HomeMy WebLinkAbout2004-P08019 - sewer/water disconnect PERMIT
CITY� OF ORONO Permit ►vumber:
2750 Kelley Parkway- PO Box 66 P08019
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: io�ii2ooa
SITE ADDRESS: 1690 Shadywood Rd
Wayzata,MN 55391
PID: i�-ii�-23-2i-ooi�
DESCRIPTIOI�:
Proposed Use: Residenrial
Permit Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer&Water Disconnectic
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 70.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: OWNER: James&Darcey Loffler
1690 Shadywood Rd
Wayzata,MN 55391
TT�UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE SSUED BY SIGNAT(IRE
Copies: 1-File(SiQnitures Required), 1-Arn�licant, 1-Monthlv Renorts. 1-Assessin¢, 1-Finance Page 1
(Updated 1/5/04)
CITY O�ORONO APPLICATION FOR UTILITY PERMITS
Box.d6 (2750 Kelley Parkway) SEWER/WATER & SAC
Crystal Bay, MN 55323
GENERAL INFORNIATION
1. You may apply for utility pennits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pemut 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. Wark must not begin unless the peinut card is available on the job site.
5. Utility comtection 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 Deparhnent. Issuance of a pernut does not grant tl�is approval.
7. All work must be done in accordance with State Code requirements.
8. All work nnist be inspected before it is covered. Call(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: /��� �� -����lf ���`'�
Occupancy Type: /� Residential Commerciat
Owner's Name: "�..� �v�l=����- Phone Number:
Mailing Address: _ �,-� �-- City: Zip:
Conh-actor s Name: C ��•c j?c�-y�'-- .���
r �/,��l.�rr�� �c.,:ij,—���-c,-,,,,� Phone Number•
Mailing Address: 9�%=s— �:rf i�( �s— City:/��,��`-.�i.:�Zip: ��_;5- �
PERMIT TYPE ❑ Coiuiections ❑Repairs Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge inust accompany all sewer pennit applications unless prepaid.
(If not p►•epaid, a sewer connection will not be issued)
Munieipal Sewer CQnnection/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.3� inches; material�opper; 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 tanlcs = 75'
REQUIRED setback froin sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above pennit 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 perniit requested.
3. Posta�e & Handlin� (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.
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Signature of Applicant: �rv -�~� Date: _/�S/
DATE TIME v
CITY OF ORONO CALLED IN
INSPECTION NQTI� a SCHEDULED �D�' -
PERMIT NO. /�d � I COMPLETED I �"�4
ADDRESS d �
OWNER ONTR.
TELEPHONE NO.
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� DESCRIPTION �S ����-Q �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILUNG
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 OS 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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:�ES_NO
v�i COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED ���� 1 ❑ PROJECT COMPLETE
W O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR 1MLL RETURN ❑ CITATION ISSUED
❑STOP OFiDER POSTED.CALL INSPECTOR
� INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor on site:
Inspector.
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