HomeMy WebLinkAbout2005-P09000 - sewer connection � PERMIT
CI�TY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09000
Crystai Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 7/26/2005
SITE ADDRESS: 25 Brown Rd S Unit#
Long Lake,MN 55356
PID: 03-117-23-21-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Pernut Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid &assessment waiver must be signed
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,450.00
TOTAL FEE: $ 1,485.50
APPLICANT: Ouverson Excavating OWNER: Susan Powers
252 36th Street S.W. 25 Brown Rd S
Montrose,MN 55363 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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APPLICANT PERMITEE SIGNATURE [SSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE ONLY
��� City of OCOnO Date Received: 1�Permit#
O t Q P•O.Box 66
�^ �,,, 27�0 Kelley Parkway ❑In-House'SAC Determination Form Completed
��'���r;�'_ �. Crystal Bay,MN 55323
�� ��-}��r��,{c.�o` (952)2a9-4600 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 1nn��cation is received)
GENERAL INFORMATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will
be sent by retuin mail within 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility connection permits may be issued to licensed contractars only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locatious.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pemut 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 Apply)
,
�Residential(May Require Approval) ❑ Conunercial(Approval Required)
[�'New Coiuiection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect
Job Site/ Owner Information:
Site Address: �.5� � ,��2�'yL ��- �•
Owner:�il,Pvr,, 4'C/Lts��l MailingAddress: �S- -5 !�'�`k�?i ��-v�
City,�1� / ' Zip: .� � �c���� '
/
Home Phone: 7;a- �7�/�� Altenlate Phone:
Contractor Information:
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Contractor: �� �� Contact Person: �
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Address: ,�-�� ��� ' �S��v State License #: l°� �
City: ��'l?i1������ Zip: �,���xpiration Date: _
Phone: ���- �f�� �Cf� � Alternate Phone: ���� �-�'�� - �5���� /,�"
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DETERMINING PERIVIIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(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)
� ewer Connection/Disconnect/Repair($35.00/Per Stub) $
�1/��' Pipe size inches;material Schd 40 air tested; cast iron
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❑ Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Pernut Requested: $
2. STATE SURCHARGE $ .SO
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $
ADDITIONAL 1NFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pemut.
■ 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 far 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 rtifies that all statements made on this application are, true and correct.
Applicant: 0 '�'� Date: � � d �
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/� ����� �<�E O� TIME
�/ CITY OF ORONO CALLED IN ��
INSPECTION NOTICE SCHEDULED =�3/� _��
PERMITNO. �f� jCC2� COMPLETED �'C%5 �
ADDRESS ��J �owr1 ,(�GY S
OWNER CONTR. �[..c
TELEPHONE NO. �� ��-� ��J��g�
� DESCRIPTION � ��rn�{��
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
� 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/CONTRACTOH TO MEET YO _YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED Il PROJECTCOMPLETE
W ❑C RECT WORK&PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY
O ❑Ct�RRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR n CITATION ISSUED
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (952� 249-460�
Owner/Contractor on site:
Inspector. � _ � �
White Copyllnspector's File Canary CopylSite Notice