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Home My WebLink About2004-P07764 - water connection PERMIT CI��.Y OF ORONO Permit Number: '�750 Kelley Parkway - PO Box 66 P07764 Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit (952) 249-4600 Date Issued: ��3o�2ooa SITE ADDRESS: 865 Ferndale Rd N Wayzata,MN 55391 P I D: 25-118-23-44-0002 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Sub-rype(s): Water Connection Permit Type: Sewer and Water Permit DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: SAC Paid-Years Ago FEE SUMMARY: PermitFee: $ 35.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 35.50 APPLICANT: Dave Perkins Contracting Inc. �WNER: ST Edwards Episcl Church 14230 Basalt Street NW 865 Ferndale Rd N Ramsey,MN 55303 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. \_//';� � , // j J'�/�� C Y'�L..t� I'. L C�rf Y�GC /� V . �� ,�f. � �� APPLICANT PE [TEE SIGNATURE ISSUBD[3Y SIGNATURE Copies: 1-File(Si�nitures ReAuired), 1-Applicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 (Updated 1/5/04) CIT�' OF ORONO APPLICATION FOR UTILITY PERMITS Box 6t��2750 Kelley Parkway) SEWEWWATER & SAC C�-ystal Bay, MN 55323 GENERAL INFORMATION 1. You may apply for utility pern�its by inail 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 �naiL the satne day the application is receivcd. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on thc job site. 5. Utility connection pennits 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 permit does not grant this approval. 7. All work inust 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: �� d�e R�` Occupancy Type: Residential X Commercial Owner's Name: '�Q�,t��QXI Cd �-�Ct��a� Phone Number: 5 '�j 2.-• 'i?3 ' 3 �Oq� Mailing Address: "�4 5Go �jp.5,s�uf Lv� ('�eOr�- - City:l�2,(J�d Zip: s S 3 7 3 Contractor's Name: �3Phone Number: Mailing Address: � "` • City: Zip: y , Rameay, A�p�..�5 303 PERMIT TYPE [�Connections LJ Repairs ❑ Disconnect (Check One) SAC Charge (2003 rate $1,350.00) $ (Set Rate) Sac Charge must accompauy all sewer per�nit applications unless prepaid. (lf not prepaid, a sewer connection will not be issued) Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ pipe size inches; material Schd 40 air tested; cast iron do Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ ,3 S pipe size� inches; material��copper; other WATER METERS �nust 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 minimuro setbacks froin drain field and septic tanks = 75' REQUIRED setback from sewer line = 20' PERMIT FEE CALCULATION a,,� I. Subtotal of above pennit requested $ ?'s 2. State Surchar�e $ .50 (Minimum) The State Building Code Division Surcharge of$.50 per per�nit inust be included for each well,sewer and water connection pennit requested. 3. Posta�e & Handliug (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 ar omplete, true and correct. Signature of Applicant: Date: �v �u d Reset Form � �lr��E TIME CITY OF ORONO CALLED IN -�� INSPECTION NOTIC SCHEDULED -��1//�Y � S PERMIT NO. V � COMPLETED ADDRESS �LC� / V • �%Z�'C�C-�f.-� . OWNER CONTR. ,��_,C,� ��oy� TELEPHONE N0. :�L�� -" �� ' /� �� DESCRIPTION ^ ' ��-�-�� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING �TNAC 19 LAKESHORE/WETLAND` 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 i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:�YES�NO � COMMENTS: � W 0. o S Ct. � �!' �l �� a � 0 � W � Q � Z W � W � � � d W� ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED �INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContracto Inspector. White Copy/inspector's File Canary Copy/Site Notice i � DATE TIME CITY OF ORONO CALLED IN INSPECTION NQ�TICE SCHEDULED t� �C� PERMIT N0. �''0 7 � CO PL TED ADDRESS Yl. � U OWNER CONTR. TELEPHONE NO. � DESCRIPTION � 01 FOOTING 11 MECHANICAL RI 18 EXCA�//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 OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 OEMO-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 FINAI 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: ab`r ��f; i v�E A tr0 u J' � � � 0 '' �— ►� c.l. t� t u D � -- 0 � W �' L.� C.�►� ' � C°/ � — � W Q � � z W � W � � d W� �ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑CORRECT WORK 8 PROCEED r� ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPOFiARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED �STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALlTO ARRANGE ACCESS. Cail for the n t inspection 24 hours in advance. (952� 249-4600 OwnerlCont te: Inspector. ��-� White Copyllnspector's File Canary Copy/Site Notice