HomeMy WebLinkAbout2006-P09810 (sewer & water disconnect) PERMIT
, CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P09810
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued: 5/1/2006
SITE ADDRESS: 3251 Casco Cir Unit#
Wayzata,MN 55391
PID: 20-117-23-43-0007
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer&Water Disconnecti<
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Lodahl Inc. OWNER: Mark Gaylord
Tom Lodahl Lori Anderson
667 Warner Ave S 182 2nd. St.
Mahtomedi,MN 55115 Excelsior,MN 55331
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPL[ANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
' �1 , �� J
APPLICANT PERMIT�E SIGNATURE ISSUED BY SIGNATURE �
Copies: I-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page l
� FOR CITY USE ONLY
�0� CItV Of 01'Ono Date Received: � Pem�it#
O f Q P.O.Box 66
�,t4r 2750 Kelley Parkway ❑In-House SAC Determination Form Comple�ed
a '!�%`'��=? Crystal Bay,MN 55323
� �� �''��`a o� 952 249-4600 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 PEI2(111TS- Mav be subiect to further review and mav not be issued when the aoplication is received)
GENERAL INFORMATION
1. You may apply for utility pennits 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 rehirn mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pennit card is available on the job site.
5. Utility coimection permits may be issued to licensed conh•actors only.
6. Contact the Public Works Department(952-249-4600) far utility shib 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 pernut does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be ivspected 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 Comlection ❑Re-Connection ❑ Repairs �Disconnect
Job Site/ Owner Information:
Site Address: � �-5 � C�SC%C� C//��[�C _
Owner: i��IL ���� Mailing Address:
� City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ���l� �- �N�-' Contact Person: -��'1
��35�
Address: (��rZ7 ������� � �����7�tate License #: � D�� �7�
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City: ��4fF�f�L''�l �1� Zip:s�/� Expiration Date: -`'���--�e�d G
Phone: ��� �7U YY�� Alternate Phone:
< DETERIVIINING PERNIIT FEES
❑ SAC Charge(2005 Rate=$1,550.00) $
(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 Connecti /DiscQnnect Repair($35.00/Per Stub) $
ipe size inc ' �l Schd 40 air tested; cast iron
___--._..---
�Water Connecti n/Disconnect/ epair($35.00/Per Stub) $
Pipe size in =��ate � Schd 40 air tested; copper
1. SUBTOTAL of Pernut 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.
Applicant:
� �c Gz-� Date: `� � ��
� DAT � TIME "
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CITY OF OR� [ ��ALLED IN S�S
� -;�,�z� -��
INSPECTION NOTICE / SCHEDULED
PERMIT NO.�9�,LCl �/ COMPLETED
ADDRESS �� �J � C�G�--d r �7 C,2 •
OWNER CONTR. ���� `� �
TELEPHONENO. S � � � ���"� � � C .
� DESCRIPTION �
lL 01 FOOTING 1 MECHANICAL RI 18 EXCAV/GRADING/F I �
� 02 FRAMING 3 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL �/ 36 FOUNDATION/REMOVAL
� OWNERICONTRACTO TO MEET YOU:_1XES_NO
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� COMMENTS: '
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W WORK SATISFACTORY:PROCEED CI PROJECT COMPLETE
� O CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
�CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W4LL RETURN i—; CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-460�
OwnerlContrac i :
Inspector.
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