HomeMy WebLinkAbout2006-P09872 (sewer & water connection) PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09872
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4�00 Date Issued: 5/16/2006
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 Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#1799-04/26/68
FEE SUMMARY: Pernut Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Don Wayne Excavating OWNER: Mark Gaylord&Lori Anderson
4960 Co.Rd. 10 E 182 2nd. St.
Chaska,MN 55318 Excelsior,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 COD$�2EQUIREMENTS.
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� � APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATUR6
Copies: 1-File(SignaturesRequrred), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, l-Septic) Page 1
FOR CITY USE ONLY
Clty Of OrouO Date Received: Permit#
� �¢���� P.O.Box 66
� �'' 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed
�� iF`'�• ��' Crystal Bay,MN 55323
t�'�'t '' •yo` (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 PERMITS- Mav be subiect to further review and mav not be issued when the analicatioo is received)
GENERAL INFORMAT[ON
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
Q Residential(May Require Approval) ❑Commercial(Approval Required)
❑New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect
Job Site/Owner Information:
Site Address: ���( �s C(� lJ(1rG��
Owner: r OrV► Mailing Address:
City: Zip:
Home Phone: Alternate Phone: �o(Z-" � Z-� ����
Contractor Information:
Contractor: � , Contact Person:
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Address: ��3� � �Og '�"1 ` State License#: "t'� l {i
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City: � Zip:� Expiration Date:
Phone: (D(�'(D�� � �� 6� Alternate Phone: �o(7i' �Z.'����
. DETERMINING PERMIT FEES
_ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staffcan determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
Sewer Con �tion/Disconnect/Repai�er Stub) $
Pipe size�inches;material chd 40 r tested; cast iron
Water Conn ction/Disconnect/Repair($35.00/Per Stub)
Pipe size � inches;material Schd 40 air tested; copp�
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 senarate 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 ordi c s of the City and the regulations of the State of
Minnesota,and certi ies that all s temen on this application are,true and correct.
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Applicant:
� �►"� Date: � - � �j '�� "'
Reset Form
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CITY OF ORONO CALLED IN ���
INSPECTION NOTICE SCHEDULED S-/7,D�o 09:00
PERMIT NO. ,�z/���7oZ COMPLETED
ADDRESS 325� C4SGo (���
OWNER CONTR. QO�'l �C�'`.r'��2- �X-�
TELEPHONE NO. �r�- 6�S� Ol O �J
� DESCRIPTION C�eGIJ�P.��w�C(l.t �.PI)LR-e���
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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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
J 10 PIUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEEf YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED f� PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED "- 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.CAL�TO ARRANGE ACCESS.
Call for the xt inspection 24 hours in advance. (J52� 249-46��
OwnerlContrac r n ite:
Inspector.
White Copyllnspector's Fi Canary CopylSite Notice