HomeMy WebLinkAbout2003-P06504 - sewer connect PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P06504
Crystal Ba�, Minnesota 55323 Per'mit Type: Sewer and water Permit
(952�4249-4600 Date Issued: �i3i2oo3
SITE ADDRESS: 4140 Highwood Rd
Mound,MN 55364
P I D: 07-117-23-44-0030
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Sub-type(s): Sewer Connection
Pernut Type: Sewer and Water Permit
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
Sac Grandfathered In-Claim from Demo Credit
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Water&Sewer OWNER: 7ames Cusack&Christine Grace
6501 County Rd 15 4140 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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APPLICANT PERMITEE SIGNATURE IS5 D BY SIGNATURE
Conies: 1-File(Si�nitures Required), 1-Annlicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
(LJpdated 6/2/03)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL IiVFORMATION
1. ��'ou 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.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pernut 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 locarions. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut 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 ryotice required.
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JOB SITE ADDRESS: I /�� �-c,Cr0 Cy �
Occupancy Type: Residentia Commercial
Owner's Name: 'r✓���" ��- � � Phone Number:
Mailing Address: City: Zip:
Contractor's Name: �J��1-'� S S Phone Number� -?�- ' SI�
Mailing Address: (>> � ��� .� - ( �� City: � Zip: s��6�
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,275.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Munici al Sewer Connection/Disconnect/Repair($35.00 per stub) $ � ` O�
P
pipe size�inches; material_�Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material copper; other
WATER METERS must 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 minimum setbacks from drain field and septic tanks = 75'
REQUIlZED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pemut requested.
3. PostaQe & Handlin� (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 Oron or issuance of a Utility Permit, agrees to do all work fln �trict
accordance with the ordinances of the City and the egu tions of the State of Minnesota, and certifies that all statements
made on this application are coir�plete, tru c rrec .
Signature of Applicant: Date: � � �
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DATE TIME
CITY OF ORONO LLEO IN �_
INSPECTION �IC� SCHEDULED i��������s`` �
PERMIT NO. �`���� COMPLEfED
ADDRESS �l ��i ,�--f �'�qoao, ' ��`�/Z_
OWNER CONTR. �K�
TELEPHONE NO._ �'��� ���� — ���' (�l�Z_
� DESCRIPTION �!`yQ'�'`�' � �✓?CZ�
� Ot 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 OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPIAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTi FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERfCONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W� ❑WORKSATISFACTORY:PROCEED PROJECTCOMPLETE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe n xt inspection 24 hours in advance. (952� 249-46��
OwnerlConU ite:
Inspector.
White Copyllnspector File Canary Copy/Site Notice