HomeMy WebLinkAbout2004-P08007 - sewer repair . - -�.,.
CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: PoBoo�
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Pernut
(952) 249-4600 Date Issued: 9/29/2004
SITE ADDRESS: 1300 Shoreline Dr
Wayzata,MN 55391
P I D: 02-117-23-31-0018
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer Repair
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Genes Water&Sewer OWNER: �chard Brown
P.O.Box 18526 1300 Shoreline Dr
4360 Lyndale Ave N Wayzata,MN 55391
Minneapolis,MN 55418
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENT'S SPECIFIED
AND AGREES TO DO ALL W CT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND STATE OF
MINNESOTA BUILDING DE REQUI ENTS.
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CAN PERM SIGNATURE ISSt1ED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-At�nlicant, 1-Monthlv Renorts, 1-Assessin¢, 1-Finance Page 1
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(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 pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee sho�vn below. Pernut cards will be sent by retum mail the same day
the application is received.
3. Permits are not valid until��ou 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 Departnient(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without e�press approval of the Public Works Deparhnent. Issuance of a pemut does not grant this approval.
7. All work nuist Ue done in accordance with State Code requirements.
S. All�vork must be inspected before it is covered. Call(952)249-4600, 24 hour notice required.
JOB SITE ADDRESS: /�fl� 5'��%e ��,�� ��•
Occupancy Type: � Residential Commercial
Owner's Name: J�`�l,q.-C (3 v�.�..=� Phone Number: ��� ' �$�- 3717
Mailing Address: �-,-,,,,e- City: �1 S Zip: �-s�'y�'t-
Conh•actor's Name: C�en��s c�ra'f-s- r .a�..:_-�-�— Phone Numbe►-:
Mailing Address: Y 3 �� ( ti.,.�R�{ i��- �, City: �.�(� Zip:
PERMIT TYPE ❑ Comlections �Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge inust accompan.y all sewer pennit applications unless prepaid.
(If not preplid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnec epa' ($35.00 per stub) $
pipe size y" inches; material - Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water mete�-s 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 from sewer liiie=20'
PERMIT FEE CALCULATION
1. Subtotal of above pennit requested $
2. State SurcharQe $ .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 & 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 gulations of the State of Minnesota, and certifies that all statements
made on this application are complete, t arid ect.
Signature of Applicant � `�� Date: � Z�?- � �
V
DATE TIME
CITY OF ORONO CALLED IN '�� �tf
INSPECTION NOTICE SCHEDULED /� E{
PERMIT NO. {�f)ROD7 COMPLETED
ADDRESS / 3CX� �h vre i i .� n,2 =
OWNER CONTR.�PS �Et.JN.r
TELEPHONE N0.
� DESCRIPTION � Z�l�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/G ADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVA�
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 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
Owner/Contr site:
Inspector.
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