HomeMy WebLinkAbout2002-P05808 - sewer/water connect � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Possog
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: 11�6�2002
SITE ADDRESS: 3375 Crystal Bay Rd
Wayzata,MN 55391
PID: 17-117-23-44-0018
DESCRIPTION:
Proposed Use: Residenrial
Pernut Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Perniit Fee: � 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Water&Sewer OWNER: Paul Vogstrom
6501 County Rd 15 3375 Crystal Bay Rd
Mound,MN 55364 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.
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APPLICANT PERMITEE SIGNATURE [SSUED BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 5/3/02)
GITY 4F 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. Pemut 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 connection pemuts may be issued to licensed contractors only.
6. Contact the Public Works Department(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 pernut 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.
�� �JOB SITE ADDRESS: � �� C✓� S �� / � r
Occupancy Type: Residential Co mercial
O�vner's Name: ��ou t.� e �{�a�� S Phone Number:
Mailing Address: T City: Zip:
Contractor's Name: �.�1 C � S w Phone Number: S' ��c (o
Mailing Address: �� c� "S City:�.�lp��� �( Zip: ���G��
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2002 rate $1,200.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Co nectionlDisconnect/Repair ($35.00 per stub) $
pipe size�inches; materialCc Schd 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 minimum setbacks from drain field and septic tanks = 7S
REQUIRED setback from sewer line=20'
PERl�1IT 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) $
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 t a of Minnesota, and certifies that all statements
made on this application are complete�true and correct.
Signature of Applicant: Date: — � �
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED �_� + 3i.1
PERMIT N0. .�1Cl_f Y COMPLETED
ADDRESS .3:�� �S ! '�- �
OWNER CONTR. (�-���� C�''\ ( ��J
TELEPHONE N0. �S � Y 7� Y � " �
� DESCRIPTION_ ��I(i�..% G�1
ty 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
ti
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP` 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP/ 06 PROGRESS
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� 07 DEMO-SITE 27 SEPTfC NIAiNT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFtCATE OF OCCUPANCY
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� ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspe tion 24 hours in advance. (952� 249-4600
OwnerlContractor on s�
Inspector.
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