HomeMy WebLinkAbout2008-P12174 - sewer water PERMIT
CIT�: OF ORONO
�'750 Kelley Parkway- PO Box 66 Permit Number: p12174
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
6/17/2008
SITE ADDRESS: 766 Bridgewater Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0109
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Pernut Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 70.00 Valuation: $ 0.00
State Surcharge 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.
APP A RE [ UCD BY SIGNATURE /r�
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page l
FOR CITI'USE ONLY
`"` Clt Of�1'Ono Date Received: Pennit#
��IO¢0���. P.O Box 66
�� ,;� � 2750 P.elley Parkway ❑In-I�ouse SAC Determinat�on Form Completed
l� ���x�`. �.) Crystal Bay,MN 55323
r{�3�}yG`/ (952)249-4600 Approved By(If Required):
���of�
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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 bc subiect to further revicw and mav not be issued when the anplication is received)
GENERAL INFORMATION
1. You may apply for utiliry 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)far 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 ) �
�Residential (May Require Approval) � Commercial(Approval Required)
�New Connection ❑ Additional Connection � Re-Connection �Repairs � Disconnect
Job Sife/Owner Information: �
Site Address: � �
Owner:���������'�2'�� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
�Contractor Information: �
� ,� �, ��'e�c.� ' ,
Contractor: Contact Person:
Address:� � U��C',����ate License #: /��
�
City: r�(1i�1 � Zi}�����Ekpiration Date: / �- � � G �Y
Phone:��� �Z�� �/ � Alternate Phone: �v l �C%/ � � �� �
� � � � � �DETERMINING PERMIT 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 Conne tion/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches; material Schd 40 air tested; � cast iron
��-
�Water Connection/Disconnect/Repair($35.00/Per Stub) $
� Pipe size mches;material�Schd 40 air tested; � copper
� (�
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1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 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.
� � ��
Applican r �� ��i�- 2 Date: � � � � � ,�
���������Re�t Form ��a
D TE TIME `�
CITY OF ORONO � CALLED IN ����
INSPECTION N TICE SCHEDULED '� 'D :4�
PERMIT NO. �� � COMPLETED
ADDRESS ��� �ti
OWNER CONTR. ������
TELEPHONE NO. •
� DESCRIPTION �� � �� —"��p���
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
Q ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
? ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �� pHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca�l for the next inspection 24 hours in advance. (952� 249-4600
OwnerlContractor on site:
Inspector. 1 , � �� ,
White Copyllnspector's File Canary Copy/Site Notice