HomeMy WebLinkAboutpermits, etc from old PID# PERMIT
CITY OF Ci�ONO PERMIT TYPE:
1335 Browre�Rd. South • P.O. Box 66 ��``''�'����i���
Permit Number: �}r.',�,7�_=��
Crystal Bay, Minnesota 55323 Date Issued:
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(612) 473-7357
SITE ADDRESS:
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FEE SUMMARY:
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' CONTRACTOR: — �F���1 i c�?�t. — OWNER:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
. _
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CITY OF ORONO ` �' `' ' �
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APPLICATION FOR MECHANICAL PERMIT
G��2AT. INFORMATION _ -�--
1. You may apply for mechanical permits by mail or erson, at the City
offices. Mailed-in permits are subject to the posta���a�.d2h��ing fees
shown below.
2. Permit cards will be sent by return mail the same day the application is
received. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORR MUST .NOT
BEGIN UNTIL THE. PERMIT CARD IS POSTED ON .THE_.JOB. .SITE.
3. When any new construction or remodeling is involved, a separate building
permit must be obtained.
4 . All work must be done in accordance with State Building Code requirements.
5. AI1 work must be inspected (rough-in and final). CaI 1 473-7357. 24-hour
notice required.
6. House Heating Test Record must be submitted before final.
INSTRIICTIONS Complete all items on this application. Compute the permit fee.
Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
If you have questions, call 473-7357.
WALR-IN PERMITS apply at City Offices, 1335 South Brown Road (Cty. Rd 146)
MAIL-IN PERMITS enclose fee - Mail to: P.O. Box 66, Crystal Bay, MN 55323
********************************************************************************
Please check one: New Addition Repair Replace
JOB SITE: �-�. ; Zip:
Owner' s Name: - �;_„-. , - Telephone Number:
Mail�ng �ddress: .,_ - City ' .,. .. Zip '
Contractor' s Name. �, , , , Telephone Number:
Mailing Address , .,; : City:J . Zip: -
***************************************************-****************************
MINIMUM FEE ( $30. 00 per project)
********************************************************************************
SYSTEM DESCRIPTION: $15. 00 each unit
Heating Systems:
Quantity: �I
Make: �',...,._. � . __. . .
Model: -
Fuel:
Flue Size:
Input BTUs:
Output BTUs: �� r.,< -
CFM:
********************************************************************************
Cooling Systems:
Quantity:
Make• �
, ,. , . _
�
Model: �
Tons:
H.Power:
********************************************************************************
�� ��� �
, � .
*WOOD BDRNING EQIIIPMSNT $15.00 each unit
Wood stove with flue
Wood combination or add-on unit
Factory fireFlace with flue
Factor Fireplace (s) freestanding Masonry--
Wood Stove (s ) franklin, other
BrandName Model No.
Mfgr' s Min. , Clearances, side , rear , min. flue dia.
Total
********************************************************************************
VENTILATION $15.00 each project
No. Ritchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
Total
********************************************************************************
FIIEL STORAGE (must be approved by fire marshal)
' $30 . 00 Permanent/Temporary
Fuel oil, gallons underground inside outside
LP Gas, gallons
Other Gas opening
********************************************************************************
GAS LINE INSPECTION
High/Low Pressure $15.00
�**��***�t*�t:+��r**�t**************************************************************
PERMIT FEE CALCQLATION
l. Total of above Installations or Minimum Fee ($30.00) $ ;c_,c
2. State Surcharge. Add the State Building Code Division
Surcharge to each permit $ . 50
3. Postaqe and Handling on all mailed-in applications, $ 1.50
4. TOTAL PERMIT FEE add lines 1-3 above $ �__
The undersigned hereby applies to the City of issuance of a Mechanical Permit,
agrees to do all work in strict accordance with the ordinances of the City and
the regulations of the Minnesota State Building Code, and certifies that all
statements made on this app lication are complete, true anc7 correct.
�'
App licant' s Signature: /, � '-' Date: - - �
.
. STANDARD HEATING & AIR CONDITIONING C0.
' SERVING THE TWIN CITIES SINCE 1930
IEAT LOSS CALCULATION FOR NASH 10'092 CDS
.---------------------------------------------------------------------
IRST LENGTN 33 WIUTH Z4 NEIGHT d
-----------------------------------------------------------------------
WINDOWS & DOORS - CRACK�GE AND AREA
WIDTH HC-IGHT N0. LIN FT AREA
10. PANE PANE LIGHTS CRACK S(� FT
1 28 16 Z 14.3 8.399999
2 28 24 2 34 24
4 2�3 20 2 62.7 40.9
1 28 80 DD 29.3 31 .1
1 34 80 DD 31 .3 37.8
1 36 80 D 19.3 20
1 32 80 D 18.7 17.3
CO�FF BTU 11/+ R. FT
NFILTRATION . . . . . . . . . . . . . . . . . 209.6 20 4192
��Ass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 50 9000
:XP WALL . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
JET EXP WALL. . . . . . . . . . . . . . . . . . . . . . . . 960 1> 12�F80
fELOW GRADE. . . . . . 6 . . . . . . . . . . . . . . . . 6II4 5 3420
;EILING. . . . . . . . . . . . . . . . . . . . . . . . . • - - - � 0 0
LOOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792 3 2376
IENTILATION. . . . . . 0 . . . . . . . . . . . . . . . . 0 0 0
�OTAL BTU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'i1468
--------------------�--------------------------------------------------
�ECUND LENGTH 24 WIDTH 33 HEIGHT 8
----------------------------------------------------------------------
WINDOWS & DOORS - CRACKAGE AND AREA
WIDTH HEIGFIT N0. LIN FT AREA
J0. PANE PANE LIGHTS CRACK SQ fT
1p ?� ZO 2 15h.7 102.Z
COEFF BTU 11�� R. FT
:NFILTRATION . . . . . . . . . . . . . . . . . 156.7 20 3134
�LASS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.2 48 4905.b
:XP WALL . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
JET EXP WALL. . . . . . . . . . . . . . . . . . . . . . . . tSU9.tS 12 9711.59y
3ELOW GRADE. . . . . . 0 . . . . . . . . . . . . . . . . 0 5 lJ
:EILING. . . . - - • . . . . . . . . . . . . . . . . . . . . . . 792 10 792_0
�LOOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0
/ENTILATION. . . . . . 0 . . . . . . . . . . . . . . . . 0 0 0
fOTALBTU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25677.2
fOTAL BTU OF ALL ROOPIS/FLOORS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57145.2
-
. � PEI�MIT
�' G'ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: '`���' ��' ���'��"i
Orono, Minnesota 55356-0815 Date Issued: `"�`"'���-�'r`w
(612) 473-7357 �is:;;`;�;.�;''�::=:
SITE ADDRESS:
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DESCRIPTION:
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APPLICANT-PER I E SIGNATURE ISSUED BY:SIGNATURE -��
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., CITY OF ORONO APPLICATION FOR UTILITY PERMITS
- Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323
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 fees shown below. Permit cards will be sent
by return mail the same day the application is :eccived.
3. Permits are not valid until you receive a per�iit 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(473-7357)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 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 473-7357.
24 hour notice required.
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JOB SITE ADDRESS: ��� � �'�E s'� �' ����-� ��' .-�-
Occupancy Type: c.,---'�" Residential Commercial
Owner's Na.-ne• PhoneNumber•
Mailing Address: City: 7ip:
Contractor's Name:S`�-��a k���.5 �1....,��i N y Phone Number: �! � o ; �u`�
Mailing Address: l ��� p �-��� �-�.� -, �Z�S2 City:�_n��+,;��- 7ip: ��3'� i
PERMIT TYPE
Municipal Sewer Connection ($35.00 per stub) $
pipe size inches; material PVC (on sand fill); cast iron
SAC Charge ($750.00) must accompany all sewer permit applications unless prepaid. If not
prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at Ciry Hall.
(5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00)
Separate Plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department (473-735'� upon
completion of ineter installation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback from sewer line = 20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50
The State Building Code Division Surchazge of$.50 per permit must be
included for each well, sewer and water connection permit requested.
3. Postage & Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERNIIT FEE (add lines 1-3 above) $
The undersigned hereby applies to the Ciry 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
correct.
Si ature of A licant: � � a�----- �� 4 � `
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PFRIVIIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 , _������� '�; ��� �:��;.�f-;
Orono, Minnesota 55356-0815 � s Permit Number: ;�,;_;�_,i�r�; �,��
(612) 473-7357 Date Issued: M1._,j;� :;.;_�::;
SITE ADDRESS:
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APPUCANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323 � �
GENERAL INFORMATION
1. You may apply for utility pemuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent
by return mail the same day the application is :eceived.
3. Permits are not valid until you receive a per�iit eard.
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 (473-7357)for utility stub as-buil[locations. DO NOT EXCAVATE
IN ANY STREET AND DO NOT TAP ANY 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 473-7357.
24 hour notice required.
JOB SITE ADDRESS: �,7� �'i�������-�'"
Occupancy Type: Resi ential Commercial
Owner's Na.-ne• PhoneNumber:
Mailing Address: City: Tip:
Contractor's Name: ` PhoneNiuY}ber: 1��� -/�y�
Mailing Address: City: ' T�: � '
PERMIT TYPE
Municipal Sewer Connection ($35.00 per stub) $
pipe size inches; material PVC (on sand fill); cast iron
SAC Charge ($750.00) must accompany all sewer permit applications unless prepaid. If not
prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
`'VATER METERS must be picked up and paid for at City Hall.
(5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00)
Separate Plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department (473-735� upon
completion of ineter installation.
REQUIRED minimum setbacks from drainf'ield and septic tanks = 75'
REQUIRED setback from sewer line = 20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50
The State Building Code Division Surcharge of$.50 per permit must be
included for each well, sewer and water connection permit requested.
3. Posta�e & Handlin� (Only mail-in applications) $ 1.50
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
correct.
Signature of Applicant: _ � �� �� '�� `�-�
QATE TIME
CITY OF ORONO CALLED IN �/��
INSPECTION NOT CE SCHEDULED
PERMIT NO. --j�/�-' COMPLETED � �� �� 'Z�3
ADDRESS ��D�/�1��r/o..f
OWNER �f�r� CONTR.�6s��l�
TELEPHONE NO. ��� "�'��s
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 16 WEL�TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINA� 18 EXCAVIGRADING/FILLING
y 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORENVETLANDS
� 04 WALL BD. 12 WATER HOOK-UP 34 TREE FEMOVAL
Z
Q 05 FINAL 13 METER S€ RN ON 17 SITE INSPECTION
� 07 DEMO—SITE EWER HOOK-UP O6 PROGRESS
� 07 DEMO—FINAL AINT. 21 COMPLAINT
= 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTIC FINAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. L pHOTO TAKEN
INSPECTOR WILL RETURN
C STOP ORDER POSTED.CALL INSPECTOR
❑ CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hdurs in advance.47�7357
OwnerlContractor on ' `
Inspector. _
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� �'ERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ;�;;f��i_f7 T{,i��
Crystal Bay, Minnesota 55323 Permit Number: �ft �;`�=_�.7
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Date Issued:
(612) 473-7357 i k�.i'�:t,i:tr�;
SITE ADDRESS:
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DESCRIPTION:
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Gi?-r�t,� �:�_���f= f�.;�. ;��i . ;�:�'�:I L��i�l'T I t�L
REMARKS:
FEE SUMMARY:
4fri�.�3H� .�.l�I�'� �'i;_i �.t�)t)
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CONTRACTOR: OWNER: _ �.��:,�-,�. ; L��-Ef. _
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A� ANT-PERMITEE SIGNATURE ISSUED BV:SIGNATURE ,�-�•
..
' Total Fee: � '��.�'Is DateReceived:
Date Approved:
Entered By: �.�'�. Pe���' 1�9�
CITY OF ORONO - BUII1DI�tG PERNIIT APPLICATION
ALL IYFOR1tiIATION I�IUST BE SL`BI�LTT'I'ED IN FULL BEFORE PL�'�t REV�tiV tiYII.L
BESTARTED
---------------------------------
-----------------
—_----�-- --------------
THE APPLICr�Y'T IS: (circle one) �WNER OR ONTRACTOR
JOB SITE
�nnxEss: � �� �� �� �/��c� v'� z�e: �� S �
NANIE OF O`VNER:� C/ � �' PHONE: (home) �1.�'�'�
(w•ork)
i�1AILINGADDRESS�2� �f�%s�7/'/<'cJ p _CITY:��v' ri' ZIP: S, .S–
,
CONT'RACTOR: PHONE:
. 1-IOBILE PHOivE/PAGER:
MAILING ADDRESS: CITY: Z�:
STATE LICENSE: #
ARCHII'I'ECT/ENGINEER: PHONE:
I�IAILING ADDRESS: CITY: ZIP:
NAivIE: REGISTRATION #
TYPE OF W4RK: New Addition Accessory Structure
Move RemodeUAlteration Land Alteration
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PROPOSEDWORK(describeindetail): % -S
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BE ROOMS: GARAGE STALLS: ATT. � DET.
ESTi�i IATE�C�
NSTRUCTIONVALUATION(eYcludingland): $ �
I hereby apply for a buildin� permit and I acknowled�e that the information above is complete
and accurate; that the work will be in`co ormance with the ordinances and codes of the City
and with the State Buildin� Code; that u�derstand this is not a rmit and work is not to start
without a permit; and that the work 1 il be in�acco � ce the approved pljn.
/ ; � �
� NATITRE: =�% �� DATE: �
APPLICAN'T S SIG
� Parade o Homes events r quire separate permit approval by Polic � epartment and
NOTE•
C'ity Council 60 days prior to the event. Non perm i t t e d e v en t s w i 1 1 n o t b e a l l o w e d.
..�-
:
Sec.13.04 RIGHTS OF SUBJECTS OF DAT?�
Subd. 1. Type of data. The righCs of individual on w6om the data is stored or to be stored shall be as se[forth in this secdon.
Subd.2. Information reqirired to be�ven individual. ,�.n individual asked to supply private or confidendal data concerning himself shall
be informed of: (a) the purpose and incended use of the requested data within the collecting'stace ageocy, po(irical subdivision, or stacewide system;
(b)whecher he may refuse or is legally required to supply the requested data:(c)any lmown consequence arisiflg from tvs supplying or refusing co supply
private or confidendal data;and(d)che idenary of ocher persons or enades authorized by state or federal law to receive�he data. This requirement shall
not apply when an individual is asked to supply invesdgadve dac�t, pursZtant to secdon 13.82, subdivision 5, to a law enforcemen[o�cer.
The commissioner of revenue mav place the noace required under this subdivision in the individual income rax or orooem raz refund
instrucrions instead of on[hose forms.
Subd. 3. Access to data by individual. lipon request to a responsible auchoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and wherher it is classified as public, private or contidendal. Upon his fur[her request,an individual who is the subjec�
of stored private or public data on individuals shall be shown thz data wichouc any charge to him and, if he desires, shall be informed of the content
and meaning of[hat data. Afrer an individual has been shown[he priva[e dara and informed of i[s meaning, [he daea need no[be disclosed to him for
six months chereafter unless a dispure or acdon pursuanc ro this secaon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall pro�ide copies of the private or pubiic data upon request by[he individual subject of the data. The responsible authoriry
may require the requesdng person to pay che accual costs of making, cerrifying, and compiling che copies.
The responsible authoriry shall comply immediate(y, if possibie, wich aay request made pursuant to this subdivision, or wi[hin five days of
the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply wich the requesc
within that time,he shall so inform the individual,and may have an addidonal five days wi[hin which to comply with the request,excluding Saturdays,
Sundays and legat holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accucacy or completeness of public oc private
data conceming himself. To exercise[his right,an individual shail noafy in wriang the responsible authoriry describing the nature of the disagreement.
T'he responsible au�horiry sha11 wirhin 30 days either: (a)correcc the data found to be inaccurace or incomplete and attempt to norify past recipients of
inaccurate or incompfete data, including recipients named by che individual; or(b) nodfy the individuai that he believes the data to be correct. Data
in dispute shali be disclosed only if che individual's statement of disagreement is included with the disclosed data.
The de�ermination of the responsible au[hority may be appealed pursuant to the provisions of the administradve procedure act relaang to
con�ested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish cenain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require chat the City deny the perm.it or license.
3. The information may be shared with other local, state or federal a�encies to the extent necessary to process
the permit or license.
4. If your requested perm.it or license requires Council action to approve, some information may become
public.
5. You have certai.n rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit. �
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Signacure
� i PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po2339
Crystal Bay, Minnesota 55323 Pet'mit Type: Mechanical Permits
(612) 249-4600 Date Issued: 4i�4ioo
SITE ADDRESS: 27o Crestview Ave
LONG LAKE, MN 55356
PID: OS-117-23-14-0009
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Mechanical Permits Permit Sub-type(s): Fireplace
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: � 2,000.00
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 36.00
APPLICANT: FIRESIDE CORNER OWNER: DOUGLAS L NASH ET AL
2700 N FARVIEW LANE 270 CRESTVIEW AVE
ROSEVILLE, MN 55113 LONG LAKE MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK 1N STRICT COMPL[ANCE W[TH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII,DING CODE REQUIREMENTS.
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APPLI ANT PERM E SIGNATURE ISSUED BY SIGNATURE
Copies: City,Applicant, Assessor, Finance Page 1
CITY OF ORONO APPLICATION FOR MECHANICAL PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GENERAI, INFORMATION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within 2 working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Mechanical Designs - Complete calculations, details and specifications are required for each heating, .
ventilation, humidification-dehumidification, and air conditioning installation including heat loss/heat gain �
calculation, design temperatures, equipment ratings and identification as to type, manufacturer and model.
Data shall be presented on form provided. Identification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remodeling is involved, a sepazate building permit must be obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected (rough-in and final). Call 249-4600. 24-hour notice required.
7. House Heating Test Record must be submitted before final.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 249-4600.
Please check one: )'�-New Addition Repair Replace
� Residential Commercial
,,
JOB SI'I`E: � 7� C�'i�.�. ��',z�i` f;:��'� Zip; _�-.5-�'; �-,
Owner's Name: ���.:�,� � Telephone Number: y;�;�_ �� �i
MailingAddress: �-� � �� ���✓;«J ,d'���� City: _�`'�, Zip: _�� > �:>�,
��_�<d-� Tele hone Number: �.5 i-� _;_; - �= /
Contractor's Name: �1/1;ec� f=, p;
Mailing Address: �;����� �4•�v;tL:; ,�. � City: �:-�;� � � C(� Zip: .5";i� �
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity: �
Make: �l�<<-f-_,�, � i��
Model: 5� - 7-%�. ��,
Fuel: �c.iw7:
Flue Size: �"
Input BTUs: _; �;����
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
�
WOOD BURNING EOUIPMENT
Wood stove with flue
Wood combination or add-on
Factory fireplace with flue
Factory Fireplace (s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand Name Model No.
Mfgr's Min., Clearances, side , rear , min. flue dia.
VENTILATION
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
Installation Removal
Fuel oil: gallons underground inside outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
r
,��,�-�.�� , �>t x .0125 $ ,�'.�_ <_��
(contract price)
2. State Surchar�e. ** Add the State Building Code Division
Surcharge to each permit. =�`r�t'- �` x .0005 $ /�c,�i
or $.50, whichever is greater (contract price)
3. Posta�e and Handling (Only mail-in applications) $ ��'
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ___3� , c.:�c�
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted
work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
customer for the work done. If any material, equipment, labor, or installation are furnished by the owner,
tenant or any other party the reasonable market value of such items must be added to the estimated cost
or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost,
the City may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
State Building Code, and certifies that all statements made on this application are complete, true
and conect.
' 'a �� � �
Arrlicant s Si�nature: j' Date:
Approved By: Date:
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N TIC SCHEDULED 5�/� _`Z '>
PERMIT NO. �� �� COMPLETED z���Uc� � v
ADDRESS o��0 cVt�U���'���' s
OWNER CONTR. -�V�S I(�.
TELEPHONE NO. �.5�- �����
� DESCRIPTION G`�✓ ��S� 3 1�--� U��' ���'�
l� 01 FOOTWG 11 MECHANICAL RI 18 EXCAV/GRADING/FILLWG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DtMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
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O �l CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
i-] INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. 249-460�
OwnerlContr tor on site:
Inspector. �� �✓L �C,� c��
White Copyllnspector's File Canary CopylSite Notice
%�
� / DATE TIME
CITY OF ORONO V CALLED IN
INSPECTION NOT E , SCHEDULED tj- /� "_lc,� vc:A..qit
PERMIT N0. CJ = I COMPLETED
ADDRESS -�7C� L���tv,��L2% �c�C'_.
OWNER '�LC7�Y'� G �'� CONTR. G��,��%c'C<..� �,'f�
TELEPHONENO. Cl S.� C� "�`� /�/ �
� DESCRIPTION �i t�ci7�� `t� Lz-�,;�tf� ��� � �/p^c�- /.��,�
t� Ot FOOTING 11 MECH ICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
5 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� EMO-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
� OWNER/CONTRACTOR TO MEET YOU:✓YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next' spection 24 hours in advance. (952) 249-4600
OwnerlCon o n it :
Inspector.
White Copyllnspector's File Canary CopylSite Notice
4 PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: pos4i4
Crystal Bay, Minnesota 55323 Permit Type: Minor atterat�ons
(952) 249-4600 Date Issued: g��i2oo2
SITE ADDRESS: 270 Crestview Ave
Long Lake,MN 55356
P I D: 0 5-117-23-14-0009
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Pernut Type: Minor Alterations Permit Sub-type(s): Windows
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 363.25 Valuation: $ 22,542.00
State Surcharge Fee: $ 11.80
TOTAL FEE: $ 375.05
APPLICANT: Window Lite Home Improvements OWNER: Charles&Corlie Aldrich
8400 89th Avenue N. -#460 270 Crestview Ave
Brooklyn Park,MN 55445 Long Lake,NIN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRIC'I'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
/J
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- � '�
APPLICANT PERMITEI;SIGNATURE ISSUED Y SIGNATURE
Conies: 1-File(Si�nitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
,; t"I;`!',1�
C i TY 0 F ORQNO �� �Q��,`��� b12249461 b 08/31/99 10:23 � :01/03 NO:429
, �:rj - ` ����
� h � Total Pce: $ �;;_ '.,�u� Date Received:
� Entcred By: � Perstut#:
-���f�
v-��� �� ` ��� CITY' C3F" ORONO - B�'�D�TG PERMIT APPLICAT'ION
,
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AlI informa�.on must be subiuitted in f1uU be�ore plan review will be �tarted.
(ptease print ad! �t�f'vrma�rion)
THE AP�'LICAN`I' IS;��^_(circle one)^ OWNE:R QR�C�NTRAC�--�--H��-�-�------�--�-
' "j1�.D.ct) � �i���,�' �� ` `"
JClH SITE A�DItESS: ,��. `f '�� ;
, ��/ �_ '/73.�
NAM� 4F �'1WNER: �(���r ��' /'i�. PHONE: (homc) �� �` ///�
(wark)
� n�J�Ii.,r�r�i�nnrt�'SS: r���' C'/�,�J�-L%;��) � �'�' CI�I�'�': ��,��,6�11�1 7aIP:,�=-�;�
cQrrrx�c�rc�x: ' � - '' , �►�arr�: �l<<�.�-� ��`��-�33�
CONTACT PERSQN: � � Q�TLE/PAGER• .
r�u.nv��nbx�ss:��r�g,u�ti_ �. crr�: 6� c,n zrp: ��,�_S'
� STA.T� LICEN5E: �`��r�, �,�1�i�f , .�
A�LC��T�I"TlENGINEER: riIiONE: �
1VIAILII+iG ADDRFSS: CITY: ZIP: ,_,_
NANiE;c � REGISTRA'i'I�N!�
T'YPE OF WORK: New Additian Accessory Struature
Mavc RemodellAluratioA Larut Alterat�an
��
�, � ��� � � �
PAUPC)SELI�VORK(de�cribe�n c�etc�i�: ,,,� �t ',i r1�;�.c ;Ls1� �.�-� �- i C�� i
ST[?RIES: SQ.�ET OF EAC�FI.00R:
NO. 4�' BEAR.UUMS: GARACE STALIS: AT'T. �„�, DET.�
ESTIMATED CONSTRUC'�'ION VALUATION (excluding land): S�� , G O
I tureby �pgiy for a building pexmit and I acknowicdge that the information a�ove is camplctc Anc�
accurate; that r�re work wili be in confpzmance with the ordinances and cades of the City and with
thz St�te Buitding Cade; that I unclerstand this is nat a permit and wc�rk is not to start withaut a
permit; and that the work will b� i ccardance with the app ved plan.
� ( -
APPLICANT'S SIGNATY3RE: �.�k � �1 I�ATEs ������(� �.
ly'Qr,�1 pa de Hnmes events r�equire se,parate per�mit approval by Poltce l)epat�mettt and
City CouncfY 60 days prtar to the evertt. Nan perrnitted events will not he aliowed.
5
Jul 16 02 0z: 15p p• 1
. CiTY OF ORONO �� G� � 6122494616 08/31/99 10:23 � :0�/03 N0:429
�So �/� � �u`�/.�3
� Totai Pce: $ ��; . c \c Date Received: '? �l�- /c��
/ &nrcrea�y: Per�nit#: ;-?c: � `f � �I
,c,
�`��,1 ����� '
eIT'� OF QItONO - 8�,��1�TG �'E�MIT APPLICATiON
� All iitf'qrmation must 6e �ubmitt�d in #�ll be�ore plan review wtll be st�rted.
�lease prinr ait ��farmation)
THE APPI:ICANT iS; (circle oi�e) OWN�R.QR OIrITRACTnR
J�JH SITE A�D1tESS: a��(� ��11��O,c.i� .� U�O�ZIP: � r �
� NAM� aF C1Wri1EIt: �',� r i '� /'i . PHONE: (homay ��—�"7-�"�//�
' MAILYiVG A.UD1tESS: ,��lU �.�-l�%�cJ �'iJf�_ C1TY: � ��) �IP; �""c'
� �1�i? —_,�>��.�0
cQrrr��o�: �' : ' � , p�axE• �I�n.�-- ���l-�33�
.CONTACT P'ERSON: ',.� O�TLE/PAGER: -
�M�7.LIN�ADDRESS: � u�1 :e D CY'1''�: �lu� C. Z,IP: ��
� ST�TE LICEI�T�E: � �,�r_�3�:�.��f ,
ARC�7CI�:TtE1VGINEER: PHO1V�: �
1VY�AIY;T[+IG ADDR�SS: C�TY: ZIP':
NANTF�: REGISTRA'i'�1]N#
,
TYPE O� WORK: New Additioa Access�ry�t�wre
Move RernodellAlteratiaa � Lan�! Alceratian ____r___.
PA.�PUS�D WORK(dexertbe en,��tat�: „� �� S �r C�--�`i
BTQRTES: SQ. F�T QF�ACH FL�R:
S�1'O. OF B��ROOMS: GARACE' STALLS: ATT. DET.
ESTIMATED�UN�TRUCTION VALUA7'ION (cxclud�ng land): $ " � , ��
I tureby �ppiy fvr a building p��mit and I �cl�owlcdge that the informadon above is complete�nd
accuratc, that the work wili 6e ia cvnGformanee with the ordinances and eflcles of tha City and with
the State Building C�de; that i underscand this is n4t a permit and wurk is not ta stArt withnut a
permit; and that the wo�k will be i ordancc with the app ved plan.
( /
APPLICANT'� SIGNAT�SRF;: � 1..(,L,, DATEs �I(p�/�s,�,
N'OT�'sl liy��qf 15Tnmes eve�ts requir�seprrr+ate pernrit approval by Pol�tce 1)epartme�tt and
GYty Counctl6D days pr�inr to the eve�tt. 11�'on permitted events will rtot be allowed.
5
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d` �+
y,�9� �
HOUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITY��,UBURB
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Electrieal Work By Gas Lins By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER �
Mod•I Mod•I
S�rial Maz. BTU Rotinq
INPUT MAKE OF FURNACE
Mod.l _
CONTROLS
THERMOSTAT Heat Plug V�nt Sizs
Valv KIND OF LINER SIZE NONE
Limit Drah Hood R�qulawr
Limit S�ttiny Filt��s Siz• ►dumb�r
Fon S�ttiny Chimn�y Locotion Insid� Outsid•
Pilot Typ� Chimn�y Construction
Pilot Mak.
Pilot Mod�l Smok� Bomb Wi►ing
Pilot Timiny D�aft T�st Taq
L.W. Cut Off Dow Pr�ssur� Liqhtiny Inst.
Pr�ssure P�rc�nt CO2 Oat• T.sr.d
Input CFH P�rc�nt OZ Companr T�stiny
51ock T�mp. Pne�nt CO Nom�of T�sf�r —
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CiTY +UF QROi�O File� _ CITY OF (?RONO Fite� -
guitding Fire Zonin�.,__._,� Bui{ding �ire Zottin�.�.,._.
Address � �� ��-�2 f(1/-��-� ��-e--�
Address
Owner Pt�ar�e # {3wner Phone � __ _
Violation Ordinanc� No. Vio{ation Ordinance ��o.
lnspection Dates InspeGtion Dates -- - —
Photos (Date� Photos (DateJ
Inspector ---- (ns7ectar
...... ..., .._._........�... .r»
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CITY OF ORONO Date ��
ADDRESS � Connected to '�,�I�
CODE SEPTIC SYSTEM INVENTORY CARD Municipal Sewer
Address _Z�C` 1� �'%L'�E���,•1� Property I.D.d�-1�7��3 /z/ ��'j(�� + WELL i ATA
�Standard trench ��� f'7 �L�,C rc� I
❑ Mound '
System type ❑ Other ` �
Legal Description '�/yy� --��� O
d
Permit No. � ,�'3�� Date of permit _/�—Z�•-�? Installer ` � t
_S ���IVAn� � � o"
No. Bedrooms Garbage ,� d I
Building type �cCS/i�FJI; t- or GPD � ��' Laundry�Dishwasher_1� Disposal��: � � =
E a o
SEPTICTANKS: Material �i�n;�.: �iyCC_�C Capacity 1) f�'-G>f; 2) .�C�� ° � ; .o
�, a
� >
Proper outlet and inlet Baffles iq 'd depth to RO level + •
:% �
� '� � E
Height of tank bottom above water table i tanc t n rest building f�� � m �
�
DRAINFIELD: Total length of lines .2.-'1�� Num o li s � � � Trench width �.�-- �•T ��
Y ,
C :�
Total treatment area (sq.ft.) �[.'(�.% Height o drain ' I above water table /v�1�' S��I�i�/L'A C � m �
� � � ✓,�
1
Type of filter material - -�i �JC_,� Soil e � �•
� � �
� � L -
Distance from nearest bldg. � � Tile Perc rate min/in ° � Q � �
� � .. m` ✓.;
Depth of fil!over drainfield D th r ck over tile under tile � a Y "
f0 E c —
p a cj �
IG Ll'�-GG�
LOCATION /�
SKETCH / 2��L
INSPECTION RECORD PUMPOUT RECORD � �
+: _
�
DATE ti�t COMPLIANCE DATE GALLONS
5,.�,:.FAc..'..�. `; � ��,�'
8 Z•S`7�% cd.���� c�;r�vt� S S-Jln-g� /.S c7� ��„1 ��E,r,�C�c`v .�
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7'�-�� o'Z�L::J rA/lr (��s��C � 1 /
1D-��o /�bT S�t�a�`'V-Sow+� DF � �
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i 37 E�t
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Sa',�91 '' "/n,_,��.> �'� �<� — �8�
s_7�� ,. „ ��.n_ � 2`�� %
N E-
� :�e5�v,'E(.�s
Include: 11 Well location
2) Distance from house to
septic tanks,dist.box,
and drainfield
C— CONFORMING S—SUBSTANDARD N —NONCONFORMING 3) North arrow and road
CITY OF ORONO � O�
Municipat Offices O ,� O
Post Office Box 66
Crystal eay, MN 55323-0066 � � ON—SITE SEWAGE TREATMENT
� � INSPECTION REPORT
ti
��9kESH�4'�G
Owner: 1 ��,5 /�USh Address• �/v (rrP�t7/i CL✓TrVr-•
Permit #'s: 3�3� Dates: ��7� Contractors: SL�/i�:r
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
7he on-site seuage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(7his is �1 an existing system [ ] neu construction)
SYSTEM CONFORM[TY (1-3): �
1 "CODE SYSTEM"-A system uhich meets all the location, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface waters.
2 "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants tnto ground or surface waters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic [ ] has or (�- has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.>
TANK CONDITION (5-10): �
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be p�ped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. [nspection risers (4" dia. pipe) must be installed in each
tank at next pumpout. If tanks have not been pumped out within the last three years, they should be p�xnped
out now.
� Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pumped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14): �
Drainfield inspection indicates:
11 Drainfield is dry, no surfacing evident.
Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Cna�act the Citv Inspector
i�ed�ia� te�_l Repairs must be completed within 90 days.
14 Drainfiel e��and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.):
COMMENTS; � � yr,+ � ,$J� �
.0 � � ' �
�
ate of Inspection Septic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that this report does not guarantee or certify that an existing system will continue to function
properly� but is merely an opinion of the adequacy of the system under current conditions based on the available
information.
This report must be kept on the prE�nises with the system loc�tion and pumping records.
WNITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore o f
Lake Misznetoyzka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay, MN 55323
473-7357
OWNER �� ,��/� ADDRESS �/'� Z__.C1�S�l�,Lr�/� ,�/�P�
PERMIT NO.'S.
�6� DATES 1� v v 7`� CONTRACTORS� �
City Ordinance No. 210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.The onsite sewage
treatment system at the above address has been inspected and appears to fall into the category checked below.
(This is �an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.Appears to be operating
properly.
� 2 Does not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
located, and constructed ge�erally in accordance with previous codes. System appears to be functioning properly; no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to desig�, construction,or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
�4 System may or may not meet current City standards for design, construction or location, but is failing to properly treat and
dispose of the current input,and is endangering a water supply,or is a source of pollution to surface or groundwaters,or is
creating a safety hazard, or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is necessary,soil testing will usual�y be required,and a design and site plan
must be submitted for review.Your contractor must obtain a permit before work is started.
SYSTEM CONDITION ( m Checked items may require your action)
Tank inspection indicates: �"�-Inspection pipe is located directly over tank baffle.(Does not
❑ Pumpout not needed at this time. give accurate measurement of solids accumulation.) If tanks
❑ Solids accumulation in tanks indicates they should be pump- have not been pumped out within the Iast three years, they
ed out this year to help prevent future problems. should be pumped out now.
❑ Solids accumulation in tanks is at a critical level. Tanks Drainfield inspection indicates:
should be pumped out as soon as possible. ❑ Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. �-Drainfield is saturated and visibly discharging untreated
❑ Inspection risers missing—tanks could not be inspected, effluent to the surface. This condition may require replace-
Inspection risers (4" dia. pipe)must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. If tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. ❑ Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ Slope (depends on soil types,water Future Expansion
❑ Soil table,and system condition) ❑ Adequate
�-Fiigh water table ❑ Low �air
❑ Lot size O Medium LJ Poor
❑ Lake,wetland,or stream ❑ High ❑ Inadequate
❑ Drainage '�System is causing visible
urfac discharge.
COMMENTS: �� � � �
� �� f �
���-9/
Date of Inspection Septic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that
this report does not guarantee or certify that an existing system will continue to function properly,but is merely an opinion of the adequacy
of the system under current conditions based on the available information.
This report must be kept on the premises with system location a�d pumping records.
WHITE COPY/ Inspector's File GOLD COPY/Nomeowner
On the North Shore of
Lakc Minnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
� _ � � 1335 S. Brown Rd.
Crystal Bay, MN 55323
473-7357
OWNER �Q.�'a5 `} /v/aY 1 ADDRESS �/`� C_Vt`_�S"TY/P[� t1V1"i.
PERMIT NO.'S. ��� DATES �� ���7J CONTRACTORS .�l�/�V �
City Ordinance No. 210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.The on-site sewage
treatment system at the above address has been inspected and appears to fall into the category checked below.
(This is �, an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.Appears to be operating
properly.
� 2 Does not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
located, and constructed generally in accordance with previous codes.System appears to be functioning properly;no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design, construction, or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
� 4 System may or may not meet current City standards for design,construction or location, but is failing to properly treat and
dispose of the current input, and is endangering a water supply, or is a source of pollution to surface or groundwaters,or is
creating a safety hazard,or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is necessary,soil testing will usually be required,and a design and site plan
must be submitted for review.Your contractor must obtain a permit before work is started.
SYSTEM CONDITION ( m Checked items may require your action)
Tank inspection indicates: qu Inspection pipe is located directly over tank baffle. (Does not
❑ Pumpout not needed at this time. give accurate measurement of solids accumulation.) If tanks
❑ Solids accumulation in tanks indicates they should be pump- have not been pumped out within the last three years, they
ed out this year to help prevent future problems. should be pumped out now.
❑ Solids accumulation in tanks is at a critical level. Ta�ks Drainfield inspection indicates:
should be pumped out as soon as possible. ❑ Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. �Drainfietd is saturated and visibly discharging untreated
❑ Inspection risers missing—tanks could not be inspected. effluent to the surface. This condition may require replace-
Inspection risers (4" dia. pipe)must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. If tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. ❑ Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ Slope (depends on soil types,water Future Expansion
❑ Soil table,and system condition) ❑ Adequate
❑ High water table ❑ Low ❑ Fair
❑ Lot size ❑ Medium �Poor
� Lake,wetland,or stream ❑ High . ❑ Inadequate
❑ Drainage �System is causing visible
surface discharge.
COMMENTS: � 'e s � ' / ���y � ' 'Q/ �� %
,
2 � l� CS � T W•
� ,/-���
Date of Inspection Septic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that
this report does not guarantee or certify that an existing system will continue to function properly,but is merely an opinion of the adequacy
of the system under current conditions based on the available information.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/ Inspector's File GOLD COPY/Homeowner