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Home My WebLink About2000-P03077 - SAC only PERMIT CIT:Y �3F ORONO 2�750 Kelley Parkway - PO Box 66 Permit Number: Po3o�� Crystal Bay, Minnesota 55323 Pe�mit Type: Sewer and Water Permit (612) 249-4600 Date Issued: toi3i2oo SITE ADDRESS: 190o Fox Ridge Rd LONG LAKE, MN 55356 PID: 03-117-23-13-0009 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Sewer and Water Permit Permit Sub-type(s)� SAC Onl nnection Y DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SU1I�MARY: Permit Fee: $ 35.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 SAC Fee: $ 1,100.00 TOTAL FEE: $ 1,135.50 APPLICANT: �TTER EXCAVATING OWNER: S M&E W POLANSKY 7120 VERNON STREET 1900 FOX RIDGE RD ROCKFORD,MN 55373 LONG LAKE MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL INtPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. ' � � �_� � L� �Gc� �"�� `'�'�'i' � — C�—' �� -�� 4�h�rZ APPL[ ANT PERIv1IT�rNATURE IS D BY SIGNATURE Copies: City, Applicant,Assessor,Finance Page 1 CI�Y OF ORONO APPLICATION FOR UTILITY PERMITS ` Bos 66 (2750 Kelley Parkway) SEWER/WATER Crystal Bay, MN 55323 GEPIERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applications are subject to the posta�e and handling fees shown below. Permit 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 bejin 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(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. Ca11249-4600. 24 hour notice required. � , i � / JOB SITE ADDRESS: �7�� C� ` �- C/y�� Occupancy Typ • Residentia Commercial � � � i /� � Owner's Name: �;� ��-� / .-��-'�i�-' Phone Number: � �%-� - -�� j �lailing Address: /J �-�=�� City:�� `'-�"�� 7�p: � ��,�5�� Contractor's Name: � ��'-�=r C<�''`�-'' Phone Number: 7,%" �- %� � /' Nlailing Address: �� , �� z �:.-•-�,-<�/'--� City: %�==' z�! Zip: }_y_�� PERi�IIT TYPE ��Tunicipal Sewer Connection ($35.00 per stub) $ pipe size inches; material Schedule 40 air tested; cast iron SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. If not prepaid, a sewer connection permit will not be issued. Municipal Water Connection ($35.00 per stub) $ pipe size inches; material copper; other WATER METERS must be picked up and paid for at City Hall. `Vater meters must be set and sealed by Orono Water Department(249-4600)upon completion of ineter installation. REQUIRED minimum setbacks from drainfield and septic tanks= 75' REQUIRED setback from sewer line=20' PERIVIIT FEE CALCULATION 1. Subtotal of above permit requested $ 2. State Surchar�e $ .50 The State Buildin�Code Division Surchar�e of$.50 per permit must be included foc each well, sewer and water connection permit requested. 3. PostaQe & Handlin� (Only mail-in applications) $ 1.50 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 �vork in strict accordance with the ordinances of the City and the regulations of the State of �linnesota, and certifies that all statements made on this application are complete,true and correct. � �-,��- ,��--,- Date: � __ �7 - � iJ Signature of Applicant: �"='� DATE TIME � CITY OF ORONO CALLED IN INSPECTION NQTICE SCHEDULED D- 0 '��'� PERMITNO. f''o��?'� COMPLETED �G yI �e� �� ADDRESS �� F�X ��9� OWNER�II�sC� CONTR. �� -� TELEPHONE NO. �a" ��6 � �- DESCRIPTION S� W�-2 ��'kt�.� � � l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS h Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WA�L BD. 12 <-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP � O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL = 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL J � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � 6� �i/1u�3' �k � a /Z�� s� � J O '' ,�- �"1�� 1�w�/� � 0 � W � Q � z W � W � �G��0� t N s�T[C'�') -�-��f �-fa��ks �rt �C�-- l�l-OG GW �WORKSATISFACTORY:PROCEED I PROJECTCOMPLETE � CI CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY W � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. PHOTO TAKEN INSPECTOR WI�L RETURN C',STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cali for the next' pection 24 hours in advance. 249-460� OwnerlContr cto on ite• Inspector. � White Copylinspector's File Canary CopylSite Notice / , DATE TIME ` CITY OF ORONO CALLED IN INSPECTION OTICE SCHEDULED ld��l�� d�� PERMIT NO. O � COMPLETED f 0--I�� IQ�A�J ADDRESS 1�� 'x �f �/ OWNER P�` �25�`� CONTR.�� TELEPHON E NO. R��q '1�6 l �- DESCRIPTION t�'�� Pu'{�►� �(�H✓IRC-� � l� 01 FOOTING 11 MECHANICA RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q OS FINAL �WER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT J 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: � �� r k ct�+�t w 'l� tt�^i` � �av "a �r � � �ok tz;. � O � � n��' � O �, 7 W � � t� ��< Q � � /� 6'J � k W � �— �E" Gt j O � f'i WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE W C;CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY � Ci CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT C';CORRECT UNSAFE CONDITION WITHIN HOURS. pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR GTATION ISSUED �7 INSPECTiON REQUIRED.CALL TO ARRANGE ACCESS. Cail for the n inspection 24 hours in advance. 249-46�0 OwnerlContr c r o s' e: Inspector. White Copyllnspector's File Canary CopylSite Notice