HomeMy WebLinkAbout2003-P06043 - sewer connection CI'�TY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Po6o43
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 2iisi2oo3
SITE ADDRESS: 3264 North Shore Dr
Wayzata,MN 55391
P I�: 08-117-23-44-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pemut Type: Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Yonak Sewer&Water OWNER: Russell Norum
1495 Gabler Ave. 3264 North Shore Dr
Buffalo, MN 55313 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 P ITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Si�nitures Required), 1-Apvlicant, 1-Monthlv Reports, 1-Assessin�. 1-Finance Page 1
(Updated 5/3/02)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66'(2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pemut card is available on the job site.
5. Utility connection pernuts 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 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: �2l Sl N. S�i� Q-�.
Occupancy Type: �/ Residential Commercial
Owner's Name: � �l „�. , Phone Number:
Mailing Address: City: Zip:
Contractor'sName: � a �r/ PhoneNurraber: 7L-3-y7�-5��u
Mailing Address: City: � �� Zip: ss 3i'�
PERMIT TYPE Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2002 rate $1,200.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $
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'
REQUIRED 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 pernut must be
included for each well,sewer and water connection permit 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 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 ar c mplete, true and correct.
SignatureofApplicant: ' Date: �- i3` �'3
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DATE TIME
CITY OF ORONO CALLED IN � "%�- �-�
INSPECTION� I E � SCHEDULED �- `-�' -'�t�
PERMITN0. �I � COMPLETE �`r-�� ►�. � �
ADDRESS � � '�--�� '��� ��-e_ �L�'
OWNER CONTR. � U n�� �
TELEPHONE N0. ' � J
� DESCRIPTION S� �%��' � � ��s`< <--�''
� 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 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL � 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEEf YOU:�YES_NO
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� ❑WORKSATISFACTORY:PROCEED /�CTIzROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED � ❑ I SUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WIIL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� Z49-46��
OwnerlContractor on site:
Inspector. ��'� "�`""'�_
White Copyllnspector's File Canary Copy/Site Notice