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HomeMy WebLinkAboutP04696 Sewer & Water Disconnect PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P04696 Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit (952) 249-4600 Date Issued: 12/5/2001 SITE ADDRESS: 2795 Pheasant Rd EXCELSIOR,MN 55331 PID: 21-117-23-32-0002 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnectic 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: Thompson Plumbing OWNER: ROYAL J DOSSETT&WIFE 15001 Minnetonka Ind.Rd. 2795 PHEASANT RD Minnetonka,MN 55345 EXCELSIOR MN 55331 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. /...ei-Ce— (51-7y1,a4eL} /2 y APP PERMIT ATURE ICED BY SIGNATURE Conies: 1-File(SiQnitures Reauired). 1-Applicant. 1-Monthly Reports. 1-Assessing. 1-Finance Page 1 Doc-04-2001 12:44pr Frcrr-CITY OF ORONO +0522404616 T-217 P.001/001 F-305 �jI_ kuptinu u`rtbryMp t� 1 `5 CITY OF ORONO APPLICATION FOR UTILITY PERMITSP6' 174� Box 66(2750 Kelley Parkway) SEWER/WATER Crystal Bay,MN 55323 GENERAL INFORMATION I. You may apply for utility permits by mail or ilk 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 the same day the application is rec+sived. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department (95?-249-4600) for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Warks Department. Issuance of a permit does not grant this approval. 7, All work must be done in accordance with Stale Code requirements. 8. Al work must be inspected before it is covere+l. Call(952)249-4600. 24 hour notice regaired. JOB SITE ADDRESS: 6i 79 s rl CS` ck Ocoupan 'TYpe; Residential __-- Commercial Owner's Name: .j rey-- -n = rr i-- Phone Number: Mailing Address: City: tip: Contractor's Na ne: iTloi N.fx Y:, `7"-I (-1.;-)p Phone Number:9r-c -93-5-'/'7/'7 Mailing Address:/.!-1 /�Ltd Viri,,. "► 4 . City: PERMIT TYPE t`�Ci,,�< c- Municipal Sewers ($35.00 per stub) Ver pipe size inches; material Schedule 40 air tested; cast iron s-'17' SAC Charge (2000 rate$1,150.00)must accompany all sewer permit applications unless prepaid. Loi c If not prepaid,a sewer connection permit will:lot be iissued. Municipal Water Conntetien($35.00 per stub) c`'' • $ pipe size inches; material_ copper; other WATER METERS must be picked up and paid for at City Hall. Water meters must be act and sealed by Orono Water Department (952-249-4600) upon completion of meter installation. REQUIRRD minimum setbarks from drain field and septic tanks=75' REQUIRE) setback from sewer line=20' PERIYHTFEE_CALCULATION ]. Subtotal of above permit requested $ '70.C;() 2. State Surcharge $ . .50 The State Building Code Division Surcharge o S.50 per permit must be included for each well,sewer and water conne<lion permit requested. 3. Postage&Bandling(Only mail-in applications) $ s_ 4. TOTAL PERMIT FEE(add lines 1-3 above) $ '7©. :Lb 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 complete,true and correct. Signature of Applicant:�l ar f2-yr KF Daft.1 -• �, � .t f - DATE TIME CITY OF ORONO CALLED IN INSPECTIONTIC C SCHEDULED I -( f //• t 0 PERMIT NO. 0 � � COMPLETED �j�--r,'`( IV.-C!C l ADDRESS .-.2 7 %5- ./. . ,.e OWNER CONTR. -,t_7°.,'14.44,,,6 TELEPHONE NO. 7S -- 7 3 3-- 77/7 DESCRIPTION `{'"tGC' 2 /&i-z2-e:297-4-Vitr-e 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING 14. Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORENVETLANDS " 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 06 PROGRESS 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP cC 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO O MENTS: '4." / / /. -6-7Y. 4t.. i--i co x4,-2_ k'/4--rjr-777) -( CC 4 +- 1 11-'6 5Ca CC 4. ( c( -e i' ' W Q W Z W CC d W ORK SATISFACTORY:PROCEED / iOJECT COMPLETE 0 CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY O(..) BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR`WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contraa or on site: Inspector/��-` �--LCa�I2 White Copylinspector's File Canary CopylSite Notice