HomeMy WebLinkAbout2010-00009 - sewer connect � •
CITY OF ORONO PERMIT NO.: 2010-00009
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �ssuEn: OU06/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3105 CASCO PO[NT RD
PIN : 20-117-23-34-0006
LEGAL DESC : REG. LAND SURVEY NO. 1311
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RES[DENT[AL
CONSTRUCTION TYPE : CONNECTION
NOTE: RECLAIM SAC CREDIT-SAC PD
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
DASEN CO. STATE SURCHARGE SEWER& WATER 0.50
24245 NATCHEZ
LAKEVILLE, MN 55044- TOTAL 50.50
(952)461-2100 PAID W[TH CC# 7883
Minnesota State License#: 1612
OWNER
R[CHEY, KENT& SUE
3105 CASCO PT RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
"I�he work for which this permit is issucd shall be performcd according to
thc approvcd plans and specifications,applicablc City approvals,and the
State Building Code. This permit is for only the wark described and does
not grant permission for additional or related��ork which rcquires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This pennit will
expire and become null and void if construction authorized is not
commenced within I 80 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 rcquired inspections are
requestcd in conformancc with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signaturc Date Issued By gnature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
Jan 07 ib 01 : 56p p, l
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FnR CI'fY U:iF�ON��Y
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CYTY O�'ORONO—SF..WF.R&W�1►TER/CLNEI�+iI,P�i.RMI.T
("N��te:Snmc pennits may r�equire nDD��a�bY��l�uil�mF Ulticinl unU(UI I'ub1�C Worlw Depar(rnenl')
(,A�1 1 R�'�Ma'['y M r�rc n.Fiarl 1u f rll��r evtil� A rnrv wi 1 An I�a�t�when thq�y�l�"g8��yee i�e rec�ivod)
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G�,NERAL IN�URMATION
1. You may aa�ply for utili4y pe�mit�hy rnail o�in ner.c�n at the C.ity offccs.
2- Mailed in application�are subjcct lo ihe poSta�e and handling fee cbow»below. PCrmi[cflr(1S will
be scnt by rcturn mflil wi(hin z buSineSs d:rys_
3. 1'cYmitx Hre np[vatid until you receive s perm9t rara.
4. Work rnusl nol bvgi�t uolcss Thc rcrmit curd is availnblc an nc�job sitc.
5, Utility ca�nactipn permits msy bc is9ued to licensod con��tors only,
!,. Cont�ct tho l�uhlic W�rks Dcpartnicnt(952-249-dG00}for utilily bfub as-buili locatipna.
DU NOT�XCAVATT IN ANY STREET ANiD AO NOT 7'nP ANY I�Ailv without exp►'ess
approvs�l niuu Pu�lic WorKs l7epamnent_ lssuance ofa permit docs not�[fhis approval.
7. All work must bc donc in uccordFuace with Stacc Code requ�remenkc.
8. All work must bc inspcctcd bc8orc it ia oovcrcd. Call(952)249-4G00,Z4+hour nolUcc roquired.
f �rvPr or PrRMi•r
I �cti��k nii rt,s�n�piv�
�lzesidential(May Ttequire/�pprp�al) ❑Commerciul(Appraval Rcquircd)
• �-�1ew C:o�tn�Ccion �.A,ucNtionnl C:Oru+�don Q T{e-Connectipn ❑ I�epai� ❑DisconnocL
Job Site/Owner l.nformation:
.c. i�, �� � �
Sitc Rddress� �—?����' � {t �f,�/1�'li� ��''�1,1-f���C..G
C-. , � : , , . �
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Ch�vner� _��►�1;iY���'�)'(�{� '�.�/Y�-C� Mailin�;Addre�s: ��-'�7�i ._ '� ��l�f /�
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Ciry: _T�.l�'1 C���I'� Zip: �- y�-��,�—
Home Phone: 1r.�f,� --��'� ,��Z� - Alternate Phone: _
Contractor lnformztion:
_J .'�_,f_1�1 � �Yl�T�l+`N n�ontAct Persotn. F
COIl��l01': �J i' '(� ;�f��t,I
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Address_ c'--,�1�-�c���l-� .`._� I��'�-��'�'i��.L}+�-'C �
Staie License#: � f ��'/��-
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Ciry: (..�C�1' Q: > �� _ Zip: Expirativn Da.tc: � �' -�i����/� •
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Phonc: � ���;3� � !.;� Altcrnalc.Phonc: ��r� ,-j.:�� l���7��
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Jan 07 10 01 : 56p p, Z
�— DCT�12M�1�11NC PERMIT FT:i:S
❑SAC Ch�rgc(20118 linte=Sl,Sz5.n0) S
(SAC Char�!�mu5C i�eCOmpany all scwor permit applicalions unlc��pror,u�d)
(Orono City Slu(�can dolcrmine if:�plicabl�)
(IfnaC prepaid,0 5�vvcr canncction pet'mit wil!not be i�9sued)
❑tirwer Coonecl':un/Dirconnect/ILep�ir(S3S..OU/k'er Slu�} $
Pi��c cizc in�bes;matcrial Schd 40 air tcstcd;... _casl iron
❑Wutcr Conucction J niaconnect/Repair(535.4(1/Pcr Stub) $ _.,_,.._
I'ipc sizc ,inches;matcrial , 5chd 40 air tcstc;d; copper
1. SUS'fOTAI.of Pcrmit Ctcqucstcd: $�_
2. S7'ATE SURCHARGT: S •5�1
3_ POSTAGIi&I-IANDLiNG(Only on M�i1-�n,A,ppliciitionc) $ I.SO ____
4. TaTAI,l'�RMIT FEC(Add 1_incs 1-3 Abuve) S
ADDITIONAL 1NTORMA"C10N --WATfyR MET�,RS ��
. - WA7'ER 11��1'rILS must bc pickecl up and paid for aC Oroao Ciry liall,thcse are on a s�aratcpermi[,
• WATER 1VI1:'1'E1tS mast be sc� and cealed by �nlnu wster Depurtmcol ('lSZ)249-4G00, upon
COrtAplCtion of inetcr instaUAtSnq.
The undersiUncd hereby upplies to thc City of Orono for issuance of a Utility Permit,agrees to do
all work in siriet.�.ccardancc wiih thc ordinanccs of lhe City aod tho rcgul�tions of tho �tatc of
Minncsota,ancl�eartiiic,that all-sttncmcnt�madc on this applicartion;3re,trut and corrcct.
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�PP�icant:.. � :� .,�' � -� ``�( (y��� .. ..... w _� Dat@:�„J� / �./
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�,����` c�� pATE � TIME
CITY OF ORONO CALLED IN l/ � ��C
INSPECTION NO ICE , SCHEDULED / � ,�-.�
PERMIT NO. -� C' I C` ���' OMPLE�
ADDRESS �� � C�'`-� L �,,,�����(� � ��
OWNER `CONTR. b /�l/�(,! ���� ,
TELEPHONE NO. �%���� ��C � � ��L,��
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� DESCRIPTION �_��-�-t-��- ��%��� �-�
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
i ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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��WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED '= ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
OwnerlContractor on site�
� "7
Inspector. �`L �i .�_ � � ��- �
White Copyllnspector's File Canary CopylSite Notice