HomeMy WebLinkAbout2006-P10629 - sewer connect � �'°� PERMIT
CITY OF ORONO permit Number:
2750 Kelley Parkway- PO Box 66 P10629
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued: 12/12/2006
SITE ADDRESS: 1860 Shoreline Dr Unit#
Wayzata,MN 55391
PID: 10-117-23-42-0004
DESCRIPTION:
Proposed Use: 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: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPUCANT: Westonka Sewer&Water OWNER: Troy Broitzman
6501 Co.Rd 15 1860 Shoreline Dr
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.
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LICANT PERMITEE SIGNATURE SSUEU BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
t �
FOR CITY USE ONLY
��� City of Ot'ono DateReceived: _ Per!nit#
P.O.Box 66
�y�,; � 2750 Kelley Parhway ❑In-House SAC Determination Form Completed
a �f����� �* Crystal Bay,MN 55323
�`�t��'ch!W'w°~ (952)249-4600 Approved By(If Required):
'�saxo$
CITY OF ORONO — S�WER& WATER/ GENERAL PERMIT
(*Notc:Some permits may require approval by the Building Ofticial and/or Public Works Department*)
(AI L PERMITS- h'fav be subicct to further review and mav not be issued when thc aonlication is reccived)
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 sho�m below. Pernut cards will
be sent by rehi�zi mail within 2 busuless days.
3. Permits are not valid until you receive a pernrit card.
4. Work must not begin unless the peinut card is available on the job site.
5. Utility coimection permits may be issued to licensed conh�actors oi�ly.
6. Contact the Public Works Department(952-249-4600) for utility shib as-built locations.
DO NOT EXCAVATE Il�ANY STREET AND DO NOT TAP ANY MAIN without express
approvai of the Public Works Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
S. All work inust 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) ❑ Conmiercial(Approval Required)
�-New Connection ❑Additional Coimection ❑Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: ���(.i ���d� ���c> �� .
Owner: t'c��, � ���-����S �'���K�'S Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: � �S��`� ✓� S`� Contact Person: (��`��•� �. (�f�I
Address: �' / ��-_J �S State License #: � S�� `�'T��~7
City: ����`�` Zip'S�j�`� Expiratioi�Date: l� � S�"��`'�
Phone: �, �j� l `t7� -Y��b Alternate Phone: � ����� 7��'� �� �
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';� `DETERIVIINING PERMIT;FEES;'' '� -
❑ SAC Charge(2005 Rate=$1,550.00) �
(SAC Charge must accompany all sewer pernut applications wiless prepaid)
(Orono City Staff can determuie if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�.Sewer Con ection/Disconnect/Re_ pair($35.00/Per Stub) $
� Pipe size�inches;material .�� Schd 40 air tested; cast iron
❑ '��'ater Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches; matenal Schd 40 air tested; copper
1. SIJBTOTAL of Pernut Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In A�plications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) �
ADDITIONAL INFORMATION—WATER 1VIETERS
■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate pernut.
■ VVATER METERS must be set and sealed by Orono Wate►- Department (952) 249-4600, upon
completion of ineter installation.
The undersi�rned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in shict accordance with the c�, � arices of the City and the regulations of the State of
Minnesota, and certi�res that all s in� s made on this application are,true and conect.
� �
Applicant:
�'� Date: (�- /� -c�:E,
� DAT�� TIME V
CITY OF ORONO CALLED IN �
INSPECTION N CE SCHEDULED - - • �
PERMIT N0. g COMPLETED
ADDRESS IC��D �J ��
OWNER CONTR.�/�/1'�J7� ��
TELEPHONE NO. �la � T� �7 7 �
� DESCRIPTION 5����� ��'� �� ��
� 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS: �"�uSt?
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W� y�WORKSATISFACTORY:PROCEED PROJECT COMPLETE
W '��CORRECT WORK&PROCEED ❑ 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. (g52) 249-4600
OwnerlContracto s t :
Inspector. �-
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