HomeMy WebLinkAbout2004 - P07522 - sewer connect CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: P07522
Crystal, Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(p52) 249-4600 Date Issued: 6/18/2004
SITE ADDRESS: 1801 West Farm Rd
Long Lake,MN 55356
PID: 27-118-23-44-0016
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:
Double Fee Permit
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,350.00
Misc.Fee: $ 35.00
TOTAL FEE: $ 1,420.50
APPLICANT: OWNER: James&Judith Pierpont
1801 West Farm Rd
Long Lake MN 55356
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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APPLICA T ERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Siinitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessine, 1-Finance Page 1
(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. , Y u 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 the same day
the application is received.
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(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit 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.
JOB SITE ADDRESS: /80/ Gd i '*t Reel
Occupancy Type: Residential Commercial
Owner's Name: �a► - ,o Phone Number:
Mailing Address: ,-epi i9,6- City: eizove, Zip: "3>�
Contractor's Name: ,e4" Phone Number: die-3'9-2f93
Mailing Address: 6,.7.R 944".57.-- Js City: /gs c a Zip: As1'r
PERMIT TYPE. El Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $
pipe size 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 meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of meter installation.
REQUIRED minimum setbacks from drain field and septic tanks=75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surcharge $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Postage & Handling(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 the regulations of the State of Minnesota, and certifies that all statements
made on this application are complete, true and correct.
Signature of Applicant .��r Date: ‘-a/Cif
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. 4O7°22-- COMPLETEDrTh\-0.--1 W-CC.-)
ADDRESS I'0 1 "^-tcr f`lr'�
OWNER Q cR`r— CONTR.
TELEPHONE NO.
DESCRIPTION 5(-''r t`
LI 01 FOOTING 11 MECHANICAL R� 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
h 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 EWER HOOK-UP 06 PROGRESS
07 DEMO-SITE SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
ci
Lti 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU: YES NO
oy COMMENTS: — C\ Pv°'0
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W ❑WORK SATISFACTORY:PROCEEDOJECT COMPLETE
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El CORRECT WORK&PROCEED SUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
U BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
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) 249-4600
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Owner/Contractor on site:
-
Inspector. ON"N ,
White Copy/Inspector's File Canary Copy/Site Notice