HomeMy WebLinkAbout2011-01434 - sewer/water connect �
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CITY OF ORONO PERM[T NO.: 2011-01434
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE [SSUEn: 1U14/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 3095 CASCO POINT RD
PIN : 20-117-23-34-0005
LEGAL DESC : REG. LAND SURVEY NO. 1311
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER CONNECTION-4"PIPE SIZE
WATER CONNECTION- 1"PIPE SIZE
APPLICANT $EWER CONNECT/DISCONNECT/REPAIR 50.00
FINAL GRADE, INC WATER CONNECT/DISCONNECT/REPAIR 50.00
3441 BLUFF DR.
JORDAN, MN 55352 STATE SURCHARGE SEWER& WATER 5.00
(952)492-5100 TOTAL 105.00
Minnesota State License#: 1442 PAID WITH CC# 5018
OWNER
WHIPPLE, PHILLIP
3095 CASCO PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 1'his permit is for only the work described and does
not grant pennission for additional or related work which requires separate
permits. All provisions o1�laws and ordinances governing this type of work
shall be compied with whether or no[specified herein.This permit will
expire and become null and void if construction au[horized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Buiiding Code.This permit may be
revoked at any time for due cause.
Applicant Permitee Signature /Date / � � // � / � �
Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NOU-lz•-2011 {MON) 12� a2 Final Grade In� (FRX)952Q925101 P. 002I003
FOR ITY 3.F ONLY � �
,¢0 A, Clty of Orono Deca Received: / Pennit# /�-/�/ 3
`�` P,O,Dox 66
� "+ y, ^ O 2750 Kellcy Parkwoy ❑In-Huuse 5AC eterminntion Fonn Complett.�i
� � r ,r a.. t Crys�al�ay,MN 55323
. i ��*�.�`� (952)249-4600 Approved By pf Required):
�%pa�'
CITY OF ORONO—SEWE�R & WATER/ GENERAL PERMIT �
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("Note;Sonte pennits muy rcquirc n��roval by the Building Oflicial end/or Public Worka Deparcment'") /
(ALL NERMI'fS- Mav be enbleet Ca further review nnd mnv not ba insucd when thc xonll�atiun in receivcd)
GENERAL INFORMATION
1. You may apply f�r utility permits by mail or in person at the City offices.
2, Mailed in appNeaCions ere 9ubjeCC to thc postagc and handling fee shown below. Pennit cards will
be se��[by recurn n�ail within 2 busincss days.
3. Perltllts al'e not vs►lid until you receive a permit card.
4. Work „�us[not begin unless che perinie eard is availablc on the job sitc.
5. Utiliry conneetion pe�7niCs may be issued to licenscd contractors only.
6, Con[act the Public Works Department(952-249-4600)for utility stub as-built locations.
DO IVUT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress
approval of tlle Pub11C WnCka Department. lssuancc of a permit does not grant this approval.
7. All work must be done in aeeordanee wiCh Slate Cocie requircmcnts.
B. All work must be inapected before it is covcrcd. Call(952)249-4600,24+��our notice requlred.
TYPE OF PERMIT
Cl�eck All That A 1
❑Residential (May Require Approval) ❑Commercial (Approval Required)
❑New Conneetion ❑ Addilional Conncction ❑ Re-Connection � Repairs ❑ Disconncct
❑ Water Availabilily Conncetion Far Futurc Hook-Up to Water
Job Site/Owner Information:
siteAddress: 3095 CASCO POINT ROAD
Owner;PHILLIP WHIPPLE �(ailing Address: 3095 Cesco Point Raad
Cit Wayzata Zi 55391
Y� p'
Home Phone: N�A Alternate Phone; N/A
Contractor In�ormation:
FINAL GRADE, INC JAMIE BOLLER
Contractor: Contact Person;
3441 BLUFF DRIVE N/A
Address: State License#:
JORDAN 55352 NIA
City: Zip: Expiration Date;
952-492-5100 612-369-2B99
Phane: Alternate Phone:
NOU-•1Gz2011 (MON) 12; Q2 Final Grade In� (FAK)952a925101 P. 0031003
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❑SAC ChArge(Z011 Ilatc=$2,23U.DU) S
(SAC Ch�t'ge muet accompany alf sewer permit applicalions unless prepaid)
(Orono City Starf can determinc if applicable)
(If not prepald,a eewer connection permit wi{1 not be isRued)
�■ Sewer Connectlon/Dlsconnect/Repair($50.00/Per Stub) $50.00
Pipe size ��' inches;material Sehd 40 air tcstcd; cast iron
�Weter Connection/Ulsconnect/IZepalt'($50.(111/Per Stub) $50.00
Pipe size I� inches; mscerial Sehd 4U air cested; eopper
❑Water Aveila�ility F`or Future Houk-Up to Wate�'(SSU,UO) $
Wuter Aveilabilitv Exolanetion:
ConcrActor installcd line to inside of house for future hook-ttp,
This line w111 bc inspccted by the Public Warks Deparcment.
$gqlAit�d DePore Watcr Connection PermiC is Jssued:
l, lesue Water Mcter& Horn Permit
2. Any Addtlional Conncction Fees Paid(If Applicabfe)
lssue Wa�er CQnnection Pcrmit:
l, Collcet Pcrmit Fee&lssue Water Conneclion Permit
I. SUBTOTAL of f�ermit Requested: $100.OD
2. STATG SURCHARG� $ 5.00
3. PpSTAGE&HANDL,INCl(Only on Mail-In Applications) $ 2.D0
4. TOTAL PERMIT FF,E(Add Lines 1-3 Above) $ 105.00
ADDITTONAL.INFORMATION`-WATER METERS
• WATFR ME'fER5 muet be picked up and paid for at Orono City Hall,these are on a senarate permit.
� WA,TER METERS muet be eet and sealed by Orono Water Depsrtment (95Z) 249-4600, upon
completion of ineter Installation.
The undersigned hereby applies to the City of Orono for issuance of a Utility P�nncait, agrees to do
all work in etrict accordance with rhe ordin,ances of tlie City and tlie regulations of.tlle State of
Mionesota,And certifies that all atatements inade oa this application are, true and correct.
Applicant• �..!�,�9� '� � �'" Date: � � � ��
�� �I ,�.rd;I..�
/
�.� ��� DATE TIME J
CITY OF ORONO CALLED IN I L�
INSPECTION ICE SCHEDULED / �'
PERMIT NO. - � � co LETED
ADDRESS � �
OWNER ` LEP�,H,��NE NO. �����-���g
CONTRACTOR L ���.SiC.�-� o.��/�-
>; DESCRIPTION _���(,�1,/ � �C/�'!/L� C%y�L��cG7�
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREM/ETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEEf YOU:_YES_NO
� COMMENTS:
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� ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED !7 ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETIJRN
❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� Z49-46QQ
Owner►Contractor on site:
-�
Inspector. � `_. �" �, ��>
White Copyllnspector's File Canary CopylSite Notice