HomeMy WebLinkAbout2004-P07964 - sewer & water connections PERMIT
CITY C-: ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po�964
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: 9�20�2004
SITE ADDRESS: 793 Boulder Dr
I.ong Lake,MN 55356
PID: 33-118-23-11-0013
DESCRIPTION:
Proposed Use: Residential
Pemut Class: General
Permit Type: Sewer and Water Permit Pemut Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid on 9/9/04 P07896
FEE SUMMARY: Permit Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: �'estonka Water& Sewer OWNER: 7ohn 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 P ITEE SIGNATURG ISSUED BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
(Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Ke11ey Parkway) SEWER/WATER & SAC
Crystal Bay, MN 55323
GENERAL INFORNIATION
L You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown belo�v. Pernut cards will be sent by rehirn mail the same day '
the application is received. ,;, �i+�
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3. Permits are not valid until��ou receive a permit card. (i,`� "`' (��`� -
4. Work must not begin unless the peinut card is available on the job site. �I� [ r; �1 ��
5. Utili ty coivlection pernuts ma y Ue issued to licensed contractors onl y. � C
6. Contact the Public Works Departmevt(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND ':
DO NOT TAP ANY VIAIN without express approval of the Public Works Deparhnent. Issuance of a pernut does not grant this approval. `
7. All�vork 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 required.
JOB SITE ADDRESS: '��'1� �%�� `�C-� ��,'
Occupancy Type: � Residential Commercial
Owner's Name: � �l���;.,u� �„ S Phone Number:
Mailing Address: _ City: � Zip: �
Contractor's N1me: ��-; ,,,�'� 5�/�� Phone Number: �5.� � �f7-�- yS5-j
Mailing Address: (���( � . ,�- _ ��� City: ;�c.�-�-,cj Zlp: S`��� �/
PERMIT TYPE �omlections ❑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 prepaid, a sewer connection will not be issued)
Municipal Sewer nection/Disconnect/Re air ($35.00 per stub) $
pipe size inches; material ��chd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Re air (�35.00 per stub) $
pipe size ,�— inches; material�opper; other
WATER METERS nrust be picked up and paid for at City Hall.
Water 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 tanlcs = 75'
REQUIRED setback froin sewer line= 20'
PERMIT FEE CALCULATION
1. Subtotal of above pennit requested $
2. State SurcharQe $ .50 (Minimum)
The State Building Code Division Surcliarge of$.50 per pernut must be
included for each well,sewer and water connection pennit requested.
3. Postage & Handlin� (Only mail-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 Minnesota, and certifies that all statements ;
made on this application are complete, true and correc
,
Signature of Applicant: ' Date: ����/
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/1DAT€/1 TIME
CITY OF ORONO CALLED IN �7����J
INSPECTION N TICE SCHEDULED �j. 27-b�G %
PERMIT N0. D COMPLETED
ADDRESS �-� �
OWNER CONTR. ��S J�
TELEPHONE NO. g5 Z S�7 2- Tq�
� DESCRIPTION `� �� �� �
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/ RADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED f7 PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �, pH0T0 TAKEN
INSPECTOR WILL RETUflN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (J52� 249-4600
Owner/Contra��C�n it :
Inspector. '�
White Copyllnspector's File Canary Copy/Site Notice