HomeMy WebLinkAbout2008-P1180 - sewer & water connections � PERMIT
� CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: p118o1
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
1/10/2008
SITE ADDRESS: 743 Bridgewater Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0107
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00
State Swcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Sewer&Water OWNER: O.T. Development,LLC
775 Tower Drive 2670 Kelley Pkwy
Hamel,MN 55340 Orono,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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LICANT PERMI I:E SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRegui�•ed), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, l-Scptic) Pagc]
.
FOR CITY�USF ONLY
p`�� City of Orono Date Received: Permit#
/O¢�`�`O�; P.O.Bo�66
i �; �ti 2750 kelley Parkway ❑In-House SAC Determmation Form Completed
���� �(" �� _ �� Crystal Bay,MN 5�323
���t 1r �,v yt`f (952)249-4600 Approved By(If Required):
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CITY OF ORONO-SEWER & WATER/GENERAL PERMIT
(*Note,Some permits ma}'require approval by the Building Official and/or Public Works Department*)
(AL1,PERI�IITS- Ma��bc subiect tn further review and mav not be icsued whcn the aoplication 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 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.
TYPE OF PERMIT
� (Check All That A 1 )�
�Residentia] (May Require Approval) � Commercial(Approval Required)
� New Connection ❑ Additional Connection � Re-Connection (� Repairs ❑ Disconnect
Job Site/Owner Information: C� "J � ��1 �� �, J ���
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Site Address: � � � /���.Q/ w�/y/��2 l'�-L ,o
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Owner: � � �t� 7� S� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Infor�nation:
a�- �
Contractor:���� �� � Contact Person: �
Address: �? � / %��� � �!2 State License #: � � Z- �
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City: ����1�-G� Zip:�5 '7 Expiration Date: / � 3� D �
Phone: � La � �7 � (v 7 I � Alternate Phone: �p / � J/ � �� y�
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DETERMINING PERNITT FEES '
� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connecfion permit will not be issued)
�Sewer onnectio Disconnect/Repair($35.00/Per Stub) $
Pipe size � inches;material�_Schd 40 air tested; � cast iron
� � �-
(,_,( �--,
'�[J Wate Conr�e ti /Disconnect/Repair($35.00/Per Stub) $
�� Pipe size inches;material ('a � � Schd 40 air tested; 0 co er
�o� PP
l. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines l-3 Above) $
ADDITIONAL INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
■ 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.
Applicant: �� /������� Date: /— /lJ � �
Reset Form
ATE TIME V
CITY OF ORONO CALLED IN �
INSPECTION NSJ,TIC�D/ SCHEDULED � � 3=�
PERMIT NO. � COMPLETED �_
ADDRESS `� G���
OWNER CONTR. d�� U �'
TELEPHONE NO. � 3 ^ ��
� DESCRIPTION ���� ry ��
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
❑ TREE REMOVAL
Z ❑ WALL BD. �4(ATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL �SEWER HOOK-UP ❑ PROGRESS
� � DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:�S_NO
� COMMENTS: —
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W " ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C, pHOTO TAKEN
INSPECTOR WILL RETURN i.�CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUiRED.CALLTO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-460�
OwnerlContractor on site::
Inspector. � �,-�
White Copyllnspector's File Canary CopylSite Notice