HomeMy WebLinkAbout2005-P08840 (sewer & water disconnect) PERMIT
�ITI' OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p08840
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Pernut
(952) 249-4600 Date Issued: 6/15/2005
SITE ADDRESS: 3799 Casco Ave Unit#
Wayzata,MN 55391
PID: 20-117-23-32-0021
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnecti�
DETAILS:
Approved perresolution#:
Separate permits required:
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NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Atco Utility Services OWNER: James Pederson
3660 County Rd/ 101 S 24275 Mary Lake Trail
Minnetonka,MN 55391 Shorewood,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.
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APPLIC E ITEE SI TURE I SUED BY SIGNATURE
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Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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' FOR CITY USE ONLY
�0�` City of Orono Date Received: Permit#
"r P.O.Box 66
�° � 2750 Kelley Parkway ❑In-House SAC Determination Fo�m Completed
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�j'���=�'. �* Crystal Bay,MN 55323
�� �'�, µ" o~ 952 249-4600 A roved B If Re uired
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CITY OF ORONO—SEWER & WATER/ GENERAL PERMIT
(*Note:Some pennits may require approval Uy the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issucd when the ann�ication 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. Pein-ut cards will
be sent by retuin mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pemut card is available on the job site.
5. Urility connection peimits 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 Apply)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs �.Disconnect
Job Site/ Owner Information:
� �Site Address: .3�� �� ��5�-o U;�
Owner: �,.�,� ��Z-f�.�<� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �%('�� l�-r��,��c- Contact Person: � C�, ,�,2
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Address: _�f��,v �a. ,P�Ipf State License #:
City: �TIGe— Zip:s'.t'3i� Expiration Date:
Phone: ��—�1?�- ��.�7 Alternate Phone:
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DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Connection/ 'sconn Repair($35.00/Per Stub) $
Pipe size inc , terial Schd 40 air tested; cast uon
�Water Connection/ isconne /Repair($35.00/Per Stub) $
Pipe size in , erial Schd 40 air tested; copper
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 pernut.
■ 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: �i /.3� �
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OATE TIME "
CITY OF ORONO CALLED IN
INSPECTION NQTI E SCHEDULED `�� �.' � y`
PERMIT NO. f COMPLETED
ADDRESS 3799 �4SC0/�U-��
OWNER CONTR. �"T���
TELEPHONE NO. /SZ �7.3 7 Z`� 7
� DESCRIPTION ����`t� �� O�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 P�UMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑ CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ext inspection 24 hours in advance. (J52� 249-46��
OwnerlContra r o site:
Inspector.
White Copyllnspector's ile Canary CopylSite Notice