HomeMy WebLinkAbout2007-P10687 - sewer/water disconnect , �-
PERMIT
Y �CITY OF ORONO
�750 Kelley Parkway- PO Box 66 Permit Number: P1o687
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-�600 Date Issued: 1/11/2007
SITE ADDRESS: 2216 Shadywood Rd Unit#
Wayzata,MN 55391
PID: 17-117-23-42-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Pernlit Permit Sub-type(s): Sewer&Water Disconnecti<
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 Sewer&Water OWNER: John J Henry III
6501 Co. Rd 15 2216 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.
� / � r � �
�-�._, � \ _ -� '��'--�-- �I
r' �
APPLICANT PERMI E SIGNATURE / SSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page I
e '
c
4
EOR CITY USE ONLY��1 j U���
�0� City of Ot'ono Date Received: . Permit# i"
P.O.Box 66
��; � 2750 Kelley Park�vay ❑In-House SAC Determination Form Completed
'�����. � Crystal Bay,MN 55323
��l a'�,,���i�}b�o` (952)249-4600 Approved By(If Required): /
'�rasxp4` �
CITY OF ORONO— S�WER & WATER/ GENER.AL PERMIT � '�(� � 5
(*no te:Some permi ts may r e quir e a p p r o v a l b y t h e B u i l d i n g O f t i c i a l a n d/o r P u b l i c W o r k s D e p a r t m e n t*)
(ALL PERMITS- �'iav be subicct to further review and mav not be issuecl when the apnlication is received)
GENERAL INFORMATION
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. Pernut cards will
be sent by rehirn mail�vithin 2 busuiess days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the peinut card is available on the job site.
5. Utility coimection pemzits may be issued to licensed conhactors only.
6. Contact the Public Works Department(952-249-4600)for utility shib as-built locarions.
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.
TYPE OF PERMIT
(Check All That APPlY)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑ Additionai Comiecrion ❑Re-Connection ❑Repairs �Disconnect
; ,
� �
Job Site/ O�mer I�-if'ormation:
Site Address: �` `� ��'�E �� ✓/�
Owner:� ��. �me� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
��S��ar���� �P�� J�i �'ti���� r�n�
Contractor: Contact Person:
Address: 1���� (,��,� �l� �� State License #:
City: ��Q�`�`", �lr� Zip: Exp�ration Date:
(�r� c�� �
Phone: � Alternate Phone:
►
�- ►
�
,::- {t ' , ',;�+� , DETERMININC��.ERIVIIT FEES; , `' � ,=- ,,', ,�°�
�. �
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit fvill not be issued)
�Sewer Connectio Disconnec /Repair($35.00/Per Stub) $
Pipe size in s; ial Schd 40 au tested; cast iron
�Water Connection/ isconnect Repair($35.00/Per Stub) $
Pipe size inc Schd 40 air tested; copper
1. SUBTOTAL of Pernut Requested: $
2. STATE SURCHA.RGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applicadons) $ 1.50
4. TOTAL PERMIT FEE(Add Liues 1-3 Above) $
ADDITIONAL INFORMATION—WATER METERS'
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate pernut.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigr►ed hereby applies to the City of Orono for issuance of a Utiliiy 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 teine ts made on this application are,true and conect.
�
� f��
Ap�licant: —�1 Date: �
�� DATE TIME ✓
CITY OF ORONO CALLED IN `���U
INSPECTION NO CE ja SCHEDULED f_I� �•���1
PERMIT NO. �U CL'v COMPLETED
ADDRESS .��_� l�^_��Ct��i.j�,✓�J4-7-� �
OWNER CONTR.^Z'J��; �t��-
TELEPHONE NO. ��y�l�-G �' l� ��� �� 7 �/
�
� DESCRIPTION ���;��� �- � C�-'o��'�.r� ���f c ��,�-� ���
tL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
ti
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q O5 FINAL 14 SEWER HOOK-UP 06 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 FOUNDAT�ON/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
W
a
J �� C.� � �
�O L^
� � ( Q�Q � � �'"LJ �l�Gi `
O
�
� �h SQ�� � � ��ti/
Q
�
2
W
�
W
�
�
� �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED !� ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-46QQ
OwnerlCont n site:
Inspector. �
White Copy/lnspector's File Canary Copy/Site Notice