HomeMy WebLinkAbout2004-P07965 - sewer & water connection CITY OF R N PERMIT
O O O Permit Number:
2750 KP,F,�ey Parkway - PO Box 66 P07965
Crystal�Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 9�2o�2ooa
SITE ADDRESS: 791 Boulder Dr
Long Lake,MN 55356
PID: 33-118-23-11-0012
DESCRIPTION:
Proposed Use:
Permit Class: General
Permit Sub-type(s): Sewer&Water Connections
Pernut Type: Sewer and Water Pernut
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
SAC Paid 9/10/04-P07895
FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: �'estonka Water&Sewer OWNER: John Terrance Homes, LLC
6501 County Rd 15 8266 Xene 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 STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE 1 SUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC
Cryscal ��y, MN 55323
GENERAL INFOR�VIATION
l. You may apply for utility pernuts by mail or in persov at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown belo�v. Pemut cards will be sent by return mail the same day
the application is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pemut card is available on the job site.
5. Utility connection pernuts may Ue 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 PuUlic Works Deparmlent. Issuance of a pemut does not grant this approval.
7. All work must be done in accordauce with State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600, 24 hour notice rec�uired. jJ(�
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JOB SITE ADDRESS: � �� ��YL'�� ��. �v � �1�, � "
Occupancy Type: � Residential Commercial '; ��
Owner's Name:�`��j ,.����r�„� ((-�.�.c,s' Phone Number:
Mailing Address: City: --� Zi�:
Contractor's Name: ����,����,� Phone Number: ��S�? �f 7-t- ���
Mailing Address: �S� �a. �� �5 City: �c%��� , Zip: S3-3G "
PERMIT TYPE �Coiuiections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer pennit applications unless prepaid.
(If not p►•epaid, � sewer connection will not be issued)
Municipa( Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material�Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair($35.00 per stub) $
pipe size�inches; material�copper; other
WATER METERS niust be picked up and paid for at City Hall.
W�ter meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks =75'
REQUIRED setback from sewer line = 20'
PERMIT FEE CALCULATION
1. Subtotal of above pei7nit requested $
2. State Surcharae $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
iucluded for each well,sewer and water connection permit requested.
3. Postage & Handlin� (Only inail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
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 Mimiesota, and certifies that all statements
made on this application are complete, true and correct.
Signature of Applicant: � Date: �--2� - �`�
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9 �q/�I.T� TIME
CITY OF ORONO CALLED IN �'��
INSPECTION N �C�6� SCHEDULED - Z -4 J�.��D
PERMIT NO. COMPLETED
ADDRESS `7� �-�
OWNER CONTR. �
TELEPHONE N0. 9S 2 �7 2. . ��5�
� DESCRIPTION � �b�
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� 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
Z
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED i� PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑ Ct�RRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-4600
Owner/Contr�`�ite:
Inspector.
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