HomeMy WebLinkAbout2006-P10165 - sewer disconnect PERMIT
CITY OF ORONO Permit Number:
2750 Kel!�y Parkway- PO Box 66 P1o165
CryEtal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: 8/1/2006
SITE ADDRESS: 1430 Cherry Pl Unit#
Mound,MN 55364
PID: 08-117-23-33-0015
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 Vatuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Sewer&Water OWNER: Glenn Solie
6501 Co. Rd 15 1430 Cherry Pl
Mound,MN 55364 Mound MN 55364
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.
�_--
���c 7�;��1�-�� �_� ��!_-�,�'��.�. L- �_ �-�� ,
�-`-,
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE � /! "
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
6 �
FOR C[TY USE ONLY
0 City of Orono Date Received: Permit#
¢ � P.O.Box 66 �� �
��;,v,,,. � 2750 Kelley Park�vay ❑In-House SAC Determination Form Completed � � '1�
a ji��,�� � Crystal[3ay,MN 55323 , � 2��
�� q�� ��o o` (952)249-4600 Approved By(If Required): ���
t t�i�'�$v
Mr�Ho
CITY OF ORONO —SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- May be subiect to[urther review and mav nat be issued when the application is received)
GENERAL INFORMATION
1. You may apply for utility pennits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will
be sent by rehun mail within 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the pennit card is available on the job site.
5. Utility connection pemuts may be issued to licensed conhactors only.
6. Contact the Public Works Deparinlent(952-249-4600)for utility stub as-built locations.
DO NOT EXCAVATE Il\'ANY STREET AND DO NOT TAP ANY MAIN�vithout express
approval of the Public VVorks Department. Issuance of a pernut 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 ApplY)
0'1�esidential(May Require Approval) ❑ Conunercial(Approval Required)
❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs [`��isconnect
Job Site/ Owner Information:
Site Address: ��� �T r t
Owner: �/�' � U� t�--`,'i1� ) Mailing Address:
City: Zip:
Home Phone: Altemate Phone:
Contractar Information:
Contractor: ��'St���- Contact Person: `- l �
Address: �S�1 �� �L� � �` State License#: 1 (�� -1 �� .
City: �U� Zip:553��Expiration Date: /� � � t- �' �
Phone: �I S Z- �7 L_ `I �l'�(O Alternate Phone: � �Z- �� � ~ Y�� (
.
•
- DETERIVIINING PERMIT FEES :
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued) �_
�%
� �Ci
❑ Sewer Conne tion/Disconnect/Repair($35.00/Per Stub) $ �
Pipe size � �' uiches;material Sclid 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: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applicarions) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATION—WATER ivIETERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut.
■ 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 ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this app]ication are,true and con-ect.
` ! ���1 �_
�/lJ�e S��-�/�(� ��:�._ � -c�(o
Arplicant: Date:
(�� l/`/ I I'�''l'Q� DATE . �`��
V CITY OF ORONO CALLED IN ��
INSPECTION N gTICE SCHEDULED �� �
PERMIT NO. r � ��� �D� COMPLETED
ADDRESS � C
OWNER CONTR. ���,��ILQ_
TELEPHONE NO. �5� " � �a" y9�OCl� `s � w
� DESCRIPTION C�--�-�'-E� � C`� ��C�
� 01 FOOTING 11 MECNANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FR,qMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET Y04� YES_NO �
� COMMENTS: � G `G�.��d.�_
a ��e� f
�
�
0
� C�
o � �/
�
W
�
Q
�
Z
W
�
W
�
�
� �ORK SATISFACTORY:PROCEED � PROJECT COMPLETE
W ❑ ORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. CPHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR '-�CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-4600
OwnerlContractor on site:
Inspector. �_ r� ��
White Copyllnspector's File Canary CopylSite Notice