HomeMy WebLinkAbout2004-P07700 - Sewer repair CITY"'OF ORONO PERMIT
27�0 Kelley Parkway - PO Box 66 Permit Number: Po��oo
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: �i13i2ooa
SITE ADDRESS: 3533 Crystal Pl
Wayzata,MN 55391
PID: 17-117-23-43-0027
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Repair
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: Westonka Water&Sewer OWNER: Paul Andersen
6501 County Rd 15 3533 Crystal Pl
Mound,MN 55364 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TOMAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK 1N STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE ���
Copies: 1-File(SiQnitures Required), 1-Applicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 1/5/04)
CITY O�' ORONO APPLICATION FOR UTILITY PERMITS
Bo�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. Permit 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 pernut card is available on the job site.
5. Utility comiection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Departmeut(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 Deparnnent. Issuance of a pernut does not grant this approval.
7. All work must be done in accordance wifli State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600, 24 hour notice required.
JOB SITE ADDRESS: �S S-� 3 ���+-i S�� I i—�ls�C�
Occupancy Type: esidential Commercial
Owner's Name: ��,�,��:����= Phone Number:
Mailing Address: City: Zip:
Contractor's Name: w�;�-� �� Phone Number: `�S�, ) �f 7.,.? y j S�
Mailiug Address: (�'�o� Cv. ,E' �� City: ;tir��. �.-,��iP; <�S�,�: y
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 C` Schd 40 air tested; cast iron
,�unici�al Water Con�eetionfDisconnect/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 minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line =20'
PERMIT FEE CALCULATION
l. 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 pemiit requested.
3. Posta�e & Handling (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 co e .
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Signature of Applicant: � �_ Date: '�
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� ATE TIME
CITY OF ORONO A LED IN ��� '��°
INSPECTION NO�CbE�.��U SCHEDULED �� Q` / '
PERMIT NO. COMPLETED
ADDRESS 3 � � � � ��-1 S�� / ��- -
OWNER CONTR.��..(� �ti'?I(LL �%d�
TELEPHONE NO. � � �` � � � L��S�
� DESCRIPTION �`x� ����" f—"/ v�
� 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
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Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINA� 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPT FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDAT�ON/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED PROJECT COMPLETE
� ❑CORRECT WORK R PROCEED !- ISSUE CERTIFICATE OF OCCUPANCY
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� ❑COFRECT WORK,CALL FOR REfNSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (Q52� 249-46��
Owner/Contract 'te:
Inspector.
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