HomeMy WebLinkAbout2005-P08551 - sewer & water permit PERMIT
C�TY �F �R�N� Permit Number:
2750 Kelley Parkway - PO Box 66 Posssi
Crystal Bay, Minnesota 55323 Pe►'mit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 3�3o�2oos
SITE ADDRESS: 752 Boulder Dr
L.ong Lake,MN 55356
PID: 33-118-23-11-0015
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Sub-type(s): Sewer&Water Connections
Permit Type: Sewer and Water Pernut
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Sewer&Water OWNER: Dahlstrom Development LLC
6501 Co. Rd 15 7745 Polaris Lane
Mound,MN 55364 Maple Grove, MN 55311
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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APPLICANT PERMITEE SIGNATURE ISSUED BY S[GNATURE
Copies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
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FOR ITY USE ONLY,� �r�{
,��� Clty Of Or'Ono Date Received: U o'>Permit# ���0�) �
P.O.Box 66
��,� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
� ��'����,�;� Crystal Bay,MN 55323
������o� (952)249-4600 Approved By(If Required):
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval Uy the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the annlication is received)
GENER.AL 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. 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 comiection 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 ANY 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 Apply)
�esidential(May Require Approval) ❑ Conunercial(Approval Required)
,,�New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
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Site Address: ���-� 1���� . �< < ,! �,
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Owner: �-�c� �t /�!'�:�rcc° ���,��� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: ; )�-�5�;���� .����; Contact Person: �`� � j�'"�� � 1��' �r
Address: ��`;c-C ����>. ,E'cd /�� State License#: �'�S�' ���-7�`��
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City: jr✓�.���c' 1�� Zip: ��-� �Expiration Date: f� �/��-'=
Phone: ��5 � ��f ?� ��l�6� Altemate Phone: ��j�-�� �f�`7 ��%
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� ' DETERMINII�TG PERMIT FEE� `
❑ SAC Charge(2005 Rate=$1,450.00) $
(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)
Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches; material '��" Schd 40 air tested; cast uon
�ater Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches;material , - cast iron
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1. SUBTOTAL of Permit Requested: $
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 germit.
■ 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 application are,true and correct.
Applicant: Date: � ` �% C� !
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DATE TIME ✓
CITY OF ORONO POF�SSI CALLED IN
INSPECTION N SCHEDULED
PERMIT NO. COMPLETED �I�S"^�� �- ���-d
ADDRESS �� Z- �a �-�4-� Vv�
OWNER CONTR. W e57�r��s1
TELEPHONE NO.
� DESCRIPTION
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 2�4/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. �ll/WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL `y�SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 2lSEPTIC 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 YOU:_YES_NO
� COMMENTS•
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� RKSATISFACTORY:PROCEED C� PROJECTCOMPLETE
❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W4LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
C INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContractor on s' .
Inspector.
White Copyllnspector's File Canary Copy/Site Notice