HomeMy WebLinkAbout2001-P04298 - sewer connect PERMIT
CITY �� ORONO Permit Number:
2750 Ke�!��y Parkway - PO Box 66 P04298
Crystal Bay, Minnesota 55323 Pet'mit Type: Sewer and water Permit
(952) 249-4600 Date Issued: a�lo�2ooi
SITE ADDRESS: 2685 North Shore Dr
WAYZATA,MN 55391
P I D: 09-117-23-42-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Sub-type(s): Sewer Connection
Permit Type: Sewer and Water Permit
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: PATNODE BROS OWNER: 7&S Walker
23200 ]09TH AVE 2685 North Shore Dr
ROGERS,MN 55374 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEIv�NTS 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 ISSUED Y SIGNATURE
Copies: 1-File(Signitures Reauired), 1-Applicant, 1-Monthlv Reoorts. 1-Assessine, 1-Finance Page 1
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(Ur�ated 2/12/O1)
CITY C�F ORONO APPLICATION FOR UTILITY PER�VIITS
Bo��6 (2750 Kelley Parkway) SEWER/WATER
, .
Crystal Bay,MN 55323
E,� S 2001
GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices. - � � ��.:���,:
2. I�iailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by
retum mail the same day the application is received.
3. Permits are not valid until you receive a permit card.
4. «�ork 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
��'orks 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.
JOB SITE ADDRESS: �b�� /v��?_� � ft�✓'�' ��i u<�'
Occupancy Type: t/� Residential Commercial
Owner's\Tame: �������j;_,;�,� �iv G- �v�, Phone Number: �� ? ` ��� - 3�`6�
Mailing Address: City: 7�p:
Contractor's Name: r�(No�� Ro S Phone Number: 7c�5 � �2.F,`- ?.3`j3
Mailing Address: �,3 2.c1c: /c�G � /-1-c��,tJt City: �c,G.��S 7�:SS3�
PERMIT TYPE
Municipal Sewer Connection ($35.00 per stu ) $ 3 s,�'�'
pipe size�inches; material l�s�`Schedule 40 air tested; cast iron
SAC 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.
Municipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER VIETERS 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'
REQUIRED setback from sewer line =20'
� PERMIT FEE CALCULATION
1. Subtotal of above permit requested $ 3 S: oU
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. Postage & 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
Minnesota,and certifies that all statements made on this application are complete,true and correct.
Signature of Applicant: _��'�'v/= Date: `� �oc� (
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE/ I� Q SCHEDULED —�� �
PERMIT NO. p L� K��O COMPLETED r' �'�r • -�T
ADDRESS �
OWNER CONTR.
TELEPHONE N0. � 3 ���S— �'�9 3
� DESCRIPTION � G �,�s.p � 1'��-�,
� 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
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 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
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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W� �110RKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W �❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECT UNSAFECONDITION WITHIN HOURS. O PHOTO TAKEN
INSPECTOR W{LL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContr t r on site:
Inspector��'.��t-���15'
White Copy/lnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION TI A SCHEDU�ED
PERMIT N0. `-'��� COMPLETED ��Z'"�1 ( � �j
ADDRESS r�'� �vP_ G
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION
lL 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. 1 k-FJf� 17 SITE INSPECTION
Q 05 FINAL 14 SE R HOOK-U � 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
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
fl COMMENTS: ��`( �� '���
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� �M1/ORKSATISFACTORY:PROCEED �PROJECTCOMPLETE
W �❑ CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR C CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARflANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/Contra t r on site:
Inspector. �'L�-G-�'�C�G-��
White Copyllnspector's File Canary Copy/Site Notice