HomeMy WebLinkAbout2005-P08552 - sewer & water permit � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Pogss2
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 3�3o�2oos
SITE ADDRESS: 754 Boulder Dr
L.ong Lake,MN 55356
PID: 33-118-23-I 1-0014
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: . Sewer and Water Pernut Pernut Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Perniit 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 SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPL[CANT ITEE SI TURE ISS�IGNA7'URE
Conies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, i-Finance Page 1
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� F R J,TY SE ONLY
� ��� City of Orono Date Received:���(.' L'>�Yermit# ����2
P.O.Box G6
y ��,� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
� ���y�.�� � Crystal Bay,MN 55323
����.�o (952)249-4600 Approved By(If Required):
saxo
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 application is received)
GENERAL INFORMATION
1. You may apply for utility perntits 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 busuiess 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 contractars only.
6. Contact the Public Works Department(952-249-4600) for utility shzb 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 pemut 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 Ap ly)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: ��� %�:<< �J��!' ��(' .
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: - � � `
,�i Contact Person: (� r�
Address: ���}( C.'Ci . ��-%�-L 1 S State License#:
City: �Mt"?r���C"J Zip:`�����Expiration Date:
Phone: (�`�� Y 7�- ��S��� Alternate Phone:
�.
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� DETERMININGPERl�IIT FEES ;
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer pernut applicarions unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid, a sewer connection permit will not be issued)
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�-�ewer Con ect' n/Disconnect/R,e,p�,ir($35.00/Per Stub) $
Pipe size�uiches;material_�<!Schd 40 air tested; cast iron
�Water Connection/Disconnect/Repair($35.00/Per Stub) $ �
Pipe size � inches;material F d; cast iron
�-„���C':n
1. SUBTOTAL of Peimit Requested: $
2. STATE SURCHARGE $ .50 R
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
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 application are,true and correct.
�
Applicant: Date:
�' � ��u ��
DATE TIME
�
C1TY OF ORONO CALLED IN
INSPECTION N I SCHEDULED
PERMIT NO. ���S Y COMPLEfED ��5 ( Z-a'�
ADDRESS �S`i �°�� �2
OWNER CONTR.
TELEPHONE N0.
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� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 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 OS 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 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: Se�.�--Q-� -� w�\ �-01� ..�
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W ❑WORKSATISFAC ORY:PROCEED ❑PROJECTCOMPLEfE
� ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITNIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION AEQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor 't
Inspector.
W ite Copy/l�spector's File Canary CopylSite Notice