HomeMy WebLinkAbout2005-P09411 - sewer disconnect PERMIT
CITY OF ORONO permit ►vumber:
2750 Kelley Parkway- PO Box 66 Po9411
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued: 11/9/2005
SITE ADDRESS: 3925 Cherry Avenue Unit#
Mound,MN 55364
PID: 08-117-23-33-0086
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved perresolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 vatuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Sewer&Water OWNER: Re-Creations,Inc
6501 Co. Rd 15 835 Fox Path Ct.
Mound,MN 55364 Hamel,MN 55340
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 CODE REQUIREMENTS.
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APP ICANT PERMITEE SIGNA I'URE ISSUED BY SIGNATURE �
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
.
FOR CITY USE ONLY
40� City of OrOnO Date Received: Pennit#
P.O.Box 66
��7;;,,,, � 27�0 Kelley Parkway ❑in-House SAC Determination Form Completed
a� ���'� ��;{ � Crystal Bay,MN 55323
���,��r�w$o` (952)249-4600 Approved By(If Required):
sexo$
CITY OF ORONO —SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Worhs DeparM�ent*)
(ALL PERMITS- Mav be subiect to further revie��and mav not be issued when the�pnlication is received)
GENERAL 1NFORMATION
L You may apply for utility pernuts 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 pernut 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 locatioi�s. '
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a peinut does not grant this approval.
7. All wark 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 Apply)
,�Residential(May Require Approval) ❑ Commercial(Approval Required)
( _
❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs �Disconnect
Job Site/ Owner Information:
Site Address: ���� �•'�`��'l //'� :
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
WL"J 4`1�nI/"� , �
COI1tT'aCtOT: • � ��/C�s.'f � �
1� �c,✓ Contact Person: ��
�'j�� CCi ,�� I� State License #: ��y��l
Address: r 4
City: �/1/1�,�-✓�� Zip:���Expiration Date: ���� ��{'�
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Phone: C`��-�i��7�" `�l��o Alternate Phone: ���'z I 7`���!7 7`��
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" DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Se�ver Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size �{ inches;material Schd 40 air tested; cast iron
❑ Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $
n
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 f
all work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements mad n this application are, true and correct.
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Applicant: � Date: ���'��
�� � �� � � ✓
DATE � TIME
CITY OF ORONO CALLED IN E "�
INSPECTION NOTICE SCHEDULED 1!- ��'C� �
PERMIT NO. ('<��t�( I I COMPLETED
ADDRESS � �c� � �--�'-X-�L`-� C���-�- -
OWNER CONTR.i.�laP S1Z'�-�C�- S`� ('�-�
TELEPHONE NO. ( U � �' 7Yf l�7 C�
� DESCRIPTION J-��-�-'� �� t S� Uv1� L�
L� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 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 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 ?LUMBiNG RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO /
c�n COMMENTS: pb g�� 1%
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED L ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n t inspection 24 hours in advance. (952� 249-4600
OwnerlContr ite:
Inspector.
White Copyllnspecto s File Canary Copy/Site Notice