HomeMy WebLinkAbout2004-P07953 - sewer connection � PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07953
Crystal Bay, Minnesota 55323 Per'mit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 9�isi2ooa
SITE ADDRESS: 1265 Bracketts Point Rd
Wayzata,MN 55391
PID: 11-117-23-32-0010
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Pernut Type: Sewer and Water Permit Pernut Sub-rype(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Highview Plambing Inc. QWNER: Roger O'Shaughnessy
4301 Highview Pl 10562 Estate Drive
Minnetonlca,MN 55345 Eden Prairie,MN 55347
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 1SSUED BY SIGNATURE
�i.es: 1-File(SiQnitures Required), 1-Apnlicant, 1-Monthlv Reoorts, 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
Crystal Bay, MN 55323
GENERAL INFORMATION
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. Pernut 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 peinut card is available on the job site.
5. Utility comiection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Deparhnent(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 pemut does not grant this approval.
7. All wark must be done in accordance with State Code requirements.
8. All work inust be inspected before it is covered. Call(952)249-4600, 24 hour notice required.
JOB SITE ADDRESS: � a �� � R �C K i�►S PU i�,T � �
Occupancy Type: � Residential Commercial
Owner's Name: S'� 2 z�z��r( � ��s� � Phone Number: �c 2- �b�`�d'r b'
Mailing Add►-ess: City: ,��f'k}�� Zip: S 5�3 j
Contractor's Name: (,-{l(�N���w '(�+13 =�NZ7 Phone Number: �s a-4�3- 6 0�
Mailing Address: �/3�� �I�(,t���w,� ���uL City: �T��✓} Zip: ;�S�3Y,g'
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size � inches; material PVLSchd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must 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 minimuin setbacks from drain field and septic tanks= 75'
REQUIRED setback from sewer line= 20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
included for each well,sewer and water connection pemut requested.
3. Posta�e &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
,he undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict
�cordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements
�de on this application e complete, true and correct.
lature of Applican • Gv� Date: I (S ��
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DATE TIME
CITY OF ORONO CALLED IN -�S�'G`
INSPECTION NOTI E SCHEDULED Q'�'_— �ZS�"/ i3� v/
PERMIT NO. U��S COMPLETED �7 -�y °�'•'30
ADDRESS I� CDS g(_G�C ���_�- _ 1'�1-cl�
OWNER CONTR. �-���.J;uJ �P���ti�.
TELEPHONE N0. (���2 �l I C� �y 4 �( � �e I I
� DESCRIPTION �ew�'� ����e�t-�, p �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
y 03 If��TION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 ��k$D. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FIfJ�` 14 SEWER HOO - 06 PROGRESS
� 07 DEMO-SITE PTIC MAINT. 21 COMPLAINT
Q07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� = 09 PLUMBING Rt 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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� ❑WORKSATISFACTORY:PROCEED �(PROJECTCOMPLETE
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W ❑ CORRECT WORK&PROCEED !7 ISSUE CERTIFICATE OF OCCUPANCY
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECT�ON REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-4600
OwnerlContra�ttpr or��ite:
Inspector. �/ I~v�
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