HomeMy WebLinkAbout2001-P03990 - sewer connection PERMIT
�I T4 C.� O R�N o Permit Number:
2750 K�IIe Parkwa - PO Box 66 P03990
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Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 6i2si2ooi
SITE ADDRESS: 4to� Highwood Rd
Mound,MN 55364
P��: 07-117-23-44-0013
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:
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Coppin Plumbing OWNER: Gary L Germundsen
5089 Shoreline Dr 4101 Highwood Rd
Mound, MN 55364 Mound MN 55364
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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APPLI ANT PERMITEE SI NATURE I D BY SIGNATURE
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Copies: 1-File(Signitures Requared), 1-Appficant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1
�U�11'�7tCf�Z�IZ�O1�
�;.ITY•OF ORONO APPLICATION FOR UTILITY PERIVIITS
Bos 66 (2750 Kelley Parkway) SEWER/WATER � ��
Crystal Bay, MN 55323 O '?-,
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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 the same day the application is received.
;. Permits are not valid until you receive a permit card.
d. Work must not begin unless the permit card is available on the job site.
�. 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 Deparhnent. 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.
JOB SITE ADDRESS: � � �� v�i �� � � � �'
Occupancy� Type: � Resi ential Commercial
O�`ner's Name: C_' Phone Number:
l�Iailing Address: City; rn G�.;v`, 7ip:
Contractor's Name:�' �' �(�a. �; S4-� Phone Number: G S:1-��(7�� �3 � V
1�Tailing Address:S;', �� ��, p�e ���r City: � ,� Zip: �3 L �
PERMIT TYPE ��
��unicipal Sewer Connection ($35.00 per stu $ ��
pipe size�inches; material � ��chedule 40 air tested; cast iron
S:�C Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid.
If not prepaid, a sewer connection permit will not be issued.
n�unicipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
��'ATER METERS must be picked up and paid for at City Hall.
«'ater meters must be set and sealed by Orono Water Department (9�2-249-4600) upon
completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line =20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Posta�e & 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 work in strict accordance with the ordinances of the City and the regulations of the State of
I�linnesota, and certifies tha all statements made on this application are complete,true and correct.
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Sianature of Applic t: � Date: � �
" V DATE TIME
�
C Y OF ORONO CALLED IN �
INSPECTION IC � SCHEDULED 7�� .�--a� ��''����L''
PERMIT NO.� Ci COMPLETED ��aS-O� �' ,/U
ADDRESS �� n '� �
OWNER CONTR.
TELEPHONE NO. �S � � 7 � � � ��
� DESCRIPTION �e-� �� ����- �
L 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
1 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 W TFR Hnnk_Lio 17 SITE INSPECTION
� OS FINAL 14 SEWER HOOK-UPI� 06 PROGRESS
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� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
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= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YO . YES_NO
� COMMENTS: - �eSSUr� .�c ��'-�i S^��n.
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W� ❑WORKSATISFACTORY:PROCEED L��, iT�PROJECTCOMPLETE
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W ❑ CORRECT WORK&PROCEED �: ISSUE CERTIFICATE OF OCCUPANCY
� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
� CORRECT UNSAFE CONDITION WITHIN HOURS. -. pHOTO TAKEN
INSPECTOR WILL RETURN
! 1 STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
i ' INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. 249-46��
OwnerlContrac or on site:
Inspector.
White Copylinspector's File Canary CopylSite Notice