HomeMy WebLinkAbout2005-P08510 - sewer & water connections • PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Pogsio
Crystal Bay, Minnesota 55323 Permit Type: seWer ana water Pe�t
(952) 249-4600 Date Issued: 3iioi2oos
SITE ADDRESS: 781 Boulder Dr
Long Lake,MN 55356
PID: 33-118-23-11-0008
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 pernuts required:
NOTICES/REMARKS:
SAC Paid#P07987- 11/09/04
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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PPLICANT PERMITEE SIGNATURE ISSUGD I3Y SIGNATtJRE
Copies: 1-File(Sienitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
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FOR C[TY USE ONLY �
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� ,��� City of OCono Date Received: _�L Pem�it# �t%�
O} O P•O•Box 66 r,� `�
�,�`,s„ 2750 Kelley Parkway [� [n-House SAC Determination Form Completed ' � .�"1���f 1�'
.� �j?'>�,�� Crystal Bay,MN 55323 `y� `
������i�..�o� (952)249-4600 Approved By(If Required): Y_
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CITY OF ORONO —SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Vlav be subiect to further review and mav not be issued when the annlication is received)
GENERAL INFORMATION T
1. You may apply for utility pernuts 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 connection pernuts 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 peimit 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: ��� ��,c ��2�� ���
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Owner. �, �b�1 �P;���� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: � .� � Contact Person: �r c�.•r ����� �
Address: l�a State License #: C���Y`���
City: c�✓'l Zip: 5"5�� Expiration Date: 1�— ���-�5
Phone: ���1 �?� �l s( Alternate Phone: � �.� � ��� �
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DETERMINING PERMIT FEES j
❑ SAC Charge(2005 Rate=$1,450.00) $ -
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
❑ Sewer Connect'on/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; cast n�on k
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) $ s
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 made on this application are,true and correct.
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Applicant: ----` Date: �-- �O� L�4J
� � D TE -^ TIME ✓
CITY OF ORONO � CALLED IN ���L/�S
INSPECTION NOT CE SCHEDULED �E
PERMIT NO. % S S� �% COMP TED
ADDRESS �� I ���- ��h ��
OWNER CONTR. ��(�-���
TELEPHONE NO.__ _ �� ,� `� 7� ��/ S� , �
� DESCRIPTION �G�J�U�YI
� 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
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FO�LOW-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 WORKSATISFACTORY:PROCEED f� PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CA�L TO ARRANGE ACCESS.
Call for the next spection 24 hours in advance. (J52� 249-460�
Owner/Contract
Inspector.
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