HomeMy WebLinkAbout2008-P12056 - sewer/water disconnect ! ►
PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P12056
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 5/12/2008
SITE ADDRESS: 1885 Concordia St Unit#
Wayzata,MN 55391
PID: 17-117-23-23-0002
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnecti�
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: Hagberg Excavating Inc OWNER: Robert Mack
34497 Nacre St 1885 Concordia St
Princeton,MN 55371 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 REQUIREM6NTS.
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APPLICANT RM ' E SIGNATGRI: ISSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), l-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FO CIT iJSE ONL]'
�- �(�"` City of Orono Date Received:..�/ � Permit# fo1D S
„O�¢' '�'p�l P o.8��;��
,;... . � 2750 Kelley Parkway ❑ln-House SAC Determination Form Completed
�il� tj�R � ��� Crystal Bay,MN�5323
�d 'i� r GJ (952)249-4600 Approved By(Ifi Required):
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CITY OF ORONO-SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval bl'the Building Official and/or Public Works Department*)
(_ALL PF,RMITS- �1av be subiecf to further review�nd mav not be icsued when thr apn��cation is received)
GENERAL INFORMATION
1. 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 below. Permit cards wili
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 permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations.
DO NOT EaCAVATE IN ANY STREET AND DO NOT TAP ANl' MAIN without express
approval of the Public Works Department. Issuance of a permit 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 A 1 )
�Residential(May Require Approval) � Commercial(Approval Required)
� New Connection ❑ Additional Connection � Re-Connection � Repairs �Disconnect
Job Site/Owner Information:
Site Address: � ��J� ��y� �j iy���/ � �
Owner: i�_ �,� � Mailing Address:
City: D ,�v- zip:
Home Phone: Alternate Phone: G�/�-,3(0_ '-�/yc,�
Contractor Information:
Contractor: ������ � Contact Person: � � ��
Address: ,����G��� S � State License #: Zoo-S= /8S'�
City: r�' - Zip:�� Expiratio�� Date:
Phone: �G3-Z1-3� yl�l/ Alternate Phone:
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' DETERMINING PERMIT FEES
� SAC Charge(2007 Rate=$1,675.00) �
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if appiicable)
(If not prepaid,a sewer connection permit will not be issued)
� Sewer Connection iscon t/Repair($35.00/Per Stub) $ ��' �
Pipe size �" inches;material Schd 40 air tested; � cast iron
� Water Connection Disc nnect/Repair(535.00/Per Stub) $ ��• �
Pipe size�inches;material �>> Schd 40 air tested; � copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ ,5p
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 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 Cit} of Orono for issuance of a Utility Permit, agrees to do
all work in strict accordance with the ardinances of the City and t11e regulations of the State of
Minnesota, and certifies that all statements made on this application are, true and carrect.
Applicant: Date: �—IZ—�
Reset Form
� —� � DATE TIME V
CITY OF ORONO CALLEW�,G u� � �'-,�
INSPECTION T2ICE SCHE6trn��--t� - v
PERMIT NO.��I�� COMPLETED '
ADDRESS /�'�.� ��-�� �� -
OWNER CONTR.� a✓'�t-�i
TELEPHONENO. ��3 - �g�^��P`� � �
� DESCRIPTION Uv��� �u��� �-5���
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W'�WORK SATISFACTORY:PROCEED f_l PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
Q ❑ CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CALITOARRANGEACCESS.
Cal1 forthe next inspection 24 hours in advance. (952� 249-4600
OwnerlContractor on site:
Inspector. „ /
White Copy/lnspector's File Canary CopylSite Notice