HomeMy WebLinkAbout2007-P11030 - sewer disconnect PERMIT
� C'�TY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: p11030
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
5/22/2007
SITE ADDRESS: 1055 Edgewood Hills Rd Unit#
Wayzata,MN 55391
PID: 02-117-23-42-0002
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
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: Elmer J.Peterson Company OWNER: Mr. &Mrs. Jackson
5921 Dague Ave SE 1055 Edgewood Hills Rd
Delano,MN 55328 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 REQUIREMENTS.
p���G/��� l � GZYI ( /''�-�
APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
� ��
POR C[Tl`USI;ONLl'
��"'�`-> City of OCOnO Date Reeeived: Permit#
/;.:�`, ,�;;.�
;!O O�';� P.o.Bo.66
27�0 I`elley Parkway ❑In-EIouse SAC Detennuiation Form Cotnplefed
�(.� ii}'�, :�I Cnstal Bay,b4N��323
����K�Ho�ec,�� (9�2)249-4600 Approved I3y(IfRcquircd);
Cl'TY OF ORONO—SCW�R & WATER/G�1��12AL P�RMI'I'
(K 1otc:Some permits mav requirc approval by Ihe Building Offieial and/or Public lVorks Dcpartment*)
(;1LL PI;Ri�IfI�S- �'iav bc sublcct to furthcr rc��icw and ma�'not bc issuecl�shcn�hc applico-i�ion is recci��cd)
GENCRAL 1NFORMATION
1. You may appfy for utility permits by mail or in person at the City offices.
?. Mailed in applications are subject to tile postage and handliil� fee showii belo�v. Permit cards�r�ilf
be sent bv return mail �vithin 2 business days.
3. Permits are not valid until you receive a permit c1rd.
4. �Voii. nwst not begin unless the permit card is available on thejob site.
5. Utility connection permits may be issued to licensed contractors only.
6. Cont�act the Public �Vorks Department(95?-249-4600) for utility stub as-built locations.
DO NO"C E\CAVA'CE 11�' ANV STRLET r1ND UO NOT TAP ANY NIAIN without express
�pprov�l of thc Public�Vorl<s Department. Issuailce of a permit does i�ot grant tltis appr-oval.
7. All work must bc done in accordance with State Code requirements.
8. All worl:must be inspected beforc it is covered. Call (952)249-4600,24+hour notice required.
TYPE OP PERNIIT
(Check All That Apply)
��Residential (May Reqiiire Approval) � Commercial (Approval Reqt�ired)
� New Connection �, Additional Connection � Re-Connection �OJ Repairs � Disconnect
Job Site/ O�vner Information: I
Site Address: �� !.—� . e ��=v f'`` `� ��
�-}�. n �� , �^� /r � ,Q�
Owne��Q, 'r�f.��- 14c�rti J� sp'� Iviaiiing Acicicess: ��� � (- < ''.��J f"I� �5 y�
c�t>>: ���24�� m-� . z���: �5�535/
1-(ome 1'IZon��_5 2J ��� ^'� �/5 Altecnate YllOtle: �� � �,3`����,J
� �,011ll'aClOI' jlltOl'I11a11011:
I
�
r-- �. � ��r �--� C:6 - ��`,�-, �r�-E e�h��,-►
Coiltrlctor: -G 5 Contact Pecsori: �'
;'lddi-ess: 5 �2( 'Da9�'-e ��z��, State License #: 2 � �
City: ,V��G�v _ 7.,ip:ss�� Expiration Date:
Pllonc: ��43 ��2"2�26 _ Altecn�t�ePho�le: ���2 ZC>Z��J���
�! �
�— DETERMII�iING PERMIT FEES �
[� Sr1C Chargc(2007 Rate=�1,G7�.00) $
(SAC Char�e i��ust accompany all se�ver permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a se���cr connection permit�vill not be issued)
� Se�ver Cotu�ectio /llisconnect Repair(535.00/Per Stub) �
Pipe size in �ial__Schd 40 air tested; 0_cast iron
�� �i�ater Connection/Disconnect!Rep�ir(53�.00/I'er Stub) �
Pipc size___ inches; material____Schd 40 air tested; � copper
1. SUI�TOTAL of Permit Requested: $
2. STATE SURCH,IRGG $ .50
3. TOS"I'�1GE� I-IANULING (Oniy on Yiail-In Applications) a 1.50
�4. T�TAL P1:6ZN�1'9'�'EE(Add Lines 1-� Above) �
ADD[TIONAL INFORMATION -VVATER MLTERS
■ �j'A1'F,R�iGTERS must be picked up and paid Por at Orono City Hall,thesc are on a separ<�te permit.
� 1l'AT�R I�tL'I'El�S �nusf be set a��cl sealed uy Orouo W'ater Dep�rtmcnt (9�21 249-4600, upon
completion of mctcr installation.
'1'lle undersigned hereby applies to the City of Orono for issuance of a Utility Permit, aQi-ees to do
all ���orl: in strict accordance with the ordinances of the City and tlle re�ulations of the State of
Minnesota, and certifies that all statements madc on this lpplication are, true and correct.
Applic�nt � Date: � - 22��3�
Reset Form
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO ICE SCHEDULED
PERMIT N0. G�.� COMPLETED �Z3'��� ���S i¢�..�
ADDRESS /G� ���/Q�-`���� /S�i��S �d
OWNER CONTR. C�J�L''�5 ����/-i
TELEPHONE N0. �(0 �� r7'�—.� 1r��
� DESCRIPTION ���•?tic/`fit.. l��-
� 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
Z04 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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEEf YOU:_YES��10 mi �- '�3_C%�
f /7�
� COMMENTS: ��� �` 5Co-9, ..�7'�
C ,` y �� �l�,'�'d G°� U'�tjs aZ�7� �'1�TY�/h�i
j
o v ic�
'� � o i
�
0
�
w
�
Q
�
Z L y �
� /7�S ��1"I/�fG�' �S ��'i .J� �%1 �-!@ '`b �m
j /�(o� �Y'�Jry /�1� �iq-� �S e•4 5 f' �l �rr
a
W ❑WORK SATISFACTORY:PROCEED f 7 PROJECT COMPLEfE
� CJ CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR W4LL RETURN u CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-Q6QQ
OwnerlContractor on site: ���»e�.�s (�e�'��'�.
Inspector. ��7</ ���-�'�'��"
White Copyllnspector's File Canary CopylSite Notice