HomeMy WebLinkAbout2005-P09127 - sewer connect PERMIT
CITI�i OF ORONO
2�5D Kelley Parkway- PO Box 66 Permit Number: P09127
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
9/1/2005
SITE ADDRESS: 4460 Forest Lake Landing Unit#
Mound,MN 55364
P��� 07-117-23-24-0015
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Grandfathered In 11/13/72
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Final Grade,Inc OWNER: Paul&Ida&Peter Martinson
1315 Maras St 4460 Forest Lake Landing
Suite 1 Mound,MN 55364
Shakopee,MN 55379
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 SUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE ONLY
O,¢��O City of Orono Date Received: Permit#
P.O.Box 66
. 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a i,a'f• �. Crystal Bay,MN 55323
':��+ � .0�/1� (952)249-4600 Approved By(If Required):
<Vr�xo�,i�!
CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Deparlment*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received)
GENERAL INFORMATION
l. You may apply for utility permits 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 within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits 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 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.
TYPE OF PERMIT
(Check All That A ply)
� Residential(May Require Approval) ❑ Commercial(Approval Required)
�,New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect
Job Site/Owner Information:
Site Address: yy��?' ��,Q1t�i" .�/�Kl� �/�/Ul�l/U(�
Owner: �,�r� ���/L�O�i.� Mailing Address: ��P���D �%t X�S �J���/�_
City: ��ID,Q, �/�1�� Zip: .1�. -J'���'
Home Phone: `� Alternate Phone: �/�- ���-�3/� �
Contractor Information:
Contractor: �illy�f��-.��A,I�� �L`'�• Contact Person: ��Il/'N«� /�/�l.l�l�L/f�/l�S
Address: �31 S ,��,Qf}5 >r�1t�l State License #: /y�r-�-
City: .S 1�K0��'� Zip: �A� Expiration Date:
Phone: `�, �a�3'/p�0�� Alternate Phone: �/��?lr�/'i�t���
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DETERMINING PERMIT FEE5
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(if not prepaid,a sewer connection permit will not be issued)
� Sewer Connection/Disconnect/Repair($35.00/Per Stub) $ ���j. ��L'
Pipe size / inches;material_.� Schd 40 air tested; cast iron
� Water Connection/Disconnect/Repair($35.00/I'er Stub) $ ���jf ��
Pipe size l inches;material X Schd 40 air tested; cast iron
1. SUBTOTAL of Permit Requested: $ ��, !n�
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines l-3 Above) $ �,��
ADDITIONAL INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
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,true and correct.
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Applicant: /f� , ��i%� Date: ��
Reset Form
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� � MUCA Pipelayer Training Certification
"1 Jamie Boller
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� has completed the Pipe Laying Training
G � Cours�ough the '
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MinneSo a ti ity Co�ac rs A55ociation
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and is a Certified Pipe Layer having completed
the required course work in pipe laying and the
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MinrresQta Plumbing Code
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This card ce[tifies that the cardhofder
has completed training in the required areas
of the Mir�nesota Plumbing Code related �
to Pipe Laying as determined by the
Minnesota Depar•tment of Health '
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� Minnesota Utility Contractors Ae5 ciation j ,
6043 Hudson Road,Suite 378,Woodbur�MN 55125
(651)735-3908,1-800-567-MUCA' (651)7�5�3018(fax). �
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�T�� TIME
CITY OF ORONO CALLED IN
INSPECTION�OTICE SCHEDULED ��G •� �� 1 "� L
PERMIT NO. �9 1�-� COMPLETED
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I 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q F AMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
� 03 INSULATION 2 PLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP � 17 SITE INSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE . 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 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W L7 CORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Call for the n t inspection 24 hours in advance. (g52) 249-4600
OwnerlCo ra r o ite:
Inspector.
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