HomeMy WebLinkAbout2007-P11466 - sewer connect PERMIT
CIT; OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11466
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued:
9/18/2007
SITE ADDRESS: 1150 Heritage La Unit#
Wayzata,MN 55391
PID: 10-117-23-13-0004
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 Paid-On This Pernut
FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,675.00
TOTAL FEE: $ 1,710.50
APPLICANT: Coppin Plumbing OWNER: Mr. &Mrs.Nicklow
8460 County Rd 15 1150 Heritage La
Minnetrista,MN 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 PEKMIT SIGNATURE ISSUED 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 LJSE ONLY
�,¢� City of Orono Date Received: Permit#
� P.O.Box 66
�l��y;;, �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
�1'�.''/�r �� Crystal Bay,MN i5323
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����,�,������G`� (952)249-4600 Approved By(If Required):
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CITY OF ORONO-SEWER & WATER/GENERAL PERMIT
(*Note�Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received)
GENERAL 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 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 l )
�Residential(May Require Approval) � Commercial (Approval Required)
�New Connection ❑ Additional Connection � Re-Connection �Repairs ❑ Disconnect
Job Site/ Owner Information:
Site Address: (� 'e. f� ? ��'�
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Owner: 1 r'i Y1�•i �C.,��1 D �J Mailing Address:
City: Zip:
Home Phone: Alternate Phone: � I� 7��i ��Gt 0�
Contractor Infonnation:
Contractor: '�.-���� � t' I��'1 � Contact Person: �^Gi►'1 C e
Address: � `{ �0 C�-� Q J �� State License #: � � � �
City: l. '► '�`^ L�'�`S��Zip��J Expiration Date: ���� � ��
Phone: I S a � 7�-�-� I �O Alternate Phone: � �� �'� �- � 1-� v
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� � � � DETERMINING PERMIT�FEES ��=� �� �� ��� � � �
� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit appiications 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) $
Pipe size inches;material Schd 40 air tested; 0 cast iron
❑Water Connection/Disconnect/Repair ($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; 0 copper
1. SUBTOTAL of Permit Requested: $
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 c rtifies that all statements made on this application are, true and correct.
Applicant: Date: � ' � �
Reset Form
ATE. TIME ✓
IT OF ORONO CALLED IN � /D�
INSPECTION NOTI SCHEDULED ` �7
PERMIT NO. COMPLETED
ADDRESS I
OWNER CONTR. � j
TELEPHONE NO. �-�'��- � -��� `� �� —�._�/ L�'
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� DESCRIPTION ��P_�.� _ �-NKJp '
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/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 05 FINAL 14 SEWER 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
� OWNEHICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑WOR FACTORY:PROCEED f� PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
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O ❑ Ct�RRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46��
OwnerlContra o ite:
Inspector.
White Copyllnspector's File Canary CopylSite Notice