HomeMy WebLinkAbout2006-P09878 - sewer connect PERMIT
CITY OF ORONO
2750 Ke��y Parkway- PO Box 66 Permit Number: P09878
Crys�al Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
5/17/2006
SITE ADDRESS: 2175 Shevlin Dr Unit#
Wayzata,MN 55391
P��� 03-117-23-34-0007
DESCRIPTION:
Proposed Usc: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: � 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,550.00
TOTAL FEE: $ 1,585.50
APPLICANT: Groth Water&Sewer OWNER: Patricia Naegele&Matthew Clements
775 Tower Drive 2175 Shevlin Dr
Hamel,MN 55340 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: ]-File(Sigriatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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' EOR CITY USE ONLY
��� City of Orono DateReceived: Yermit#
P.O.Box 66
��t,, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
'�j����2 � Crystal I3ay,MN 55323
s� y..�'��..o` (952)2�9-4G00 Approved By(If Required):
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CITY OF ORONO— SEWER& WATER/ GENERAL PEI2MIT
(*Note Some permits may require approval by the Building Oflicial and/or Public Works Department*)
(Af L PFRMITS- Nlav be subiect to further revierv and mav not be issued when the apn��cation is received)
GENERAL INFORMATION
1. You may apply for utility pennits 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 rehirn mail within 2 business days.
3. Permits are not valid until you recei��e a permit card.
4. Work must not begin unless the pennit card is available on the job site.
5. Utility co�mection permits may be issued to licensed conh•actors only.
6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations.
DO NOT EXCAVATE IN ANY STREET ANll DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pernut 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 ❑Additional Comiection ❑ Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
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Site Address: �� � � `��'l� U l ' ''I ��
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Owner:yfl- �' i � ? Mailing Address: ���'J ��'�'
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City: � o �q�. Zip:
Home Phone: ��� ���L' �� �3 7 Alternate Phone:
Contractor Information:
Contractor: v(b't'� .�.e.�:,�ra l.l)�e V Contact Person: Y f
Address: �7�������` � � State License #: �I Z2
City: .� �— Zip:S�J Expiration Date: ' L �� � �
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Phone: 7�, � `�7� � 7/ 2_. Alternat� Phone: L 5°
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DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Char�e must accoinpany all sewer pernut applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued) �
�.Sewe�-Con �ction/ isconnect/Repair($35.00/Per Stub) $ �� �
Pipe s' � mches;material Qt)( , Schd 40 air tested; cast iron
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❑Water Connection/llisconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. T01'AL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL 1NFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
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 th �d]7'statements made on this application are,true and correct.
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Applicant: �` �� Date: �
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DATE TIME
CITY OF ORONO CALLED IN ����'-'C«`� �►� �'(��
INSPECTION NO ICE SCHEDULED --.��-�� 1 �•��
PERMIT NO. O R g� COMPLETED r'�''+ � • L�
ADDRESS � l -1 S SI/1Q u L I 1� I��
OWNER CONTR. '
TELEPHONE NO. ,� � �- �-� �� " � o� �O�
C�,`..� C �� C��-f�\ �`Yl
� DESCRIPTION YY� - �5�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUM8ING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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��/ORK SATISFACTORY:PROCEED ❑ PROJ ECT COMPLETE
W ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL 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.
Call for the next inspection 24 hours in advance. �952� 24Q-46QQ
OwnerlContractor on si e:
Inspector. o,� �/ o .
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