULATION
1. Subtotal of above pennit requested $
2. State Surcharee $ .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. 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 and correct.
Signature of Applicant: 1�-�-�-V Date: �"� �2 I � I
V
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO IC SCHEDULED
PERMITNO. ����5— , COMPLEfED �0-�4-a`�
ADDRESS �S 10 SanC�S'ro�� I�qc��
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION �e-�r �"' �''^�� (C'r�rl(,.J�;'Cl�
� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHOFIE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL �^ 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOp TO MEET YOU:�\YES_NO
y COMMENTS:
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W� ❑WORK SATISFACTORY:PROCEED �ROJECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-460�
OwnerlC actor on site:
Inspector.
White Copyllnspector's File Canary CopylSNe Notice