HomeMy WebLinkAbout1983-7000 - general permit GENERAL PERMIT CITYPERMITNO. —_—�OOo �
CITY OF ORONO �
P.O.BOX 66 Date � — �
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Ow�ier � I��F2�'t-- _ � Ad�ress ���� ���n�D� �.
Contractor�����5. C�rvs i Address /�/'
Ci[y License No. State License No.
RF,MARKS AND SPECIAL CONDITIONS
PF,RMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
lnside Plumbing � # fixtures ) Fee $ � On Site Septic System Fee $
�i � �pC.�
Water Meter (Size�) Fee $,_L.r.�L— Water Well Fee $
Meter # ��g���y+
Mechanical Equipment Fee $
Remote# _,'3d I[�327�i
Municipal Water Connection Fee $_,_ Moving/Lifting Buildings Fee $
❑Copper ❑ Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Mtinicipal Sewer Coniiection Fee $
❑ PVC ❑ Cast ❑ Other: Fee �
M'vVCC SAC Charge Fee $ After-the-fact Investigation Fee $
�,5�
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special 'vlformation,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law StatC SUICrldi�e: Fet; �
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this permit does (,��
not grant any authority to do work or activities requiring TOt3� f�1170Ut1t �ill(� t0 Clty Fee $
sepazate perxnit approvals; and that this permit does noL
�ant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict complience with all City ordinances, buIIding
codes and/or health department regulations, and shall be T111S peTlTllt IS riOt Vi.11l(� Ulltll trle pCOpel' t`ee IS �dl(� ilri(�
subiect to inspection, approval or reiection by the c�cY. it is approved by an authorized City Official.
Whenever so ordered, Lhe un�iersigned agrees to correct
any work found to be in violation of the conditions of
this pe .
Signa re of Ap icant �, Signature o � 'ty Officia
l� G� �`�� ���'`
Code:White—Pile Copy Canary—Inspectc�r's Copy Pink-I�inance Copy Gold—Applicant's Receipt
_ � T
MINNEGASCO SERVICE INSTALLATION
Map No. Natural Gas ❑ Propane Vapor C� Permit No.
Municipality Minneapolis � Order No.
Folio No. Date Ordered _:=;- { E No.
Customer's Name Tel.
Installation Address . Zip
Lot Block Addition
Method of Installation or Construction (including method of compaction
and excavation) will be in accordance with procedures as described in
Minnegasco Operations Manual,Section 500, "Excavating, Backfilling and
Surfacing",the most recent edition on file with the permitting authority.
Install: Service Main Location
Additional Info.
Pressure Class
Date Completed Foreman's Name
To the (City Engineer
(City Council
(Village Council
(Town Board
The Minnesota Gas Company hereby requests permission to perform the work
indicated above.
MINNESOTA GAS COMPANY
�1
1 f`�� ..�:
/��j'��.P/ V_Y� { �-'�\.
(Chief Engineer)
� '
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform the work
indicated above.
of
Date By
(Authorized Signature)
Form 52 R 5/78
CITY OF ORONO CALLED-IN � �ATE � T�
' /��vME
INSPECTION NOTICE SCHEDULED � -'� ��-
PERMIT NO. COMPLETED
ADDRESS ���� ��9���r�yrzri�,� -
OWNER COI�TR.
TELEPHONE NO.
❑ FOOTING p PLUMBING RI ❑ SITE INSPECTION
❑ FRAMING p MECHANICAL ❑ EXCAV./GRADING/FILLIN(
� O INSULATION ❑ WATER HOOKUP ❑ LAKESHORE/WETLANDS
� �WALL BD. ❑ METER SET/TURN ON ❑ LICENSING
W FINAL ❑ SEWER HOOKUP ❑ COMPLAINT
� ❑ PROGRESS ❑ SEPTIC INSTALL. ❑ FpLLOW-UP
� ❑ DEMOL. ❑ SEPTIC MAINT. ❑ SEPTIC FINAL
Q ❑ FIRE PREV. p WELL TEST PUMP ❑
Z
= COMMENTS:
� .
� �
J � � _
W ' '
Z i� '� �� � iZ
v
z �z r , � -
o -
� � � .. ...._..
W
�
� / �<(
O � `�� S�
�
�
O
�
W " � _
� �
Q .( , art�1'��(+sl��.'C w '�J�
� � C u"��,S �t s.r+ v � �' al�i --t.�J1'1 U�
W
�
� /'`
j ..G�;Z11� [ ,� / t
a
W
�
p ❑ WORK SATISFACTORY: PROCEED
❑PHOTO TAKEN
O ❑ CORRECT WORK& PROCEED
V ❑ CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. INSPECTOR WILL RETURN.
❑STOP ORDER POSTED. CALL INSPECTOR.
p INSPECTION REQUIRED. CALLTO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
Owner/Contr. on site
Inspector 41.;-7357
White Copy/Inspector's File Gold Copy/Site N�tfce