HomeMy WebLinkAbout2005-P08638 - sewer connect ITY nF OR N PERMIT
C "_' � � Permit Number:
2750 �Celley Parkway- PO Box 66 P08638
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernrit
(952) 249-4600 Date Issued: a�2s�2oos
SITE ADDRESS: 45 Smith Ave
Wayzata,MN 55391
PID: o2-ti�-23-22-000s
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernut Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer Connecrion
DETAILS:
Approved per resolurion#:
Separate pemuts required:
NOTICES/REMARKS:
Sewer Connecfion and SAC Charge Paid
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,450.00
TOTAL FEE: $ 1,485.50
APPLICANT: �tter Excavating OWNER: David S Phelps
7120 Vemon Street 45 Smith Ave
Rockford,MN 55373 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 SUED BY SIGNATURE /�
Couies: 1-File(Sir;nitures Required). 1-Apvlicant 1-Monthlv Renorts, 1-Assessin¢, 1-Finance Page 1
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_ . FOR CITY USE ONLY
. 4�� Clty of Ol'on0 Date Received: Permit#
P.O.Box 66
��;.� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a �>> ��,' � Crystal Bay,MN 55323
��^t ri���M�.$a` (952)249-4600 Approved By(If Required):
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CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the aaDlication is received)
GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
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 connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600) for utility stub as-built]ocations.
DO NOT EXCAVATE IN ANY STREET AND 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 Ap ly)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Connection ❑ Additional Connection ❑ Re-Coruiection ❑Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: �'/' 5�-�-►v�-�`� �'L°'�"
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Owner: aC/..-C�-�-�- �''���'�� Mailing Address:
City: �.%L�Z�-- Zip:
Home Phone: ��G� 7 3 �F y� Z Alternate Phone: ,�i �� 7„�j � �J�✓��
Contractor Information:
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Contractor: /%.G�,,,,_d��,���DG- Contact Person: ,�i��- i��.
Address: �l � d �.�-/�z' State License #: � � �� `
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City: � Zip: ��3T�xpiration Date: � � `
Phone: ��� " ���1- /��L- � Alternate Phone: � `� ��`� "l�� �-
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` ` DETERMINING PERMIT FEES `
❑ SAC Charge(2005 Rate=$1,450.00) $ � � y��G�
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
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❑ Sewer Connection/Disconnect/Repair($35.00/Per Stub) $ ,�� ��'
Pipe size�inches;material�(�� Schd 40 air tested; cast uon
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Pernzit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
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4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �� t��,-�""
ADDITIONAL INFORMATION-WATEK 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 that all statements made on this application are,true and correct.
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Applicant: ����e'���" Date: '-'f' �
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N TI E SCHEDULED � ��vd
PERMIT NO. � 6 co PLETED
ADDRESS � ��'
OWNER CONTR. �� P�
TELEPHONE NO. �I oZ -�{ I C(�l��o[
� DESCRIPTION �-�-�—�
� 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. 1 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL �EWER 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 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑CORRECl'WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
G INSPECTION REQUIRED.CALLTOARRANGE ACCESS.
Call for the next in pection 24 hours in advance. �952� 249-46QQ
Owner/Contractor
Inspector.
White Copyllnspector's File Canary Copy/Site Notice