HomeMy WebLinkAbout2009-00814 - sewer/water disconnect � ' CITY OF ORONO PERMIT NO.: 20o9-oos14
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1U20/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3105 CASCO POINT RD
PIN : 20-117-23-34-0006
LEGAL DESC : REG. LAND SURVEY NO. 131]
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER& WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE: WATER&SEWER DISCONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
DASEN CO. WATER CONNECT/DISCONNECT/REPAIR 50.00
24245 NATCHEZ STATE SURCHARGE SEWER& WATER 0.50
LAKEVILLE,MN 55044-
(952)461-2100 TOTAL 100.50
Minnesota State License#: 1612
OWNER
RICHEY, KENT
3105 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. This permit is for only the work described and does
no[grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if construction authorized 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 res onsi le for assuring all required inspections are
requested in fo h t e Building Code.This permit may be
revoked nyt se
' 2�_ /� l ��l 2�� � �_ .��—� J -� ��C�����--� i/l :j7C%l � c,
A plicant Permitee Signature Date Issu� By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Nov 13. 09 04: 34p p. l
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F R .f UtiF.ONI.Y ('�j�
'" ��'�'•�,.. Lify U�ViUnO Dutc liwcrvcd�l��i��l'crmi�fl C��� a /
�� ��\ 1'.U.liux GG �_ �
�i`�w• �'' 275U Kdlcy I'urkwuy ❑In-Housc ti�G�k�crniinauon f�orm Complctud
�"� '�I!�,r n ' � ('rystul li�y,MN 5532i
\\ ii.,��� (VS2)2d9.a�,0(1 1lpproved fiy(11'Rey�i�ed1: .__,
�aw .
C���v Ur ORONO—SEwER& WATER/G�NE1tAL PEItMIT
(Y Nm�;Somc rCrmil�may requirc.�ippruval by lhe I3uilding U(liciul unJ/or Public Works Lk:purlmen!°)
(,nl,�l,['IiltMl'1'1- Vlav hc yubirct tu fu�ther revicw xnd mHy na lie icvued when t6�a�rliralion iv rcccivcif)
GENERAL INPnRMATCON �
!1. Y�iu mtly tipply lor utility permits hy mail nr in�ici:snn a[�hc C..ily o1�7�iccs.
2. ivls►ilecl in�p�licc�liuns are subject to thc postagc and ha�idling fcc shown bclow. Pcrmit cards will
� be�ent by rclurn mail within 2 business d�ys,
. Pcrmits nrc nqt vnlid u�►til yuu reeiive�perrnil curd.
� Work must not hegin unless the perrnil.�►rd is f►vFiil�iblc un thc,job sil�.
. lJtiliry connection p�rmils rn�y bc issucd tu liccnscd conUactors only.
. Contact the Public W�rks Dcpar�mcnl(952-24n-4600) for ucili�y ti�ub as-built locxtions.
UO NU'1'�aCAVATE 1N ANY STRCET AND DO NOT TAP ANY MA1N withqut cxprerv
Hpprov�l ul�il�c Public W��rks Dep:►rtment. lssuance of a permit does not gr�uit�his approval.
(7, All work musl bc Jnnc in accnrdancc with Sl,zu C'�dc raquiremcnts.
�. t�ll wurk must bc inspected hefnr� ic is coven;d_ C:sill(�)52)249-4f.ipU,24+tiqur nqtie.e required.
TYPE O� PERMIT � +y� ��urµ�! �
__ 4 ,,,,_ (Chcck�111 That ApPly)
Rcsidcntial(May Itcquire npp�uvr�l) ❑C:ummcrcial (Approv�l Rcquircd)
❑ New C:onnecu�n ��� Adclitional Conncction ❑ Re-C'onnection ❑ lte:pairs i�connoct
❑ Watcr Availahiliry C;onnec[ion Por 1'�ul.ur� I luok-Up lq W;il�r
Job Site/Uwner lnformation: W����1
SiLc;�lddretis: O� `� ��� L� � P(� � CO
� 1 �% �
()w�cr:--.�_�(`C•� ���L ��'�1� Mailinb nddress: I J ��J '"-
� �Cit ���.:,: � �ip: C� c`7� .� __._,
I fom c Yhonc: ��j �����SnZ(� /�Itcrnatc Phonc:
I
Co tractar [nfarmation: V
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Ccn tractor: V .�T�(;'i-�i'Co�tact Pcrson: . (,)'l C., ��r-���.
1 �, l-� p
Ad ress: ��� ' ' 2 '�tc Liccnsc tf: ������.�.._.
, � _ . � , /� /
C.'tt ��, i %i���Cxp�ration U��i�: L�/ �
Pho ie: `�GJ��,,,�Z1�� A Iternate Phone: ���-" �ZJ ��C����
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Nov 13• 09 04: 34p p• Z
�
DETERMiNING PERMiT FEES ��
L�snc c:i,n����aui�� K�t���z_nno.uo� x
�5nc ci,:ir�,c rnust aca�mpai�y Fill �;w�r p�rmil;��plication,unlcsti prcpaid)
� (Oruno C'it.y St�ifl'can Jctcrminc if<ipplicablc)
O f nut prep:�id,si scwcr connection permit will not bc issucd)
I I..�I 5cwer Cunnec ' /Di�conn��ct/ pnir(!�SO.Op/r'cr Stuh} � � � d �
f'i�a yi��c mc ,., iateri�l___Schd nU air�esled;�_. C�54 iron
Wa►tcr c;onncct- n/1)isconnecf/ �p�ir(35U.UU/Ncr 51ub) � �—� , � �_
I�i�c sirc _inc cs;m�lcrit�l Schd AO air tcslcd: copper
I n W�Icr A�rilability For I'uturc HoalrUp to Wntor(�SU.OU) �
' Ws�tcr Avail�ltiilit�+ F.x�1�nHCion:
Gonlraclor insl:illcd linc to inuide of h�uw for futuro hoqk-ur_
Thi�linc will he in�rac��d by �h�Pul>lic Wp�k�: f�;p�.Rm��il_
R�n��irai Rc�fom.Walcr Conncclit�n Pcrmil is Issucd:
� 1. Issuc Walcr Mcicr R:Hom Pcrmit
2. Any Addilional Canncctian Fccs!'aid(If Applicahlc)
I Issuc Water C;onnecr.ion 1'ermiC:
iI. (;ollect Pernu�1'ec;�c ls�ue W�dcr Cunncction Pc:rmil
i .., ..,.,...._._"
� 1. SU6'1'07'AL of Permil f2eyues4cd: x . : ...._ .....---..
2. S'f'/�'I"�SURC;HI�RGE '� ,5�
3. POSTAGF.&. HnN1)I,ING(Unly on M�i.il-In Applicali�ns) � 7...OU
a. �roTni,rrRnhrr rrF;(ndd �,��,.::� i-� nbo��) $ l�(, • �
�� ADDI"I'IONA1. 1NPpRMATION—WA'f'I�R Mk'I'}:125 �
■ �VATER MI?7'w.kti mus:t be p�ckcd up and puiil(orat Orono(:ity H�ll,thcsc:�rc�n a scnarr�lc ncrm�l.
■ �VI/A'1'/;FL Mk:�I'ERS must be xrt Had Fealed by nrnno VN�tcr nernrtment (952) 2d4-4(00, upon
�omplcliun ulmeter inctallatic►n_
The undcr:i�rned h�reby applies to the City oi'Orono fnr iSsuanec oi'a lJcility Pcrmit,agrces to do
all vrork in scrict ace��rilancc with tl�r. v�dinances of the City and the re�ulations of the State of
Min�,csolx, .ii ert` ii7es that all ststements C Of) LF1t$ it�(�Ij(;3liUn t+re;, Lruc;3nd c:o►rCct.
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� APP'ican � -,'r�(/�_ � fj[ 1% � Datc: 1 � \r,-�v v�
�
�-�� �
�— — TIME �
CITY OF ORONO CALLED IN �� � �
INSPECTION T C �/s CHEDULED �
PERMIT NO. 'D�8�5` cOMPLE
ADDRESS Ca
OWNER CONTR.
TELEPHONE N0. � �� ` r���� ��9
� DESCRIPTION �.�/`t.`/�-� GiIJ���� ��.���.11}�/(��
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
O ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
? ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO ^
� COMMENTS: ,_Sli.u� �v��r e7,/ /�� Cv✓'j �'��o /.✓
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a !��^�Ut w�y, .�«.� a/s�sh��- c � �S C'�rJ�+� ��d- f'c�a��y
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W ❑WORK SATISFACTORY:PROCEED C i PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED 1=; ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUiRED.CALITO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContractor on site:
Inspector. �(��C 7� �d`'r+'�/5.�.''��"
Whi1e Copyllnspector's File Canary CopylSite Notice