HomeMy WebLinkAbout2008-P11899 - sewer/water permit ' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Pi 1899
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued:
3/3/2008
SITE ADDRESS: 2470 Cobblestone Ct Unit#
Long Lake,MN 55356
P��� 33-118-23-11-0080
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Scparate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Sewer&Water OWNER: O.T. Development, LLC
775 Tower Drive 2670 Kelley Pkwy
Hamel, MN 55340 Orono, MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK 1N STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PGRMITEE SIGNATL`RE LJED BY SIGNATUKE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,([f Septic, 1-Septic) Page 1
FOR CITY USE ONLY
"J�,��\` City of Orono Date Received: Pennit#
;jOg `�`��" P.O.Box 66
� *+,,.;;., 4� 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed
��� ij��,,�,- �� Crystal Bay,MT�'S5323
��`�" r,r�*�,S`� (952)249-4600 Approved By(If Required):
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by thc Building Official and/or Public Works Departnent*)
(ALL PERMITS- Mav be subiect to further review and mAv not be icsued when the aoulication is received)
GENERAL INFORMATION
1. You may apply for utiliry permits 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 permit 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 locations.
DO NOT EXCAVATE In ANl'STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a permit 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 A I )
�Residential (May Require Approval) � Commercial(Approval Required)
� New Connection � Additional Connection �Re-Connection � Repairs � Disconnect
Job Site/Owner Information:
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Site Address: �,` � �L� �� � /� � l'���C,1 �
Owner: � L."�,L�� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
�
Contractor: �'� Contact Person:
Address:�� 5 �D Gv (� l/� State License #: �l Z `�
-` C
C�ty: � Zi��yUExpiration Date: � � �� d �
Phone: ��� ��� �� Alternate Phone: ��� �J� � ��� C�/ �
DETERMINING PERMIT FEES
� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany ali sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�ewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size i.�inches;material Schd 40 air tested; 0 cast iron
�`
`�Water Connection/Disconnect/Repair($35.00/Per Stub) $
� Pipe size�inches;materia��_ Schd 40 air tested; � copper
1. SUBTOTAL of Permit Requested: $
3. 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.
■ N'ATER 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 application are, true and correct.
T � ^ i
Applicant: Date: � ��
Reset Form
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E TIME �/
CITY OF ORONO CALLED IN ��
INSPECTION NO ICE c SCHEDULED � �
PERMIT NO. �� / COMPLETED
ADDRESS a��7� Cobb/Ps� G�-
OWNER CONTR. �S'1�L/1 ��
TELEPHONENO. ��3-`�7��(�7�� �i�-9�9 - �af7
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� DESCRIPTION dS�GC�P�� � Gv� ���G�1 d-j'L,
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
� ❑ 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
v ❑ 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:
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o�WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �952� 249-46��
OwnerlContractor on site:
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Inspector. (.+,� �
White Copyllnspector's File Canary CopylSite Notice