HomeMy WebLinkAbout2004-P07390 - sewer repair _ � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�390
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: a�i3i2oo4
SITE ADDRESS: 1635 Shadywood Rd
WAYZATA,MN 55391
P I D: 1�-11�-23-22-0012
DESCRI PTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Pernut Sub-type(s): Sewer Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: �'�'estonka Water&Sewer OWNER: �LPH E MILLER ETAL
6501 County Rd 15 1635 SHADYWOOD RD
Mound,MN 55364 WAYZATA MN 55391
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 BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessine, 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 INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day
the appiicarion 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 connection permits may be issued to licensed contractors only.
6. Contact the Public Warks Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCA�':1TE IN AI�'Y STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Deparm�ent. 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.
JOB SITE ADDRESS: ` b�� ���4�" w c�o ��
Occupancy Type: x Residential Commercial
Owner's Name: � �, ���/�� ? Phone Number:
Mailing Address: City: _ Zip:
Contractor's Name: ��'�,l! �c,� Phone Number: �� �-l7� -
Mailing Address: �sv� C�. ��� . ��`� City: Zip:
PERMIT TYPE ❑ Connections �epairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) S (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/Repair ($35.00 per stub) S
pipe size L inches; material� Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair($35.00 per stub) S
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
l. Subtotal of above permit requested S
2. State Surchar�e S .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Postage & Handling(Only mail-in applications) S 1.50 (Mail In Onlv)
4. TOTAL PERMIT FEE (add lines 1-3 above) S
The undersigned hereby applies to the City of Orono for issuance of a litility Permit, agrees to do all wor� 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 orre .
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Signature of Applicant: Date: �� �
DATE TIME
V
CITY OF ORONO CALLED IN I3-0 -��
INSPECTION NO CE SCHEDULED
PERMIT NO. c MPLETED
ADDRESS ��_�� cS� Gc�U ��l�.
OWNER CONTR. l�-- C�-
TELEPHONE N0. `�•�� �?� ��sCl
� DESCRIPTION c__�Q..(�.��X '�Z�G<-� (-
� 01 FOOTING 11 MECHANICAL I 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 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 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO e�}
� COMMENTS: �l
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� ,�WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor it .
Inspector. ��
White Copy/lnspector's File Canary Copy/Site Notice