HomeMy WebLinkAbout2007-P10708 - sewer disconnect - PERMIT
CIT`Y OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P10708
Crystal Bay, Minnesota 55323 Permit Type:
(952) 249-4600 Sewer and Water Pernut
Date Issued: 1/22/2007
SITE ADDRESS: 1580 Long Lake Blvd Unit#
Long Lake,MN 55356
PID: 26-118-23-33-0031
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
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: Up North Mechanical(See Comments) OWNER: Shawn Hendrickson
43900 Elmcrest Ave.N. 1580 Long Lake Blvd
Harris,MN 55032 Long Lake,MN 55356
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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ICAN ERMI E S GNATURE ! [SSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, ]-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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- EOR CITY USE ONLY
�0� City of Ot'ono Date Recerved: ; ,: .Permit#
O A Q P.O.Box 66 '. �
2750 Keiley Parhway ❑In-House SAC Determination Form Completed .
a ��'�y �t�. Crystal Bay,MN 55323 '
��'���;�a���� (952)249-4G00 Approved By(If Required):
CTTY OF ORONO—S�WER&WATER/GENERAL PERMIT.
(*Note:Some permits may require approval by the Building O�cial and/or Public Works Department")
(ALL PERMITS Niav be subiect to further review and mav not be issued when the annlication is received)
GENERAL 1NFORIVIATION '
1. You may apply for utility permits by mail or in person at the City offices.
Z. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will
be sent by reh.uzi mail within 2 busuiess days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the peinut card is available on the job site.
5. Urility comiectio�i 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 pernut does not grant tlus approval.
7. All work must be done in accordance with State Code requirements.
S. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required.
, TYPE QE PERlV1IT ' `.
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(Cfieck All That A"`'ly)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑Additional Connecrion ❑Re-Connection ❑Repairs �Disconnect
Job Site/ Owner Information: '
Site Address: �✓�i�' �Or✓� ��� ,�/l/Gf '
Owner:��1�4'r�"/"��r� Mailing Address: f O .L �!�/va/.
City: �Gh/� ' Zip:
Home Phone: Alternate Phone: �,2 —�32� — /`�✓�j�
Contractor Jnformation:
Contractor: � „��l,j� Contact Person: �<... ��.
Address: J��D �1'�l1 pC 3� State License#: o V�
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City: YI� .S Zip:��t� Expiration Date: �DO S
Phone: lo.�� 0��� '�s�� AlternatePhone: �0�- ��5�����"
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�� �, `��< < ' � ' 't'•` DETERIVIININC�P�RlulIT;FEES ::� ;'f� ,'`�' �;�
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❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications m.iless prepaid)
(Orono City Staff can deternv.ne if applicable)
(If not prepaid,a sewer connection permit will not be issued)
Sewer Connecti Disconnect_/�epair($35.00/Per Stub) $
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Pipe size incZie§;n�atenal Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Pem-ut Requested: �
2. STATE SURCHARGE $ .50 _
3. POSTAGE&HANDLING(Only on Mail-I�l Applications) $ 1.50
4. TOTAL YERMIT FEE(Add L'uies 1-3 Above) $
' ' '�ADDITIONAL Il�FORMATION—vWATER 1VIETERS `
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut,
■ 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 regularions of the State of
Minnesota,and certifies that all statements made on this ap�lication are,true and co�ect.
A�plicant: Date: � Z 2 ��
� �� � ��:a.�� �
�� DATE TIME
.f CITY OF ORONO CALLED IN ��
INSPECTION NOTICE---7 SCHEDULED " % � "�'Z�''�'1
PERMIT NO. ��C1 /C� COMPLETED I���,� �� ,�1`.`�f"`(
ADDRESS ' �� ' � Gr'1 L� � ✓ �i�.
OWNER CONTR. �✓ � �,�
TELEPHONE NO. �<� ��S `��S� � -
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� DESCRIPTION '�._�G�c-c-'� C\c S�Gr1�'�l,Ec'-t
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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
� 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
Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑ RRECT WORK&PROCEED J ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
G INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �95Z� Z49-4600
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OwnerlContractor on site: - -
Inspector. �/ /
White Copyllnspector's File Canary CopylSite Notice