HomeMy WebLinkAbout2006-P09987 - sewer & water connections PERMIT
CITY �F ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Po9987
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
6/14/2006
SITE ADDRESS: 769 Boulder Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0007
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water&Sewer OWNER: Paula Zachman
775 Tower Drive 2466 Dunwoody Ave
Hamel,MN 55340 Wayzata,MN 55391
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 SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-MonthlyReports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE ONLY � ���
0 �City of Orono Date Received: Pem�it# ��
¢ � P.O.Box 66 �
�" � 2750 Kelley Yarkway I ❑In-House SAC Detemiination Fonn Completed
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'�j!'i�,�c�: � Crystal Bay,MN 55323
�a ��'?�}j���. o` (952)249-4600 Approved By(If Required):
t'�sexo�"
CITY OF ORONO — SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by tl;e Building Official and/or Public Works Department*)
(ALL PER�IITS blav be subiect to further review and mav not be issued�vhen the annlication 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. Permit cards will
be sent by rehu'n 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 perinits may be issued to licensed conh�actors only.
6. Contact the Public Works Department(952-249-4600) for utility shib 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 Apply)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑ Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: 7�v I �b�C ��'�f� ,���
Owner: �i�'�l/'���� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor In rmation:
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Contractor: "D � ���c� Contact Person: ,,.�<<� /�-��1��
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Address:���� �� t.J�J� �� State License #: � / �
City: �Y! — :'-� Zip��xpiration Date: / � � / �� �'
Phone: �CO ���� lD �/� Alternate Phone: �� T, � / � � �`� j
DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompairy all sewer permit 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 iron
�]Water Connection/Disconnect/Repair($35.00/Per Stub) $
� Pipe size�inches;material Schd 40 air tested; copper
1. SUBTOTAL of Pennit 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 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 application are, true and correct.
Applicant: �-� ' � Date: � � � � �
��' �-�" �+�°�"�S ��/l.�-�
�( DATE TIME
CITY OF ORONV CALLED IN � �
INSPECTION NOTI p'`/� ��EDULED j ? �
PERMIT NO. pC�O l0 � OMPLETED
ADDRESS ��'� � ��� � G�� ��n �--
OWNER CONTR.�►_T_�� �Z� �'
TELEPHONE NO. �� 3 ��� -��� �' ���
� DESCRIPTION � / / a� �DYI�'i�G�
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. i2 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
i09 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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W WORK SATISFACTORY_PROCEED ❑ PROJECT COMPLETE
� ❑ RRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALI INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-4600
OwnerlContractor on site �-
Inspector.
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