HomeMy WebLinkAbout2004-P08280 - sewer/water connect PERMIT
CITY C?F ORONO
2750 K,ciley Parkway- PO Box 66 Permit Number: Pos2so
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: i2iioi2oo4
SITE ADDRESS: 1690 Shadywood Rd
Wayzata,MN 55391
PID: i�-ii�-23-2i-ooi�
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernut Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
SAC Grandfathered In#1552-07/17/67
FEE SUMMARY: Pernut Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Widmer Construction LLC OWNER: 7ames&Darcey Loffler
9455 County Rd. 15 1690 Shadywood Rd
Maple Plain,MN 55359 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 ISS[JED Y SIGNATURE
Cooies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports, 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 INFORMATION
1. You may apply for utility pernvts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee sho�m 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 pemut card is available on the job site.
5. Utility coiuiection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility shib 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 nuist be done in accordance with State Code requiremeuts.
8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: ���1' ����9c� �--%G�� ���-%���
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Occupancy Type: �f,/Residential Commercial
Owner's Name: ��� ��, �',=/E�- - Phone Number:
Mailing Address: City: Zip:
Co�rt�•actoi-'s Name: �,�/.ry � ��r�'%�I/G�,>,���',G'�Plione Number: �-SS-�- - .�o G—?
Maili�g Add►•ess: �"yS��� .���/,S— City;�?���/� ��«Zip: -s-s�-s f
PERMIT TYPE � Connections ❑Repairs ❑Disco�lnect (Check One)
SAC Cl�arge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer pennit 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 C��nection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material copper; �11er
WATER METERS nn►st be picked up and paid for at City Hall.
Wate►• 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 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 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 and correct.
Signature of Applicant:__ �� �a�r--�����-. Date: �2%'� —.�'��
�� � DATE TIME V
CITY OF ORONO CALLED IN 1 I(� C�
INSPECTION N TICE SCHEDULED .������ . � �
PERMIT NO. COMPLETED
ADDRESS
OWNER ;CONTR. /,/ ,� �
TELEPHONE NO. �� � � c�
� DESCRIPTION ��/'ti
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEP IC 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� ORK SATISFACTORY: OCEED 1 ��'� f l PROJECT COMPLETE
❑CORRECT WORK&PROCEED V f 1 ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (J52� 249-4600
OwnerlContrac r e:
Inspector.
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